820232_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qual

1VISIDn Of WeteC REsflurces
'Facility Number rr2 - z �' Division of Soil and Water Cflnserx ation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O'lioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ei I Arrival Time: Departure Time: 3 7 County: ary/'!WY Region: FI
Farm Name: a -s Fo,, " Owner Email:
Owner Name: LA ri tint S ��44 T; -J" Z,A c' _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: U w' S 1&'C' h&k Title: Phone:
Onsite Representative: I l Integrator: �V'ey
Certified Operator: G (Y °1 10 fy, t -s Certification Number: Z7 ti qb
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&N5 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
[:]Yes ❑ No
[:)Yes tC3. -3'�o
[::]Yes Q o
D,D�A ❑ NE
❑-3qA ❑ NE
E3 -VA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop; Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
o1
D .P,oult .
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�s
F
N Turkeys
Other _
-
Turkey Poults
Othe�r
:..,,Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&N5 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
[:]Yes ❑ No
[:)Yes tC3. -3'�o
[::]Yes Q o
D,D�A ❑ NE
❑-3qA ❑ NE
E3 -VA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 9'1 - 3 Z Date of inspection: k(v
IL.— """
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[D,16o_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�o 0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[D-<
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
-7 `
Observed Freeboard (in): !
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yeso
❑ 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
Ly' o
❑ 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?
❑ Yesdo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ca//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
[V] No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q.No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Ponding p 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
n Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 93 efwt,u-4AS'(j cD
13. Soil Type(s): cv, 4�4 h rot/
14. Do the receiving crops differ from th6se designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
IL.— """
❑ NA
❑ NE
❑ Yes
01C
❑ NA
❑ NE
❑ Yes
[D,16o_
❑ NA
❑ NE
❑ Yes E No
❑ Yes Vo
❑ NA ❑ NE
❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ YesF4 "'�' ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes l _ qo ❑ 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 [3No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: ;_ - 0- 3 Z jDate of Inspection:
dj
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
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
Lt!1' q'o
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT") certification?
❑ Yes
[3'No
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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 Reviewerhnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�J'No ❑ NA ❑ NE
❑ Yes E3<o ❑ NA 0 NE
❑ Yes [5"No ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
❑ Yes L_ 4o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes FJ'No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7-- t 6
q317v
to - '�3ogr k S(
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone t'O — ,
Date: 9dall 1�
2/4/2015

Type of Visit: (3 -Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0xoutine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: hr1,� i Arrival Time: r Departure Time: County:_ Region
Farm Name: Q� l �% `�pc�'�`� Owner Email:
Owner Name: _ryl+in-�`•(ay`'k �`�l/ Phone:
Mailing Address:
Physical Address:
Facility Contact: wxi o . tr✓L' L Title: Phone:
Onsite Representative: L Integrator: T --C
Certified Operator: e tl (5 Certification Number: (yk,6
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
11 MW T "Design
C►urren#
❑ No
Design.,Current _.
Design Current
Swine . Capacity
Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
d. Does the discharge bypass the waste management system? {If }'es, notify DWR}
Yes
[] No
-
❑ NE
Wean to Finish
g
' Layer
❑ NA
Dairy Cow
Wean to Feeder
❑ Yes
]Non—Layer
❑ NA
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Designer Current
Dry Cow
Farrow to Feeder
d -Do
Ca c P,o
Non -Dairy
Farrow to Finish
I
jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
��F;'
Turkeys
r
Other
TurkeyPoults
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?
[:]Yes G?<o ❑ NA ❑ NE
[:]Yes ❑ No EH NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
L� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? {If }'es, notify DWR}
Yes
[] No
NA
❑ NE
?. 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
[rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2015 Continued

Facility Number: - 3 Z Date of Inspection
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [L <o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑Yes ❑ No ®•N:k ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2<o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �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 DVM
7. Do any of the structures need maintenance or improvement? ❑ Yes G]�No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E5' -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 (fKo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Erl�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;Ko ❑ 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. Crap Type(s):�Y` � 6 -- � L— C yC
13. Soil Type(s): Ltyu�A/ r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [t]'�lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�[:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3"go— ❑ 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 E'No ❑ NA ❑ NE
❑ Yes C2'Ko ❑ 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 [3] No ❑ NA ❑ NE
the appropriate box.
❑ WUP [:1 Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ca"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [El'No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

