820582_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

5 - ,A 5-4 '[ W
of Visit: Q'Campliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
►u for Visit: E)"Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: w a
Arrival Time:
�,%
Departure Time: County:, IP Region:
Farm Name: j��
��.,
DIn Current
/
Owner Email:
Owner Name: ►yt- e Phone:
Mailing Address:
Physical Address:
Facility Contact: V _ 7 7 Title:
Onsite Representative: I
Certified Operator: t(
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: r ✓Y' S
Certification Number: d yl[i
Certification Number:
Longitude:
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 C ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E No
❑ Yes 8 No
[r -A ❑ NE
Q-1'rtA ❑ NE
E SIA ❑ NE
❑NA ❑NE
DNA ONE
Page I of 3 2/412015 Continued
DIn Current
`Design
Current
Design Current
Swine
ity P p
Wet EoultryCapacity
Pap.
Cattle Capacity Pop,
Wean to Finish
Layer
Dai Cow
Wean to Feeder
[Non -Layer
Dai Calf
Feeder to Finishfol.L7i
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Q , Poalt . Ca ari
Kop.
Non -Dairy
Farrow to Finish
ILayers
r
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
I
1pullets
Beef Brood Cow
Turke 5
Outer
Turkey Poults
Other
Other
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 C ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E No
❑ Yes 8 No
[r -A ❑ NE
Q-1'rtA ❑ NE
E SIA ❑ NE
❑NA ❑NE
DNA ONE
Page I of 3 2/412015 Continued

FacilitvNnmber:- Date of ins ection:, da
��-
Waste Collection & Treatment
❑ Yes
[a Nl o
❑ NA
4. b storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IL-1
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q -%'A[:]
NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-1ao
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -<o
Observed Freeboard (in): 3 Z_
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[],,Ko
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]~No
❑ NA
ONE
(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
Ejrvo
❑ 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? 0 Yes RrNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r No ❑ NA ❑ N E
(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 JEJNo ❑ NA ❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P4o ❑ 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 1❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):2T uv �`� _. % Ll
13. Soil Type(s): -_IAC •� (�
��-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a Nl o
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑"N�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3 -<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-1ao
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -<o
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[],,Ko
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ N
F-1WasteApplication ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
F-1Rainfall ❑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 ENo
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 N ❑NE
DNA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - 2., jDate of Ins ectionr� ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D -iso ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes El No ❑ NA ❑ NE
❑ Yes [�`No ❑ NA ❑ NE
❑ Yes [Y] No ❑ NA ❑ NE
❑ Yes [�No 0 NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[allo
❑ NA
ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[ No
❑ NA
❑ NE
Cell--
Reviewer/Inspector Name: l 't/ Phone:
Reviewer/Inspector Signature: Date: 1
Page 3 of 3 2/4/2015

• ` " ivi's'iiin of Nater Resourcrs
Faciiita=r-
ON� O Division of Soil and Water Conserv attoii
r ©Other Agency
type of Visit: Q-eampIlance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: C?j 'Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: r Arrival Time: Departure Time: County: Region:
Farm Name: dcou, 'E ! Owner Email:
Owner Name: Le Phone:
Mailing Address:
Physical Address:
Facility Contact: L-JAdC ,� Title: Phone:
Onsite Representative: ! Integrator: Role_<04iw
Certified Operator: Certification Number: GQ —7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream 1m acts
I. is any discharge observed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E;kf° ❑ NA ❑ N F.
❑ Yes ❑ No ❑ A ❑ N E
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
❑ No
Design
Current
y Designs E,u ..ent
Swine
Ca aei Po
Wet Poultry
Ca acr
Po
Y"' Cattle Ca acih P._6
❑ No
Wean to Finish
❑ NE
Laver
I
[3-14o
❑ NA
Dairy Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Wean to Feeder
❑ NA
Non -La er
of the State other than from a discharge'?
Dai Calf
Feeder to Finish
b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Pool
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream 1m acts
I. is any discharge observed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E;kf° ❑ NA ❑ N F.
❑ Yes ❑ No ❑ A ❑ N E
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
L�rNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[3�`NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3-14o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
kfrNo
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 1/412015 Continued

