820098_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type of visit: (J.eompliance inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (),doutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7 t{,Departure Time: County: R PSOU Region:
Farm Name: t—&_r'rl/tis Owner Email:
Owner Name: H , r d-ed(f t e-(< , 6 F Phone:
Mailing Address:
Physical Address:
Facility Contact: (2jAk_j- �Q�(,tfivtl Title: Phone:
Onsite Representative: t f Integrator: _f�g_s
Certified Operator: Au) Certification Number: 17 �fleK
Back-up Operator: C F Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poaltry Capacity Pop.
Wean to Finish La er
Design Carreat
Cattle Capacity Pop.
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La er
71
Design Current
D . P.oul Ca ace Po ..
La ers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkev Pouets
Beef Brood Cow
Other
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Eq-KA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
❑ No
E ' A
❑ 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-iGA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Z - Date of Inspection: /(
Waste Collection & Treatment
4. It storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M_Nv--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-?d'A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dw ❑ 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
I_7 N
❑ 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
[LWo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C�Xo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑_Nv
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 Flo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C /3 n 0
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�l o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D­N°
❑ 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 [�JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E a'dii ❑ 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 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 E3--flio ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes []-Na ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Z_- Date of Ins ection: !
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes t o ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZL>k:r ❑ 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 [Z]"'.o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑_Wa ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJN°
❑ 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
[al 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
E] 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 o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
is STo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G't_ i A rn -- R--.3 ( - r b
Reviewer/Inspector Name: 9 U A
L
Reviewer/Inspector Signature:
Page 3 of 3
Phone L— 3 � ` _� 33,
Date: ! p
2141265

l ype of v ism i, - oroutine
nee inspection U operation Review V structure :valuation V l ethnical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: $�`C
Farm Name: � �� � Owner Email:
Owner Name: u r— `{- Phone:
Mailing Address:
Physical Address:
Region: f?P_i
Facility Contact: C
T,U a.�L�C" Title: Phone:
Onsite Representative: C�_f ci Q,V-&VLr%` l Integrator:
Certified Operator: rt�E `LJ�C . Certification Numb er:` 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capaci Pop ':
Wet Poultry Capacit} Pop
fCattle Capacity Pop.
Wean to Finish
[Layer
Dairy Cow
'
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish,.,'
? cJ
I
3
Desi n
Dairy Heifer
Farrow to Wean
*@`urrcnt d,
D Cow
Farrow to Feeder
D . P■oultr. off ac Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Puliets
Turke s
Beef Feeder
Beef Brood Cow
Boars
Other" �_-,-
0
Turkey Poults
Other
Other
Discharaes 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 ofthe State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [3 90 ❑ NA ❑ NE
[] Yes
0 No
Ej1'9X
❑ NE
❑ Yes
❑ No
2 TEA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ i o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes a No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facili ! Number: ff IDate of Inspection: ,,2j f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-KT-_❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [-]No ❑_IA— 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L7
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 Vo ❑ 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 ❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes T Ala ❑ 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 �o ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L 13 " -S 6 D
13. Soil Type(s): No
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
N
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
a�No[:]
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
❑ 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? I f 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 � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection: v
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Wo ❑ 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 D40 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes DAo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
j
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [n]No ❑ NA ❑ NE
❑ Yes dNo
❑ Yes [fNo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
S I It 4-1 -f 2- P� !�, 1(
Reviewer/Inspector Name: �� �` Vt Phone: o—
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/201

Type of Visit: .0'Com�pHance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: "[Old Departure Time: County: Region:
Farm Name: E_t '; Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
GwW4r ;
6404�`-W Icir Title:
Phone:
Onsite Representative:
�1
Integrator: b ---c
Certified Operator:
Nam,
Nam'
Certification Number: 17elt(
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
jDairyCalf
Wean to Feeder 11 INon-Layer I
Feeder to Finish jin
jDairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poul
Ga aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Emile
III N I'M
Other
Turkey Poults
Other
LjOther
Dischar es and Stream Im acts
I . Is any discharge observed from any part of the operation?
❑ Yes
[]-Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
[]�<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
[_11NA
❑ 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
[!�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ 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?
Page 1 of 3
21412015 Continued