F cili Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EO -Mb ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C:�4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [2<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes eNo ❑ NA ❑ NE
❑ Yes Gg-'Ko ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
EE?No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[2 -Ko
❑ NA
❑ NE
Comments -:(refer to question # ) Ex latn,an BYES answers Y c m. _io' "-
Use -drawings of facity to better explain situations," add tiopal;p genas aences � inendahotts or any o ber^comments. ;1
SG
F>- 5 �
Vo 0�-- b ��
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phon . b
Date: h
2/4 OI S

d IRS
It
0
Type of Visit: Q'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 xoutine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: r 0 Departure Time: County:_ Region:
Farm Name; .�air L<.Q sow _ Owner Email:
Owner Name: i' S 0 f [ "`'mss Phone:
Mailing Address:
Physical Address:
Facility Contact: (fol^j(5 4--1501C Title:
rr
Onsite Representative:
Phone:
Integrator: r,
5
Certified Operator: C rGvl+�t arrl7 Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑>c, ❑ NA ❑ NE
❑ Yes
Design Ctirrent
RNA
❑ NE
Current
❑ No
Design Current
Swine
CapacEty .Pop.
Wet Poultry
kesign
pacity¢
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
D ' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
-
" s
Da" Heifer
Farrow to Wean
2 p"7
Des-ign
Gu=reat
D Cow
Farrow to Feeder
D , P,oult , ,,
Ca aci "',',, _ o ^.
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qthe
I ITurkeyPoults
Other
FjOtheT
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 ❑>c, ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
[:]Yes
❑ No
[2NA
❑ NE
[:]Yes ❑ No
[:]Yes [31140
❑ Yes ONo
E3'fqA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 214/1011 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [44qo"__❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No 2 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z-7 7
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 [BIN'o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes / No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes P -Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ 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
❑ Outsidc of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3'et4t441 J (0 0 /6' C� sr C
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�J<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [ fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []I"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]j No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[9'oko
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3<o
O NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
Callo
❑ 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
C5No
❑ 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
[ rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
6No
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

ocz
Fadlily Number: - Date of inspection:
X24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R3-lKo
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 CAWNIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑oNo ❑ NA ❑ NE
[—]Yes Qlo D. NA ❑ NE
[:]Yes [3-f0 ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
[:]Yes [?'No
❑ Yes [ErNo
❑ Yes [ff'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
t ;omments (refer to question #): Explain any YES answers aniWor any additional recommendations;or any,.otperacomments
Use drawings of facilityto better explain situations (use additional pages as necessary). ' u; ,�
f r� 72—
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone:J
Date:
2/4/2 I

Type of Visit: O'Compliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: +Q'foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: Departure Time: 4 4 County: Myn - ---
Farm Name: 6pc/��µ�)'�� Owner Email:
Owner Name: �P� J ✓ +� t Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
0
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Integrator: (9:[,y_ (�
Certification Number: ol`
Certification Number:
Longitude:
Discharges and Stream Impacts �,��
1. Is any discharge observed from any part of the operation? E] Yes Li.l�s° ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑No QUA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No E NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C]"No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [jNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued
Design Current
Design
Curreint
Design Current
Swine
Capacity Pop. `Wet' Poultry
Capacity
Pop
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nan -La er
Dai Calf
Feeder to Finish
+ °;;,
DesignCurrent
Dairy Heifer
Farrow to Wean
Dry Cow
D Foul ',
Ca ani
�1?o
Farrow to Feeder
Non-Datry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
113eef Brood Cow
Boars
Pullets
Turkeys
Other
_ Turkey Poults
Other 10ther
Discharges and Stream Impacts �,��
1. Is any discharge observed from any part of the operation? E] Yes Li.l�s° ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑No QUA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No E NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C]"No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [jNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facili Number: - Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 29-#tr- ❑ NA ❑ NE
a. If yes, is waste Ievel 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 L'K ❑ 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 [�FM ❑ 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 ER'Ko ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ 'J ao ❑ 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 E5"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [5 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U lNo ❑ 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): _ _�t.e� .S G J
13. Soil Type(s):
Ap-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M -'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 [Er& ❑ 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 [INo ❑ 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/rNo ❑ NA ❑ NE
the appropriate box.
❑WUP F1 Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a 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 Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesrNo
❑ NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