Facili Number: - Date of Inspection: J
Wage Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA 0 NI
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-5A ❑ NI
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'l<o
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
Designed Freeboard (in)--
in):Observed
acres determination?
[] NA
❑ NE
ObservedFreeboard (in): 3
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ rNo
[] NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[:rNo
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[rlo
❑ NA
❑ NE
waste management or closure plan?
❑
Rainfall [—]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22.
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
[DNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Er"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement'?
Waste Apolieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tp %w4rx �' +t om S ✓'e 660
L. � C
13. Soil Type(s): p &
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E "o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'l<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
[] NA
❑ NE
the appropriate box.
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
G� o
❑ NA
❑ NE
Required
Records & Documents
19,
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!rNo
[) NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] 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
[:rNo
[] 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
e No
❑ NA
❑ NE
Page 2 of 3 21417015 Continued

Facili dumber: j52,, - Date of Iran ection: /71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [! ' o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes EEr o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 Ko ❑ NA ❑ NE
r
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes
(ET 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
2<o
❑ 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
[�J<o
❑ 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
C:2 -No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes [11Qo [] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [TNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? []Yes [,—].-No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
431 � i r _-
214/7015

t� I vIts
1b(5w
lReason
Type of Visit: (}Compliance inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
for Visit: f` 1outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other Q Denied Access
Sri
Date of Visit: Arrival Tim Departure Time: 11 j,'rounty:
Farm Name: �I r -p 4-S01-& )Wlo_ -� Owner Email:
�)
Owner Name: r �1 yµ� !' d 10-e Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: L Integrator: �V
Certified Operator: Certification Number: A/0-7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imus
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q-X° ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ©' 11.A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [-NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
& Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No [�iA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �io ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2414 Continued
Design Current,
Design ..
Cnrrent
DesignCurrent
Swine Capacity Popp :
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Cifrrent
jDryCow
Farrow to Feeder
D PoW
Ga aci
1?0
Non -Da'
Farrow to Finish
11-avers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1puilets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imus
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q-X° ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ©' 11.A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [-NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
& Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No [�iA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �io ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2414 Continued

Jjj
Facility Number: - l
.1Date of Inspection: ---
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EJ 1TX_`❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
[] Yes
Identifier:
❑ NA
Spillway?:
15, Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in):
[G]-ldtf
Observed Freeboard (in):
`y
❑ NE
5. Are there any immediate threats to the integrity of any
oaf the structures observed? ❑ Yes Eg�N� ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a [] Yes [3-Ntr ❑ 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 DVM
7. Do any of the structures need maintenance or improvement? [] Yes a -re ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EW ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 v ❑ NA
❑ NE
maintenance or improvement?
❑ NA
Waste Avolication
R�uired Records & Documents Records & Documents
10. Are there any required buffers, setbacks, or compliance a]tematives that need ❑ Yes Eio ❑ NA
❑ NE
maintenance or improvement?
l 1. Is there evidence of incorrect ]and application? If yes, check the appropriate box below. [:]Yes �o ❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
to
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
[ems]-hio'
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
[G]-ldtf
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3 -Mb
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑*9
❑ NA
❑ NE
R�uired Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EErlo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
to
❑ 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 L- Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 15No ❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