acili Number: - Date of Inspection:-" -J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q4. o� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E 1'KA ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �o ❑ NA ❑ NE
❑ Yes [ 0No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
I I _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ef /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 l0% 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): a
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 dNo ❑ 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
E!fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!�<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: Ir
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
❑ Yes o
❑ Yes 'No
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FacilimNumber: - Date of Ins ection:
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 L;�-iQo ❑ 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 [3' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [eWo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes g-Wo ❑ 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?
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 2r<o
[:]Yes []?<o
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [2rNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes � o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Vo ❑ NA ❑ NE
Comments, (refer to question ft; Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to:bettei-explain situations (use additional pages as necessary)..
��l
� (4-,A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3
Date: �13
21412011

l'ype of Visit: i>•Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Qlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I rL Arrival Time: / Departure Time: a (i County: S W
Farm Name: 1 4j —'1 Owner Email:
Owner Name: �F rv�{(,.� {�-- �, �� t-c,j Phone:
Mailing Address:
Physical Address:
Facility Contact: rare (S p,-4VtCi'l Title:
Onsite Representative: C(
Certified Operator: Iz"" , �; A -AV --
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: y—C
Certification Number: %7 �� Y
Certification Number:
Longitude:
Design Current;;
Design Current Design Current
Swine
Wean to Finish
Wean to Feeder
Capacity Pop:
Wet Poultry Capacity Pop4
I 11-ayer
I INon-Layer I
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design urre
Dry Caw
Farrow to Feeder
TAD , P.oul
Ga act
Non -Dairy
Farrow to Finish
Layers
=
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
113eef Brood Cow
Boars
Turkeys
f
. �.
,
Turke PoltltsOher
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [D-1 o ❑ NA ❑ NE
[:]Yes
[:]No
26A
❑ NE
E] Yes
[:]No
CfNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
Yes EfNo
[:]Yes G�(No
dNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: ClED jDate of Inspection'
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZL_NA_- f] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E]- _A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes c�11ylZ ❑ 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 ❑ 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 [.]o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a -Nu- ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3-lqo- ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3'1\Io ❑ NA ❑ NE
❑ Excessive Ponding 0 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): -6 Cr.>�(. t ('A,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[g'Ivo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eil-N°
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[}#o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
b
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z31 o—
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3To
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ff No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

rFacili Number: -j jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [? No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check (—]Yes [:]No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Q>o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes fi:JX6
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?
[DNA ❑ NE
❑NA ❑NE
D. NA ❑ NE
DNA ❑NE
❑ Yes [+i�tf ❑ NA ❑ NE
[:]Yes [-i oo ❑ NA ❑ NE
❑ Yes [ t�, .?do ❑ NA ❑ NE
[:]Yes Q_Ne- ❑ NA ❑ NE
El Yes 91lo
❑ Yes efiTo
❑ Yes [E 'i<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to, questtoa_#) Explain any YES answers; y_a y "` inments. . andlarfan ddrtional recommendations cir an -other co
Use drawings of fkdfi to�tietier explain situations (use`add�honai;pakes,as:necessary).
514 'e- s�V'C' yt/
t'r.4 1 a -A I--L(-1 s
Reviewer/Inspector Name: _ j t+� l/� Phone:
Reviewer/Inspector Signature: t Date:
Page 3 of 3 21412014