f
Facili Number: - Ds ection: 4S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [(jlo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E2-bla- ❑ 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 []LNs ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [: No ❑ NA [D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C]3 -<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? ❑ Ycs [EH<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [�t<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 [D -<o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2•Mob ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [3<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �o ❑ NA ❑ NE
Comdients (refer to q #): Explain any YES.answers and/or any additional recommendations or'any other4co:fiimeuts:
Use dr'a`w n s of -facility to better.explam,sitnations;{use additional pages;ies.necessary)
�� �. � - (�_r � r� r. �, -- S •� Psi 3�e
0
Reviewer/Inspector Name: _ Phone: "l
Reviewer/Inspector Signature: �( Date:
Page 3 of 3 2/412014

Date of Visit: ISUArrival Time: Departure Time: IMODPRI county: t� S
Farm Name: (9Q! lank sow Fig//h Owner Email:
Owner Name: eCne,(+ Srn til h 1P&M -;P Phone:
Mailing Address:
Physical Address:
Facility Contact:
f
la 1fn oLc ( S
Title: �� Mawaa�" Phone:
Onsite Representative: L110A I/X(i S Integrator: t::-r&f-{- Sn
Certified Operator: CIPYA( Certification Number:'T4q�
Region: FRQ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�rDCurrent
-
Design
Current
Design Current
SwineCapacity Pop.
Wet Poultry
Capacity
Pop.
Cattl�Fg apacity Pop.
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
Wean to Finish
La er
®No
❑ NA
❑ NE
Dairy Cow
Wean to Feeder
Non -La er
❑ NA
❑ NE
of the State other than from a discharge?
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanDesign
Current
D Cow
Farrow to Feeder
D.r.. _ P,oult _
Ca acity
. Po ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.:.
Turke s
Other
Turkey Poults
Other
Other
.:_, --:.:.4
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?
❑ Yes &-No ❑ NA ❑ NE
❑Yes ❑No ❑NA E] NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
t -No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

_ Facility Number: $ -05 Date of Inspection:
Waste Collection & Treatment
❑ Yes
[R No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
17. Does the facility lack adequate acreage for land application'?
❑ Yes
U No
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CS No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): J
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
t@ No
❑ NA
Observed Freeboard (in):_
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C'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
�jNo
❑ 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?
O Yes
❑ No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ER 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 �� yy [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CA -)h-,61 MALdQC av; Sfmll arQtin pvP,-.sPbt
13. Soil Type(s): C4) hfiv Ca
14. Do the receiving crops diger from those designated in the CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CS No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
t@ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. "0 Yes ❑ No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections E]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑Yes [2No 0 N 0 N
❑ Yes ❑ No ® NA ❑ NE
❑Yes f5allo C] NA ❑NE
❑ Yes [R No ❑ NA [] NE
❑ Yes 12 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes t2 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes n No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes IM No ❑ NA ❑ NE
(g q ) P { yg l recommendattonsor any.other comments.
Comments refer to uestion # : Explain any YES answers ridlor�an ..additions Tn'
Use drawn sof factli ' to better explain situationsuse addthonal: a esas necessary).
Ma'cx base sears on Q �, dvt+o vel- saeidy .s of 11 o4 o�r�sam mgr. Oafs w��
, I fled r b�* d id_ n o�o� o Uer wf 1 Plea f -e . sock- -+CFO ! fo* If 1 i� ,
sffeL Ar s�ry j�dmvch,
d,(�4
9 yo-kdumps 1M0 j0 je 1�rxn , Smalt side )fool i s^conne` d b pe_ b* bas;Ca11
y 7
Y
01, fl -e tvie_ N ra-les ` (Om Curf&& rv0jk coal jff ff � sU ra% remrdJ, N1 yak
Folin, f i elds 41fe(W i Grp � �7 q tX� S'�QQo re a s rr©fid a bd��.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
/412011