Facili Number: Date of Inspection: fu 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ea. -NT— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q.A ❑ 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 ED. -Io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �10 ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA"P?
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?
Cti{r� r,4-l9%� --
sUfs Sure.
K
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [3'110 [DNA ❑ NE
[DYes C]rNo ❑ NA ❑ N£
❑ Yes [EWo ❑ NA ❑ NE
[-]Yes R;PIQo ❑ NA ❑ NF
❑ Yes
E2 -No
❑ NA
❑ NE
[:]Yes
dNo
[] NA
❑ NE
❑ Yes
Q'fIo
❑ NA
❑ NE
Phone:
Date:
214/2074

t As 0 -' VW L' " ?cs,)
Division of Water Resources
Facidity Numiier - ] Division of 5oi! and Water Conservation
Q Other Agency
Type of Visit:C�o/mpliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
((
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: J Arrival Time: Departure Time: a4 Q� County � Region:[
Farm Name: Poof Owner Email:
Owner Name: L m-4 a e Phone:
Mailing Address:
Physical Address:
Facility Contact: L -.l(/ Title: Phone:
Onsite Representative: Integrator: r
Certified Operator: 1 Certification Number: < a 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
0 No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I INon-Layff
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
—i
Dry Cow
Farrow to Feeder
Dry P,o_Fd
Ca arl
Ro
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
I ITurk Poults
Other Other
Dischar es and Stream Irn acts
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 [�o Q NA [] NE
❑ Yes [:]No B-MV� NE
❑ Yes [:]No gg-b�* ONE
❑ Yes
0 No
Q KA
0 NE
❑ Yes
[]<o
❑ NA
[] NE
[] Yes
�o
0 NA
❑ NE
Page I of 3 21412014 Continued

[Facility Number: - Date of Inspection:
4 w
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]_No--f_9-NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No [ +Or—❑ NE.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ -110-70 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 F4190 ❑ 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 Na ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑-ice ' ❑ NA ❑ Nh
(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 -NV -0 NA ❑ \1
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ o ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3-7qo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[N6� NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E j'No_❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EEJ-5o r ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q-lgo ^ ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No ❑ NA
❑ NE
the appropriate box.
❑WUP E] Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ ' o ❑ NA ❑ NE
[❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No M NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes KrNo ❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

Facility Number:- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E> ] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0_Nv—_L] NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey E] 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 D -No-- [ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D-N-o—C] NA ❑ NE
Other Issues �--���
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document E]El
Yes 'To ❑ 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 0<0 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
E] Yes
�o
❑ NA
❑ NE;
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Reviewer/Inspector Name:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
[rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
[] NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations o any other comments.
Use drawings of facility., to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
I
ti 4
Phone: 3 L
Reviewer/Inspector Signature:
41
Date: k ��C'/'CL
Page 3 of 3
2/4/2014

Type of Visit: Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Q Koutlne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lirrival Time: �Q y� Departure Time: County:
Farts Name: Rpo �..�o h Owner Email:
Owner Name: P a I/ _e Phone:
Mailing Address:
Physical Address:
Region: 9 1
Facility Contact: �- •450 p -G Title: Phone: 719t/1
Onsite Representative: ' r j Integrator: • rr ` 1/
Certified Operator: Certification Number: t
- 1Q
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
xj _q
Wet Poultry
La er
Design
Capacity
Current
Pop.
Resign Current
Cattie Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
d
D . P.onl
Layers
Non -Layers
Pullets
Turke s
Turke Points
I 10ther
Design
Ca aci
Current
$o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �o❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No Imo] < ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No LDNA ❑ 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 �fA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eg4o` ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 10 ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

F••c€liNumber:Date of Ins ection
Waste eoliection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Gable— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EIWr-❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a ❑ Yes LS1gv
❑ NA
❑ NE
waste management or closure plan?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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 [-}-Nffo�
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C3 -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
acnes determination?
9. Does any part of the waste management system other than the waste structures require ❑ Yes [9111o'_
❑ NA
❑ NE
maintenance or improvement?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Waste Application
NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
[] NE
maintenance or improvement?
❑ NE
❑ NA
11 . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NE
PAN ❑ PAN > 101/6 or 10 Ibs. ❑ Total Phosphorus Q Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a-lgo —
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑-9'o
❑ NA
❑ NE
16. Did the facility fail'to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acnes determination?
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements
❑ Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[a'1 0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes LJ ly
❑ NA
E]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes [ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application O Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes eNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Ecitity Number: - Date of Inspection
24. Did le facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5 -ilo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes DNo— ❑ 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 g3 lVo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
❑ Yes [;�S' ❑ NA ❑ NE
❑ Yes ❑,No ❑ NA ❑ NE
❑ Yes [J>ly— ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
go C] NA ❑ NE
io ❑ NA ❑ NE
Fff No ❑ NA ❑ NE
Comments (refer to question #l): Explain any .YES answers and/or any additional. recommendations or:aay other comments �'
uk-drawings of facility to better explain situations (use additional pages as. necessary).
c4Lt 6 V-4 1d'9_%
3 (U,& S. cx�_�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IMUM
Phone: 4 ` .1/ 41J
Dat Jct.
2/4/2011