A I WAS / 3
Type of Visit: QCo ance 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
,,,���,,,,,, ,,����JyyyyJ��0 Denied Access
`///�
Date of Visit: 9 Arrival Time Departure Time Coun41-5 Region:` T
Farm Name: t'Gt! Owner Email:
Owner Name: �1 {�/ (T ll,�[l Phone:
Mailing Address:
Physical Address:
Facility Contact: ( U"f t S j3&A ,Q1 Title: Phone:
Onsite Representative: _ y _ Integrator: J
Certified Operator: _ T(k C� C� Certification Number: 17
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
tDCurrent
-- Design Current
Swine Capacity,, Pop.
Wet Poultry
Capacity Pop
Cattle Capacity Pop.
Wean to Finish
Layer
INon-Layer
- Dairy Cow
I Dairy Calf
F``r Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Dry P,oult ,
Ca act= l'oP.
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
ILayers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
-
Qtber-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E3'No ❑ NA ❑ NE
a. Was the conveyance man-made? [:]Yes [-]No Efr1qA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 4A ❑ 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 &14A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes D*o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes C:fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o '
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�❑
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4�d
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
rnam en or improvement.
11. Is there evidence of incorrect land 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 V�j
vidence of Wind Drift ❑ Application Outside of Approved Area
i2.Cro T ep rn (s:) \� <r wtt,c. Y G U
13. Soil Type(s): 'N o I,K
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�.K° ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[]Yes
No
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [-]Yes M-K-6 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes El o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 L71VO A ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fac' " Ntnnber: - Date of Ins ection: 0 H97r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Epl,y- DNA ❑ NE
❑'go ❑ NA ❑ NE
❑ Yes RJ o ❑ NA ❑ NE
[:]Yes E3'No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C8'�Nio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes r❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? El Yes ❑ NA ❑ NE
Comments (refer to question ##): JE:xplain 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).
cot,(
11-15-i3
C
Reviewer/Inspector Name: L U 1"
Reviewer/Inspector Signature:
Page 3 of 3
-0- o [0,__ 51,5 4��> 7
Phbt7e: " a
Date�
21 /2011

ivision of Watei=Quality
Facility Number ®- ® O Division of Soil and Water Conservation
© Other Agency -
Type of Visit: QKompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (a U / Arrival Time: r Departure Time: County: egion:
r
Farm Name: EE-, �,y�j�-��yt,y4� Owner Email:
Owner Name:r«`�'��� Phone:
Mailing Address:
Physical Address: j(
Facility Contact: C.._.I-lt'�tsTitle: C.b� -9eL' Phone:
Onsite Representative: c5at .e Integrator:
Certified Operator: C9-i�'yd—�/I,QJ FCertification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design, Current Design Current
Swine
re
Capgcety +Popes" _
Wet Poultry Gapacaty Pop Cattle Capacity Pop.
1
Wean to Finish
Wean to Feeder
Layer Dairy Cow
Non -La er Da' Calf
Feeder to Finish
ZQ
-` Da' Heifer
Farrow to Wean
DesignCurreat Dry Cow
Farrow to Feeder
D . P.oult a Ca ace .,1'0 Non -Dairy
Farrow to Finish
La ers = Beef Stocker -
Gilts
Non -Layers Beef Feeder
Boars
Pullets Beef Brood Cow
Turkeys
Other"'
„ Turkey Poults_,
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[•�'No
❑ NA
❑ NE
❑ Yes
❑ No
E�NA
❑ NE
❑ Yes
❑ No
CTNA
❑ NE
[::]Yes ❑ No Q<A ❑ NE
[::]Yes �o ❑ NA ❑ NE
[::]Yes [ ❑ NA 0 NE
Page 1 of 3 21412011 Continued

11
Facility Number: - Date of Inspection- II&ZZ
Waste Collection & Treatment t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W10, ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [B'IIA ❑ 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 �io ❑ 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 [3'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 ICJ o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E24 ❑ 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 Ea o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes io ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes LamN'6❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 4
13. Soil Type(s): o W' ,L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Ergo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R'�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [�3<o ❑ NA ❑ NE
❑ Yes [Bol�o ❑ NA D NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
E?<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D-10
❑ 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
E3*'�4o
❑ 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
02 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
6<A
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E11 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No BTA ❑ 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 [t.]' oo ❑ NA ❑ NE
❑ Yes ❑'NO ❑ NA ❑ NE
❑ Yes L`_'_f 1Vo r] NA ❑ NE
❑ Yes [B<o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA W MP?
[:)Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ErNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0<0
❑ NA
❑ NE
Comments (refer to question..# ): Explain any YES answers and/or any additional recommendations orwany#other coinmen
"
Use drawings of facility to.better explain situations (use additional pages as..aecessary}.
_;
(J
L% _-C6
Reviewer/Inspector Name: C y__V
7
Reviewer/Inspector
Page 3 of 3
cn�---
Phone: '21CJ
Date: l�
21412011