Q
Facility No. $a Oj Farm Name l9(��r`t�1� Sd�W Date
Permit . �,/ COC OIC
Pop. Design Current
Type
NPDES(Rainbreaker
Design freeboard
• • - - .- - ....-------
Sludge Survey Date
Sludge 1;e th (ft
Liquid Trt. Zone
Ratio Sludge to Treatment Volume
__- L't u
Desiign Flow
Actual Flow
Design Width
li1�--�---
'O it
Wettable A s
WUP _
Weekly Freeboard
1 in Inspections _
120 min Insp.
Weather Codes
Transfer Sheets
IN GAUG L�
Dea ox or incinerator
Mortality Records
xv MOWN1 �,,Ellvll I M. f I IWOW
Soil Crop Acres PAN Window Max Rate Max Amt
t a /90 W14
a,
3,I os -
Verify PHONE NUMBEV and affiliations
Date last WUP FRO 101% Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -1 3000= 213 lb/ac
&
�App. Hardware n � -
dry
!.S
Soil Test Date
pH Fields
Lime Needed
rte_
Lime Applied
Cu -1 V
Zn_I
Needs P
— �_
yaftl
Crop Yield
./ �6'�v0I�?
'O it
Wettable A s
WUP _
Weekly Freeboard
1 in Inspections _
120 min Insp.
Weather Codes
Transfer Sheets
IN GAUG L�
Dea ox or incinerator
Mortality Records
xv MOWN1 �,,Ellvll I M. f I IWOW
Soil Crop Acres PAN Window Max Rate Max Amt
t a /90 W14
a,
3,I os -
Verify PHONE NUMBEV and affiliations
Date last WUP FRO 101% Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -1 3000= 213 lb/ac
&
�App. Hardware n � -
dry
!.S

bJwrs 0_//_z6/0
Type of Visit @rCompliance 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: ArrivalTime- Departure Time: �.'/ �.. County: res �✓ Region:
Farm Name: 6 rl. ✓d Jou+ Farr, Owner Email:
Owner Name: FVW-J f Si,, -44, P., C_ Phone:
Mailing Address:
Physical Address:
1 G,�� '44, -�3 M
Facility Contact: Title: !"g ✓�-- e.✓cSr.V Phone No:
Onsite Representative: Integrator: 1'k4l
Certified Operator: S _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ 5 = Longitude: 00 ❑ I ❑ "
Design Current
Design Current
Design Current
SwineC■opacity Population
Wet Poultry Capacity Population
Cattle Capacity Populatinn
❑ Wean to Finish
❑ La er
❑Non -La er
❑ Dairy Cow
❑ Dairy Calf
JEI Wean to Feeder
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ NE
El Farrow to Finish
Non -Layers
❑ Pullets
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑Other
hfumber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12/28/04 Continued

acility Number: S2 -2-3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: dL
Spillway?:
Designed Freeboard (in): CZ _ y-- ne".,5
Azr—,,
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
& 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L/O $.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
[I Yes El No [I NA [I NE
Reviewer/Inspector Name f ?i �r �[.g, Phone: z%1t7- f l3 ,3301 D
ReviewerAnspector Signature: Date:
Page 2 of 3 11/28/04 Continued

Facility Number: Date of Inspection -2,3-/D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design b El Maps El 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
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ 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 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
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Addttional Co mments and/ai Drawings
�
Page 3 of 3 12/28104

. ion of Water Quality
FSCility Numberg2 ® �Z� O Division of Soil and Water Conservation
Q Outer Agency
Type of Visit Q-eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit efo-Utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 U' 'O. I County: T Region: �i�6
Farm Name: �4+'�"J�� Owner Email:
Owner Name: ,e</r-NeS Phone:
Mailing Address:
Physical Address:
Facility Contact: 61 e viV No rvi s Title: A r... MJ., . Phone No:
Onsite Representative: 614— ^f /ypYris Integrator:
Certified Operator: G"/eo ✓r� 'S Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I = u Longitude: 0 ° =I = u
7ill
n Current
Swine C
Wet Poultry Capacity Population
Cattle Capacity Population
❑ We to Finish
❑ Layer
❑ NA
❑ Dai Cow
Feeder
❑ Non -La er
❑ Dai CalfFeeder
FWeanto
to Finish
a. Was the conveyance man-made?
❑ Dairy Heifer
❑ Farrow to Wean
Dry Paultn,
❑ Dry Cow
Farrow to Feeder Z 2
❑ Yes
ElNon-Dairy
❑ Layers
❑ Farrow to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
El Stocker
❑ G
❑ ers
ElBeef Feeder
El
❑ Boars
Plletsilts
❑ullets
ElBeef Brood Co
,�.,,//
LANA
❑ Turke s
2. Is there evidence of a past discharge from any part of the operation?
Other. _
❑ Turkey Poults
Number of Structures:
10 Other
❑ Other
❑ Yes
2 No
❑ NA
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
[I No
,�
ETNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
2 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
,�.,,//
LANA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2 No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: 92 -2,3Z Date of Inspection
Waste Collection & Treatment :oE3NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 01 NA [__1 NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: la 5 -
Spillway?: T �d/O
Designed Freeboard (in): /17
Observed Freeboard (in): -70
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 CTNo ❑ 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? El Yes L_"_iNo [__1 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L7No ❑ 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 [:1 Yes B o ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) _g
14_ Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
C -No ❑ NA ❑ NE
L No ❑ NA ❑ NE
ff <No❑ NA ❑ NE
��No_D NA ❑ NE
�`NoD NA ❑ NE
Comments (refer to gnestion #): Explain any YESansRers and/or any:recomuiendations or any other zpmments.
Use drawmi— gs of facility"to better explain situations {use additipnal pages as,„necessary:) a
ReviewerAnspector Name iQGv S � `�� Phone: gib, , V33.3,FtjO
..
Reviewer/Inspector Signature:Date:
12/28/04 Continued