(Type of Visit: l�'7outine
Hance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date ofVisit: Arrival Time: ' Departure e: pD County:-- Region:
�
6�ell
Farm Name: f Of7ez— L-_5 6r �"`� /O'1.3 Owner Email:
Owner Name: A;L, , dpl L_ T"? Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: A9Wp7Y% Phone:
Onsite Representative: _Irl*� Integrator: err 5
Certified Operator: Certification Number: / g/'22 _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
-
Design
Current
Design Current
Swine Capacity Pop.
Wet Pointry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ No
❑ NA
Da' Cow
Wean to Feeder
]Non -Layer
❑ No
❑ NA
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
❑ Yes
Design
Current
D Cow
Farrow to Feeder
D , P,oul
Ca acit
P,o
Non -Dai
Fanrow to Finish
Layers
Ig No
❑ NA
Beef Stocker
Gilts
Non -Layers ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoints
Other
Other
Discharges and Stream Impacts
i. 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
JZ,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ig No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: fp—jo —L3
❑ Yes
®No
❑ NA
Waste Collection & Treatment
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
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 i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
®. No
Identifier:
❑ NE
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fs No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑L No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below_ ❑ Yes g 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 ED Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): J lOr l' C NSe��d
13. Soil Type(s): �,5 jZ& % K ,4 a/ZA_
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g] 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 [0 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 rg 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 2/4/2011 Continued

e.1
[Facility Number: Date of Ins ection:
.24. Did the facility fait 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 Ig No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes (n No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
C] Yes
[2No
❑NA
❑NE
❑ Yes
e5 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
Reviewer/Inspector Signature -
Page 3 of 3
Date:
.21412011

type or visit: t.L7 c:omptiance inspection v uperanon xeview V structure r.vaivauon v i ecnmcai Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /" `� Arrival Time: Departure Time: :a County: s� lit ,gory Region: f'kO
Farm Name: Poa C" In You .F %' if ' !U /.3 Owner Email:
Owner Name: Irtlt,JA/tQ �, , �U n£ Phone:
Mailing Address:
Physical Address:
Facility Contact: - AJIU-01 E -App Title: O ld/t f Q Phone:
Onsite Representative: o}Aol E Integrator:
Certified Operator: SAM E Certification Number: pi/07
Back-up Operator:
Location of Farm:
Certification Dumber:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [% No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 R] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes N No ❑ NA ❑ NE
of the State other than from a discharge?
Liage I of 3 2/4110I1 Continued
Design Current
Design
Cnrrent
Design Current
Swine Capacity
efl oultry _
'Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
I
Dairy Cow
Dairy Calf
Feeder to Finish0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
D. , P,oul
Ca aci
P.o
Non -Da'
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
Turkev Poults
OFFO—ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [% No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 R] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes N No ❑ NA ❑ NE
of the State other than from a discharge?
Liage I of 3 2/4110I1 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes n No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C , p1CWtf'3Ls0
13. Soil Type(s): QA R&. AAA . CAA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CU No
❑ NA
❑ NE
Facili Number: 5 - a (Date of Inspection: (A/98
J
W No
❑ NA
❑ NE
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: 1' �j — i(�•! 3 _
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other
Spillway?:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
Designed Freeboard (in): I 14
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
Observed Freeboard (in): C�j 1— .38 --
❑ Yes
Og No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
[} Yes
®No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
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
W No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes n No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C , p1CWtf'3Ls0
13. Soil Type(s): QA R&. AAA . CAA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CU No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Og No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []q No ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: 213 IDate of Inspection: PJ
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 Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No [-] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
R 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
[K] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[A No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Signature: <Ae& _ _ Date: �}
Page 3 of 3 11412011