t ype of visa: Ly Uompuance inspection U operation xeview U Structure Evaluation U l ecnntcal Assistance
Reason for Visit: eoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: �A "al Arrival Time: Departure Time: d t.' a� County: Region: y--
Farm Name: _ f� rYL�S - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: (( Title:
Onsite Representative:
Certified Operator: C-iizahzayi E.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Rc�wr7
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
MetPoultry
Capacity
Pop.
Cattle Capacity Pop.
We an to Finish
Layer
!
DairyCow
We an to Feeder
Non -Layer
DairyCalf
Feeder to Finish
O
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
DryPoul_ a
Ca acity
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turkeys
rr
Turke Poultser
Other
Discharges and Stream lm acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
&�rNA
❑ NE
❑ Yes
❑ No
E?(NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rq�N� ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Flo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412077 Continued

Facifi Number: jDate of Inspection: eZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [gNo ❑ 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:Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [fNo ❑ 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 E2fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 [v]ZNo [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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): - a,
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [vf No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [D'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes [dNo
❑ Yes [r, No
❑ NA ❑ NE
❑ 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
E;�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
dNo
DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: 4.1 J@S la
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [21"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 GyNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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, fi-eeboard 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:
❑ Yes [2(No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes E?f No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E2fNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? []Yes dNo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
11
Date: k-
21412011

BI:Ms z/z4100/o
Type of Visit Q-C@mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2-25- Arrival Time: Departure Time: County: S e•v Region:
Farm Name: /C Jc:�-+' -5 Owner Email:
Owner Name: �sd N �u 1��� ✓ Phone:
Mailing Address:
Physical Address: Facility Contact: a 'A s^Title- �`� • SPt G Phone No:
Onsite Representative: Integrator: !L%45 az tl
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' ❑ u Longitude: ❑ o ❑ , ❑
is
Design Curren#
DeSln Current Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
10 Layer
I
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
Rfeeder to Finish
13 72- 0 1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Non-Dairy
❑ Farrow to Finish
La ere
El Layers
❑ Beef Stocker
❑ Gilts
❑Non -La ere
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Other
❑ Turkey Pouits
it ❑ Other INumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
f
B'NO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
�,�
L7NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[T1NAA
❑ 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)
ElYes
❑ No
D-KA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[hNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 92_ - (18 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes BNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 N
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 threa notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
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. El2 Yes
- o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNoo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,L_�_
oo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,L�T,
B"Zo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ly'No
❑ NA
❑ NE
Comments refer to; uestion # . Ex lain anyal,,ES answers andlo� any'recommendations or any other comments.
Use drawings of facility to better explain si tuations-L(us ddttional pages as necessary:):
Reviewer/Inspector Name t G / ►iL S ,' '' Phone: `?10.�,�j 3300
Reviewer/Inspector Signature: Date: 2 -25- ZO/Q
12128104 Continued

Facility Number: Sz — G] Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ej o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3 o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Qa
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElE Yes
10
ElNA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El yes
,
L.jT<o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EKo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EjNo
❑ 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
�_
L,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
El<o
❑ 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
L7 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
12128104

s /O -os o 9
)ivision of Water Quality
=Facilityumber $2 9 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (3�<&mpliance Inspection 0 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: /(p- 09 Arrival Time: Departure Time: County: �`,D�D�✓
Farm Name: _ %8 '4:;i vat S _. _ Owner Email:
Owner Name:
Mailing Address:
Phone:
Region: FW40
Physical Address:
Facility Contact: S aAv"Lk— Title: S ee ­ Phone No:
Onsite Representative: integrator:
c, r- LV."1s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ c 0 Longitude: F--I 0 = 0 if
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
h ❑ Layer
❑Non -La et
❑ Wean to Finis
❑ can to Feed
Feeder to Finish
.3TZD
3 %Z
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Da Caw
❑
DairyCalf
❑
DairyHeifer
❑
D Cow
El
Non-Dairy
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 711
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 ETNo ❑ NA ❑ NE
❑Yes
El No
El NE
El Yes
❑ No
,L�_,INNA
LJ NA
❑ NE
E NA
❑ NE
❑ Yes
❑ No
❑ Yes
[3 l5o
❑ NA
❑ NE
❑ Yes
E to
❑ NA
❑ NE
12128104 Continued