Facility Number: S2 -232-Date of Inspection
Required Records & Documents ,.,%
19, Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes LfNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ER ❑ NA [IN E
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 ❑ 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, [I Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes B'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IJ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0�<�0 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes ,B o ❑ NA [INE
26. Did the facility fail to have an actively certified operator in charge? [-]B 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?
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?
Add�tioaal Comtneiais ati`d1ar�Dra
�� , -,. Wings
12/28/04
❑ Yes
e�o
❑ NA
❑ NE
❑ Yes
ffN.
❑ NA
❑ NE
❑ Yes
IJ No
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
01N.
❑ NA
❑ NE
❑ Yes
2 o
❑ NA
❑ NE
Add�tioaal Comtneiais ati`d1ar�Dra
�� , -,. Wings
12/28/04
12/28/04

8_T jiA & 9-/-7-200E? izR--
Type of Visit (TISmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (5110—utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'OpO �`, Arrival Time: $:4Q Departure Time:. G17 County: S4 Scy Region: fiec
Farm Name: sa��""'" Sd `"� Owner Email:
Owner Name: ,e5'ei1e51 .S/iklt Phone:
Mailing Address:
Physical Address:
Facility Contact: v eq, n Title: r4,`w+ A?1- _ Phone No:
Onsite Representative: t�ayew 1IIorn S Integrator: sar illi 10*t-a4_5_
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I 0 11
Longitude: ❑ ° ❑ I 0 u
Design
Current DesignAi Current
Design Current
Sv�ine Capacity
Population Wet Poultry CapSacty Population
Cattle Capacity Population
❑ Wean to Finish
B<
❑ La er
❑ NE
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
�
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
® Farrow to Feeder Z
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
❑ La era
❑ Beef Stocker
❑ Gilts
❑Non -La era
10 Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
_ ❑ Turke s
F1E Yes
Other
❑ Turkey Poults
❑ NE
Other
, [] Other
Number of Structures:
_',#.5:i.ca➢W4�.sAe.,.r - _....w, .w.,:. il;m .$--_.,� c•',rr:.�k::F:-�=ada.��]_
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B<
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
�
a. Was the conveyance man-made'?
❑ Yes
E No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
2No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
F1E Yes
�
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D,<o
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:1Yes
LINo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: 8"2-232
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
❑ Yes E'S7Vo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in): d
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C1No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_) ��,�
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes L=! nro ❑ 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 9-W ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LTNo ❑ 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 ❑ ❑ NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11- Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2'50— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) .r�e1-ua/qlf.,�-,�� = Ste!/
13. Soil type(s) a'g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [305o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes E too ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
stidwft '._f
❑ Yes ❑-No ❑ NA ❑ NE
❑ Yes GKo­ ❑ NA ❑ NE
Reviewer/inspector Name �~ �� trc�s Phone: 9199, O�3. 3330
Reviewer/Inspector Signature: Date: 9—D9— ZDa$
Page 2 of 3 12/28/04 Continued