t
. •J -. �f/ � IV1510n Of W'd�te �ua���ts ss��ja }
Pr r Q as 1 �
Farili Number ® Division oftSoilIand WaterConser+vatton `s
Type of Visit: CKompliance lnspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: tine O Complaint 0 Follow-up C) Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (] Departure Time: County: l Region: 7}
Farm Name: ,6 8*^- _ G /D7 /3 Owner Email:
Owner Name: �� tQ re� l 49 ie= __ Phone:
Mailing Address:
Physical Address:
Facility Contact: Lope Title: ,C 1an�r/ Phone:
Onsite Representative: �rc _ _ _ Integrator:r
Certified Operator: .J`��_ Certification Number: / g-/ p 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urrent
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
VVet Poultry
Capacity
Pop.
Cattle Capacity -,Pog.
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Wean to Finish
❑ No
Laver
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Non -La er
❑ No
❑ NA
Dairy Calf
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
eerier to Finish
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Dairy Heifer
❑ NA
Farrow to Wean
of the State other than from a discharge?
Design
Current
Dry Cow
Farrow to Feeder
D . P.aultry
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Uther
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
JKNo
❑ 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
KNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
s 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No E3NA ❑ 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: /— V _� 0—/3!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KA No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
S No
❑ NA
❑ NE
maintenance or improvement?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
Waste Application
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z No
❑ NA ❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
2/4/2011 Continued
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):_.-
13. Soil Type(s):��[�`j
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 7❑ 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?
Reauired Records & Documents
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
[:]Yes
5fl No
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: -,S' Date of Inspection: l� !
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes J0 No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L3 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?
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? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Z[No
❑ NA
❑ NE
Commeats_(refer to ueshon
q #): Explain any YES answers and/or any additional recommendations or any other comments._ _
Use.drawings�of facility to better explain situations (use additional pages as necessary.).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: &:l 33Lkn>
Date: W6 :jj�_� 'V
2/4/2011

f�
11
Type of Visit (9 -Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� l Arrival Time: f .� p� Departure Time: , (] O County: Region:
Farm Name:" S"' 1;7 )60 ,4 -- /D 1 Owner Email:
Owner Name: / �- ��� - _ Phone:
Mailing Address:
Physical Address:
Facility Contact: D Title: e Phoneme No:
Onsite Representative: v,f Integrator: Vzz3 m4i1 _
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =] o ET =" Longitude: E ° E-1 E_1"
Design Current
DesigF.—
Wesign Curt
SwinecityPoWet
Poultry Capaculation
Cattlepacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non-Laye
❑ Dai Calf
❑ NE
Feeder to Finish
❑ No
❑ Dai Heifer
C,No
Farrow to Wean
Dry Poultry
❑ Cow
;.No
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -La ers❑ Pullets
❑ Turkeys
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
PCIGills
Boars
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes @-No ❑ NA ❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
;.No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —
I Waste Collection & Treatment
Date of Inspection
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes , 4No ❑ 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
pillway'?;Designed Freeboard (in): / �-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [A -No ❑ NA ❑ N E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes O -No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes DINo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, cheek the appropriate box below. ❑ Yes DINo ❑ 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 Crrop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) '66`. > ort Y / -
13. Soil type(s) j2pl Lzl�a4
_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo [INA ❑ NE
❑ Yes f -No ❑ NA ❑ NE
Phone: Name
Reviewer/Ins ector _� _
p t� - �
Reviewer/Inspector Signature: Date: 9 ,�
Page 2 of 3 ' 12/28/04 Condnued