Facility Number: Sz - 9
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structureo Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): si ff
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
I--] Yes 2<oo ❑NA El NE
El2 Yes ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes La No ❑ NA ❑ NE
❑ Yes L] 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
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑' +�lo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,�
G No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
��
E o
❑ NA
❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop /Windowr ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ri.—,
13. Soil type(s) 140 A
14. Do the receiving crops differ from those designated in the CAWMP? - ❑ Yes !J No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
3- o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
u No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
LZNo
❑ NA
❑ NE
Reviewer/Inspector Name F_.k j c j( 9 '�-JJSy • n Phone: 9/0. 3.3 , .3.33 Y
Reviewerllnspector Signature: Date: 9 -& ~ 2-y0 9
Page 2 of 3 12128104 Continued

Facility Number: 82— —9 8 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 2 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B o
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
BN�o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
2No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[al l�o
[INA
ElNE
27.
Did the facility fail to secure a phosphorloss assessment (PLAT) certification?
❑ Yes
Bus o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ NNo
❑ 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
ffNo
❑ 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
ETN_oo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
01 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

SZW5 9-o</--oS X-R-
Type of Visit IEMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e_1 routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S'Z 1-D S Arrival Time: /Z :3f Departure Time: f:00 County: Q�+•� o'er
Farm Name: r �J /�� v�•ts - Owner Email:
Owner Name: __ __Frt.d 45grle± - Phone:
Mailing Address:
Physical Address:
Region: `• o
Facility Contact: Title: �- SSG • Phone No:
Onsite Representative: r�i� rW� C- Integrator: __cl:4 ; )C:�
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a =' = « Longitude: = ° =' =
Boo.. •M�
Des gn Current °� Design Current
- -.... -_ ..-_
' Design Current
-� Wet Poultry Capacity Populhon Cattle
Swore Ca aci Po lation
'
'City Population
❑ Wean to Finish 10 Layer ❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Daia Calf
Feeder to Finish
❑ Farrow to Wean
D . Point
T
0 Daia Heifer
❑ Dry Cow
" z` El Non -Dairy
❑ Farrow to Feeder
El Layers
El Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Boars
Turke s-
Other LI Turkey Points
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[]Yes
❑ No
B-lgA-
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Dlq'X-
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
�,,�
!_7 ZA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3-No-�❑
NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
ElE
tvo--
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: $2— 98 Date of Inspection
Waste Collection & Treatment �,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ,-L4T�10 El NA El NE
2
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32—
r,,�
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes t=l 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 01 o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ilo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
21qo ❑ 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
[4do ❑ NA
❑ NE
maintenance or improvement?
Waste AvUlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
t —110 ❑ NA
❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Q+iu—❑ 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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) 1�Gy uain� � �J <�44// r-h . A'v e-O - S
.
13. Soil type(s) 111014
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2 o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
©-goo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Rigo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
94K ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9-m— ❑ NA
❑ NE
Reviewer/inspector Name ��e i/,c�.s' ; Phone: 9i4�3.�..3330
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Iracility Number: 72- of 00 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps Design
g p El Other
El Yes ZNo El NA ❑NE
❑ Yes 21�o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 3 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additioaal'Gomtiaents and/or Drawings:
❑ Yes
D'Ko
❑ NA
❑ NE
❑ Yes
DNO
❑ NA
❑ NE
❑ Yes
B-9-o
❑ NA
❑ NE
❑ Yes
91Co
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
0-5-o
❑ NA
❑ NE
❑Yes
El NA
El NE
❑Yes
�0'lz0
LJNo
❑NA
El NE
❑ Yes
Blo
❑ NA
❑ NE
❑Yes
O' o
❑NA
❑NE
❑ Yes
0-9o'
❑ NA
❑ NE
❑ Yes D<o ❑ NA ❑ NE
Page 3 of 3 12128104