Facility Number: V — Date of Inspection — "'/
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JR No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EffNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ti!�No
❑ NA
❑ NE
Additional C j— is andlblr�Dra
Page 3 of 3 12/28104
Page 3 of 3 12/28104

{
i`
Type of Visit g)<ompli ce Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: l l�LJ County: Region:_
Farm Name: �A/ r�" .Ss-�&J6 e5 9f f�� /0713 Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: /2 /V Z
Back-up Certification Number:
Location of Farm: Latitude: [—]' [—]' [--]" Longitude: =] ° =' =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capaciri Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Yes
❑ Dairy Calf
❑ NA
10 Feeder to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
[:1 Non -Dairy
❑ Farrow to Finish
❑ ers
❑ Beef Stocker
❑
Non-Lay
Elers
El Beef Feeder
❑ Boars
PuulletslletsGilts
❑
❑ Turkeys
❑ Beef Brood Cowl
J.NO
Other
TurkeyPoults
klher
Number of Structures:
❑ Other
V.No
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J.NO
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
V.No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number; Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes X.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: / �t�i3
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): _ (rte 3 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes CR 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 ZJ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ®.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 12 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 Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ® No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EZ 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) --1-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 29 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16: Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 04 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [ANo ❑ NA EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes CKNo ❑ NA ❑ NE
Comm nts`j(refer to goestsoe.#) Explain any YES:answers and/or an recommendations or anv othMcopMrMenqn%5E',",7L�g ty P { Pse draHin sof taciit to better. eg lata situations: use additional ages as necess°
Reviewer/Inspector Name et—e- Phone;
Reviewer/Inspector Signature:_ _ Date:��}
11/18104 Continued

t
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 59 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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
0 -No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
S No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(3No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
SNo
❑ 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?
0 Yes
EgNo
❑ 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
Ef No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
C[No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
12128104

Type of Visit ompl' ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i _ O Departure Time: Qrr� County Region:
Farm Name: �li-.S 8/���^�3 Owner Email:
1
Owner Name: Z&Z 't Phone:
Mailing Address:
Physical Address:
Facility Contact: ` Yt 8 :° Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ,Z�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=L
= Longitude: =0=6
°06 0
Design Currentr
Design current
Design Current
Swine Capacity Populationry
_ Capaty Population
Cattle Calon
Wean to Finish
❑Dai Cow
❑ Wean to Feeder
❑ Dairy Calf
Feeder to Finish 0
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
-
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ No
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Yes
�!No
❑ Turkeys_
❑ NE
Other
❑ Turkey Pou Its
Number of Structures:
❑ Other
❑ Other
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[--]Yes
S -No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�!No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5INo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: — Date of Inspection
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,113No
❑ NA
Waste Collection & Treatment
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C5 -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: %"(D—)3
❑ NA
❑ NE
18.
Spillway?:
❑ Yes
®.No
❑ NA
cy
Designed Freeboard (in): ✓f
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
15No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IgNo ❑ NA
❑ NL
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
A.No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,113No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
[INA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
VV—
Reviewer/Inspector Name_ ,., Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

y Facility Number; � Date of Inspection �a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;3No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DI -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CSNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ 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
Wo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
;§,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
&No
❑ NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V] No
❑ NA
❑ NE
Page 3 of 3 12/2$/04

ivv cion of Water Quality
Facility Number ��� 0 Division of Soil and Water Conservationd��
t
_..__._... _ Q Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vlsit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��pC7 Departure "Time: I ., County: Region: U
Farm Name: C7�J� �''`-' Le'.S 1 3 Owner Email:
Owner Name: �1i1�t' L- Phone: y�
Mailing Address: (0,7,„ e,,Aer- &C�YLDr%Ci(_
Physical Address:
Facility Contact: Title:
Onsite Representative: �-
Certified Operator:
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
Phone No:
Integrator: _
OperatorCertification Number:
Back-up Certification Number:
Latitude: =0 [=I
�" Longitude: = ° = I = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ LaVCr
❑ Non -La eT
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
12/28/04 Continued

Facility Number:
Date of Inspection�lD
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: _Z:]L /t>-/-3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yJ? t
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
through a waste management or closure plan'?
❑ Yes LgNo ❑ NA ❑ NE
❑ Yes ,®-No [INA ❑NE
Structure 5 Structure 6
❑ Yes [A No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 9. 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 RNo ❑ 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)��LM alter
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 RNo ❑ NA ❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
9No
❑ NA
❑ NE
17. Does the facility Iack adequate acreage for land application? ❑ Yes
®,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5jLNo
❑ 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 �....-. phone:%�1�J3�J3o n
Reviewer/Inspector Signature: Date:fl07
12/28104 Candnued

Facility Number: — Date of Inspections �s
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &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
_CR 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
E4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
g No
❑ 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
RjNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CKNo
❑ 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
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
0 Yes
9No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E,No
❑ NA
❑ NE
Comments and/or Drawings:
12128/04

V
ivision of Nater Quality
Facility Number E 0 Division of Soil and I4'ater Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral Q Emergency 0 Other ❑ denied Access
DAtc of Visit:Arrival Time: l%t�50 Departure Time:W3V— .. J County: � � Region: `_
Farm Name: .'+- Owner Email:
Owner Name: "ZZAI�d- L Phone: �7
Mailing Address: �'1' 7Q1 T�r� /�Yl �/ Gid • C��; h f"O''L N t�`�
Physical Address: !
Facility Contact: >!% K 4t r Title: Phone No:
Onsite Representative: —_iie� __ Integrator:
Certified Operator: •ems Operator Certification Number:
Baek-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Q e =4 0" Longitude: =o = f = u
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
❑ Layer I I :::::]
❑ Non-Layet_
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 P.No ❑ NA ❑ NE
❑ Yes
PS No
[--INA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
R No
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes [9 No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U,Ne
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 100,0"
H No
❑ NA
❑ NE
Spillway?:
❑ Yes
F1 No
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):S v3-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,R No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
❑ Yes
CA No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s) j
nn II `` r
13. Soil type(s) _ g y B 1 G' h T1-_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U,Ne
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
CR[.NO
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
H No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F1 No
❑ NA
❑ NE
rood
Reviewer/Inspector Name 9 ,.4`. r,� x ,.. r ; Phare:'��-333
Reviewer/Inspector Signature: Date: (e 3
/1/28104 Continued

I
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CKNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps [:1 Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes J& No ❑ NA [:INE
❑ 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
C3 -No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
[__1 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RtNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
A 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
ER 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
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
IgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�&No
❑ NA
❑ NE
Addttioual Comments,aad/or Drawinzs:'---MAI
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Division of Wati
8 O'Dtvtsion of Soil,
Q btlter, Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine C Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 91M- Arrh,al "rime: OO Departure Time: County: Region:
Farm Name: Po j�S. ? � Nfzu I -S " - _w4�3 Owner Email:
Owner Name: c, o.vS _ Phone:
Mailing Address:l ar s� %�C.r±•_oso ��. �� _�iC. �F3_
Physical Address:
Facility Contact:
'ride:
Onsite Representative:
Certified Operator: _ Zr -ft �
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _GQra.a
Operator Certification Number: -1..`! Onsite
2--
Back-up Certification Number:
Latitude: =' =' ❑ « Longitude: =0=9
o=9 = i,
Design. Current Design Current: Design Current
"ySwine.:s Capacity "Population Wet Poultry Capacity Populatson :' Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 9 V 141
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ La er
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: [
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 191 No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes N No ❑ NA ❑ N E
12/28/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes BE 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
El Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) 4,
13.
Facility Number: f�—,S ,Z Date of Inspection g o
Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[y No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
EINE
Structure I Stryc r� 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: -) OOp ` I
❑ Yes
[X No
❑ NA
❑ NE
Spillway?: 161141 - C —I
Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
Designed Freeboard (in): —A q K } It
Observed Freeboard (in): ,,--3q " tr
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes BE 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
El Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) 4,
13.
Soil type(s) Qo a. C14 Plp x2u ka /9
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
W No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[X No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Reviewer/inspector Name _ a A" ` � 7. xt � � I , ,,4 Phone:
Reviewer/Inspector Signature: Date: 619 . QS
12/28/04 Continued