® Division of Water Quality
Facility Number �Z 98 0 Division of Soil and Water Conservation ✓✓✓
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I�`J/-07 Arrival Time:/•-�Q.q.... Departure Time: �Z:S� Counry: S;��Region:
f �
Farm Name: /CE 8 f�'r�YS Owner Email:
Owner Name id���Y«%1��% Phone:
Mailing Address:
Physical Address:
Facility Contact: ( ldknLS 8e1V:Jlt1k Title: -�^�L� 9?' _ Phone No:
Onsite Representative: Integrator: CAAor" RL A s
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0 =] ' [�:] u Longitude: = ° = t =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
7Z0
3317
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puilets
❑ 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?
Cattle Capaciy;Population
❑ DaiEy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 M No ❑ NA ❑ NE
❑ Yes
[59 No
❑ NA
❑ NE
❑Yes
F]No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
[4 No
❑ Yes
� No
[I NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

Facility }Number: $Z-- 14;
Date of Inspection e-_Z'T--77
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:
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes f4 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 V] 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 Cl NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (21 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [:1 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) iwGt��k i/J �lol�r%nl (OS,
13. Soil types) No /4
14. Do the receiving crops differ from those designated in the CAWMP'? ❑ Yes �0 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
[B No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ER No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name F1+c V-11 7[ZQvCI-5 Phone: 910. '133. 3300
T = D—O Z00 7
Reviewer/Inspector Signature: �� Date: / /
I2128104 Continued

Facility Number: F'Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JP No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Cl 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
PO No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[)-d 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
® 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: saeV Qf►z
Farm Name: F B I'a✓Kok5 Owner Email:
Owner Name: tr-e 4d1 e. _ _ &k+ie,
,Mailing Address:
Physical Address:
Facility Contact: rrC.,d.4 i t 13m +1 c✓- Title:
Onsite Representative: C uv[s-8�14jj`e e_ -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator: CO1-1AV0 it -
Operator Certification Number:
Back-up Certification Number:
Region: /t_X0
Latitude: [ n == Longitude: = o =, 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
13 7 Zp
6 5I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Dischar1jes & Stream Impacts
1. Is any discharge observed from any part ofthe operation?
Discharge originated at: [I Structure El Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 ((allons)?
Number of Structures: 71'
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 ❑ NE
❑ Yes
N No
❑ NA
❑ NE
El Yes
®No
El NA
El NE
❑ NA
❑ NE
❑ Yes
®No
❑Yes
®No
❑NA
❑NE
❑ Yes
5fl No
❑ NA
❑ NE
12128104 Continued

Facility Number: SZ--- <] S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? []Yes N No ❑ NA . ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ( H
Observed Freeboard (in): 3 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
N No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
N 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
M No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[8 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
[S No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[A No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes
[N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) rnti S& c1 •4 ; v 14 G rai N
13. Soil type(s) No ✓4 i k
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 determinations
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:gNo
❑ NA
❑ NE
' Reviewer/InspectorName ic.k.QeV.Y' , � , �,.Phone: 9/OJ'OeS6
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: $2 - $ Date of Inspection 5-d3-off
Required Records & Documents
09 Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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 [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
( No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concem?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
El Yes
No
❑ NA
❑ NE
Additional Commentskandlor,Drawings:
�--,;;^.
_
12128104

G
RMr im
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: 3 i 0-r Arrival Time: /a % 3o Departure Time: County: _5a ►'^G se.;J Region: P nv
Farm Name: rr ✓�`. Fa l yn.$ Owner Email:
Owner Name: 1� d r c� �aQ F*-c��s �- w 4eY Phone:
Mailing Address: Go s, e i r e "AWoev C.
Physical Address:
Facility Contact:
Title:
Onsite Representative: -(ft~. f i
Certified Operator: H Q r e 1 oQ FV _"�QC W. t C. �C
Back-up Operator:
Location of Farm:
I' -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: _ — o_ h
Operator Certification Number: %S- 3>q
Back-up Certification Number:
Latitude: =o =. Longitude: =o f=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
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'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 EN No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: ?J- — 9 $r
Date of Inspection 13 M ld>f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ✓f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 153_`Oq"?_
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [0 No ❑ NA ❑ NE
El Yes El No El NA ❑NE
Structure 5 Structure 6
❑ Yes QR No ❑ NA ❑ NE
❑ Yes [2 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 [ 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 [XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V 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/Siudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) as +4' j &_Vr h4 rvrn a
` jt55
13. Soil type(s) /V. A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
[� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Reviewer/Inspector Name ` %� � Phone: -rq J
Reviewer/Inspector Signature: Date:
/ 12128104 Continued

Faciilfty Number: 8a — 9 y Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. (M Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 9 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
® 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 fait to calibrate waste application equipment as required by the permit?
❑ Yes
01No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
C8 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[p 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
9 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
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
x� ... yOEM
Addtboaal(Comments•andlor. Drawings.Elw
d I^ f {eC.St Lim-Yi.. +-a � , , r 4-CGor_4_5 cr+ crc'r5 V.CV"aJcAQ, C-em-
12128104

Type of Visit Q bompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Cr Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Wte of Visit: Time:
FO Not Operational C Below Threshold
Permitted ®Certified Q Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ......-................
Farm Name: Y "` County: 5 +'t
�UU__.............._s.._._._._...._..—+ - -- --- - -- .....
-._
Owner Name:... --#-ME& ...._.fa.AriL'C......q.... ��1�.uC..��..... 1?honeNo:---J�}�..r �3o.1�._....�._.__. ................. . _.
Mmling Address: �y
5 ___.___.«..»_.___ _...�..._._... ....._...�..__ _. ....._.---------
Facility Contact: ..� ..�..... Q Title: . Pel*'►..�!Q...... ..... -......... Phone No:
Onsite Representative: �'S IStrwie-x Integrator: rid
Certified Operator: --------- {�ila� _ EnA i v- _ _ Operator Certification Number: / Zg. '
Location of Farm:
ffe&oine ❑ Poultry ❑ Cattle []Horse Latitude �' �� ��� Longitude '
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation? ❑ Yes to
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes - Errio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Eg-fio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes &Sio
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........+............. ....—..............
Freeboard (inches): �Z1
12112103 Continued

Facility Number: r(a — gig
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need a taintenanceltmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ct)a qr ! bar 0t" fir' Smti l rrairt
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes BNO
❑ Yes 2"No
❑ Yes fffio
❑ Yes E!rNo
❑ Yes B No
❑ Yes 31fqo
❑ Yes [-�lo
❑ Yes ERVo
❑ Yes 21go
❑ Yes 191Qo
❑ Yes [+ 1Q0
❑ Yes ©'No
❑ Yes Eivo
❑ Yes ER o
❑ Yes RNo
❑ Yes [R'No
❑ Yes [KNo