FadlityNumber: 9A --sQ Date of Inspection
Required, Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
3.G, 3.2-
Waste
.2Waste Application ❑ Weekly Freeboard ❑ waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ETCropYield Ef120 Minute Inspections ❑ Monthly and l" Rain Inspections ['Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector 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
[N No
❑ NA
❑ NE
Mrd aan or, Draw,tngs:;a x"°i`�own' VENMR-M
Piea,> 6 e pa
I Y C G -� aK oQ r VI .T Y . c� ar S d K " a_,
61
12/28/04

f
of Visit • Compliance Inspection O Operation Review O l..agoon Evaluation
for Visit r Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FDate of Visit: 3 �l!-o Time: 9.i l5 f�1
Facility Number f3� .S$�
Q =Not Operational Q Below Threshold
Eermitted EIReitified E3 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: County:
...lek! zr.4............� .. . _...� ._ .. �� U.... .
OwnerName: _ �.... �iAc�..r c, s�.............. .............. ...................... .......... ...... hone No: _...��� ... 5.�! `% 4 .._ ..._ ..........
Mailing Address:....�i.'�%_._.. ��f. lrPf._._... �%�%�.� r.l.rtl .. ��?srrri ...- -.._ �L2�dr_z .._._._. N �..W..:�.g ?2..g _........ _..._............
Facility Contact: .._._� .'� G f - . %��f,.� ................ Title :.._...... _ Phone No:
Onsite Representative: T., c. r: 166" 21 ._...... Integrator•
Certified Operator.. G f . . _-- ----_ �„ »..»»»»» ».» » ....... Operator Certification Number:
Location of Farm:
E315wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • C «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ET&o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes B-1�0
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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............ ......... ......... ................. ......
Freeboard (inches): -:0
❑ Yes ©'No
❑ Yes
9'Mo­
❑ Yes
QNo
❑ Yes
[�io
❑ Yes
OW
Structure 6
12112103 Continued

' Facility Number ,_z — S'X•3
Date of Inspection c
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 46 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes 9-fllo
❑ Yes ❑ <o
❑ Yes 01�o
❑ Yes
❑ Yes B_Ko
I0. Are there any buffers that need maintenance/improvement? ❑ Yes GN -o
I I _ Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes QW6
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cc ,a.4Lf rf 13er.r*vr! S�„�.fl..r�,;�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes S -No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [3 -No
b) Does the facility need a wettable acre determination? ❑ Yes ❑filo
c) This facility is pended for a wettable acre determination? ❑ Yes 0-9c,
15. Does the receiving crop need improvement? ❑ Yes SNo
16. Is there a lack of adequate waste application equipment? ❑ Yes & o
Odor ls,"es
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9Ne
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Q�Ko—
Air Quality representative immediately.
Comaueats {rdex tv.gaest�on�I#) E�pia aay Vwanswers anwo�r airy _recommendations or an�yyotherGo=St
=om R
Use dirawings of &dity to better ezglaen sttaado�{ose ad�tzonal pages as necessary} [cIReld Copy ❑ Final Notes-
we
Reviewer/Inspector Name '' =r — ;;
_= r,
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: _ 5-� Date of Inspection •� -G'
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WI]P, checklists, design, traps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under aNPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes UNO
❑ Yes 0-110
❑ Yes ©-No
❑ Yes Eallo
❑ Yes El -No
❑ Yes O -Ni
❑ Yes El -No
❑ Yes EgNo
❑ Yes pyo
[G -des ❑ No
❑ Yes [3wo
❑ Yes E No
g4les ❑ No
❑ Yes Q -Ko
❑ Yes B -No
113'No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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