Facility Number: — Date of Inspection
Required Records & Document,;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [OTo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes [IINo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 631�o
G;'*aste Application 2rFreeboard Waste Analysis [moil Sampling Ad
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 21fiO
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [To
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 2Vo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 94go
28. Does facility require a follow-up visit by same agency? ❑ Yes Rlgo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0'%
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 9Kes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 20fio
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ OSO
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes B—NO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ©ONo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 91<0
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: odld
Facility No. Z - q
DIVISION OF ENVIRONMENTAL MANAGEMENT
f ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: I995
Time:
Farm Name/Owner:�
Mailing Address:
County: n,
Integrator:
On Site Representative:___;
Physical Address/Location:
Phone:
Phone:
Type of Operation: Swine ..�- Poultry Cattle
Design Capacity: 3a.cte_-o Number of Animals on Site: h�.•a.� d..-.-��
DEM Certification Number: ACE_ DEM Certification Number: ACNE
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) oes or No Actual Freeboard: 6 Ft. _ Inches
Was any seepage observed from the
Is adequate land available
Crop(s) being utilized:
Does the facility meet SC5
for
s)? Yes or %Was any erosion observed? Yes or No
r No Is the cover crop adequate? e� r No
minimum setback criteria? 200 Feet from Dwellings? �w or No
100 Feet from Wells? ior
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or©o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N) If Yes, Please Explain.
Does the facility maintain adequate waste management recoydt (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? kSoor No
Additional Comments:
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: �)b
Facility No. '3 /y �!
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7It 1995
Time: 11 I-C
Farm Name/Owner � ��. r . ,s, nwp _j & , , Fg ---'s--
Mailing Address:
County:
Integrator: _ _ _ _ ._ Phone:
On Site Representative: -Zack pi c ci, 11go -v Phone:
Physical Address/Location:
f
Type of Operation: Swine Poultry Cattle
Design Capacity: 3- 13 Number of Animals on Site: , 6 C2 _ `73 &
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 6 Ft. Inches
Was any seepage observed from the lagoon(,)? Yes or N[� Was any erosion observed? Yes orb
Is adequate land available for spray? t�� or No Is the cover crop adequate? (�a or No
Crops) being utilized: c o.'A�.►..,.1�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? a o1
100 Feet from Wells? 15 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Q)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
No
Yes oK
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or<Q If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y�s or No
Additional Comments: t_e1) i,', ;,6 �-i ir_,e, 6Q,.-d
ka0-ties A VyrQ2
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

EE
r
WMM CAROLMML DEPARTMXNT OF ENVIROMMT, EMALTE b NATURAL R$SQaM=
DIVISION OF ERMONNMTAL
Fayetteville Regional office
Animal Operation Compliance Inspection Form
�°• �y mac- "�'. �..�/ .. �..../�,,,.��.»e��..i..r- x as
:a v:.. F^"�-�"..7��*w�+�y�*S�,J�r¢
'-xe'S%�;:,�,.*Qv^�'�>i.°�.'.i �r..�.��;xp..... �{�..
rzj'b 5 ACXLMTiy+.GrF�+1/+\f+..YiJaao.0il tom^
t L �U 3g C ('rn �U� 293M
R1U 5qa - 5
All gue iAC QA44XWge tively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
MZTION I
Animal gRgration � nos �
Horses, cattle, swine, ultry, or sheep
SECTION II
1. noes the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
systam)] .
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a G�tTIFpp
WASTE MAKAGZKE 4T P�,
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minima=
setback criteria for neighboring houses,
wells, etc?

AMMON III
a
kield Site Xanaa2a=
t. Za animal wag-lw sLuckpilad Or lagoau
construction within 100 ft. of a OSC5
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated wi *',in 25 it. v5 a nGGO Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application sits have a
cover crop in accordance with the
M-117IGTIM p%AH?
5. Is animal waste dischargad into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
5. Does the animal Waste management at this
farm adhere to Best management Practices
( 10) of the approved CERTMCATICKq?
T. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _)
$. Is the general condition of this CAiC facility,
including management and operation,
satisfactory?
§=01q IV
Comments
a

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s ' �
REGIS"P A?:CN FORM FOR ANVyL FTEDL OT CPWIATIONS
Depa,tment of Environment,:iealthand Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serge mare than or equal to 100 head of cattle, 73
horses, 230 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then thls fcrm must be filled out and mailed
by December 31, 1333 pursuant AA NCAC 2 .0217 (c) in order to be
deemed permitted by 005. ?lease print clearly.
t
Farm Name:
Mailing Address:
County:
Cwne= (s) Name:
Manage= (s) Name:
Lessee Name:
Farm Location (Be s stecific as possible: road names, direct ion,
Fmi�lemost, etc ) jrEot-;A (-L-InNaW 19110 JIVI E_ An I Los
�-
Lac_tude/Lcngi-ude if known: ` 5�` (rs— )L41 `� 3-10-'('3
Design capacity of anInal waste management system (Number and type
of canfined anima: (s)) CCF 37�D
Average animal copulation cn the farm (Number and type of animal (s)
-raised) E
Year Production Began: ASCS Tract No.:
Type of Waste Management System Used If
Acres Available for Land
Owner (s) Signature (s) .
!cation cif Waste:
lLk

■��
w