Facility Number: IM —Z Date of Inspection
Required Records & Documents ,.,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El yes L'_T1�to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a -o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps Design g p [I Other �/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B 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
8Io
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
G -I
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[-ice
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M -I
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑#o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B -Io
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
L_f1Vo
❑ 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
D -Io
❑ 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
B'I
❑ 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
B'I
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9tM-
❑ NA
❑ NE
AdditionalYCuminents anif/or Drawrugs.
j
Page 3 of 3 12/28/04

F -i I araS o/l oy/2,008
ulvision of Water Quality
Facility Number SZ �3Z Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
&1ioutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrivals Time: :.3ff �c f Departure Time: i County: P SO•✓ Region: ��
Farm Name: �Q Yld A/ C7 .SO u�; jf't- rA41 _ Owner Email:
Owner Name: r" �S Ph/one:
Mailing Address: '7�3� N 1_3dgj''ac(r_ hv-Z�tf
Physical Address:
Facility Contact: . & AIOryi. Title: //'/ V'x5:. Phone No:
Onsite Representative: J Integrator: 64kloF W :S�
Certified Operator: G�e Al Aker Operator Certification Number: _27 'u-z7'L/0--
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=O
=4
[ ," Longitude: =0=1 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population .Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Elocian�-r ' :q l
Cattle
] Dairy Cow
] Dairy Calf
] Dairy Heifer
]
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood
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 0 No ❑ NA ❑ NE
❑ Yes
j9 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Vj No
❑ Yes
r0li No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
12/28/04 Continued

1
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 4911
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�'1
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
❑ Yes IyNo
Structure 5 /
El NA El NE
El NA ❑NE
Structure 6
❑ Yes 0 N ❑ NA ❑ NE
❑ Yes (1 No ❑ NA LINE
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 10 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ YesNo ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 9
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo [:1 NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes VINo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 00No El NA El NE
El Excessive Ponding E] Hydraulic Overload El Frozen Ground E:1 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 Drifl ❑ Application Outside of Area
12. Crop type(s) B?eta d,_ _6eky
13.
Soil type(s)
AL
Reviewer/inspector Name r' Phone: .33DQ
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q&
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
VjNo
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
FFNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/inspector Name r' Phone: .33DQ
Reviewer/lnspector Signature: Date: 1.Z -%S— ZdU 7
12/28/04 Continued

rz1907
Facility Number: 197 — Z Date of Inspection —gyp 7
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 CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R9 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
$4 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[93 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[:1 Yes
V] 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
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes�No
[:1 NA
[__1 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
PNo
❑ 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
[:1 NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
PINo
❑ NA
❑ NE
12/28104

Type of Visit 0 Compliance Inspection Q Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: %.'00 Departure Time: � �,S County: Aw a Region: «'O
Farm Name: 6 a=V1 a Nd 6 kan '5a 1'1�� // Owner Email:
Owner Name Silli•f�'-+ Phone:
Mailing Address:
Physical Address:
Facility Contact: le/VAJ AZOrP iS Title: oO�.#'*t /#a/ Phone No:
Onsite Representative: r1pAU _ A/p rvis Integrator:. __ 66,1. ^,d cak,,f 54
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ u =' a" Longitude: =° =' = u
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [f No ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
Design urrent
❑ NA
Design C*urrent
Design Currentcipulation
l
�'ti'et Poultry
Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
Vi No
❑ Da Cow
❑ NE
❑ Wean to Feeder11E]Non-La
Non -Layer
❑ NA
❑Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
ElGilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
El Brood Co
❑Turkeys
El
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [f No ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
& No
❑ Yes
Vi No
❑ NA
❑ NE
❑ Yes
Q9 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: '72--232-1 Date of Inspection S -O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;} No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[#No
❑ NA ❑ NE
Struct"o Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Z- LAJL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in),-
in):5.
5.Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1;9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
W No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 El Application Outside of Area
12. Crop type(s) R eelw4e 44-4 Z24±2 �f< Cvv�iiV C D ut�.St
13. Soil type(s) Ca -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 IL9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
[A No E] NA El NE
VNo [:1 NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations: or any other comments
Use drawings of facility to better explain situations:. (use additional pages as necessary):
Reviewer/Inspector Name I ane: �_ 9/Oj f33 -3330
Reviewer/InspectorSignature:Date:
Page 2 of 3 12128104 Continued

Facility Number: IF4 — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RA No ❑ NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps F-1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes (g No ❑ NA EINE
❑ 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 [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
EINE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[d No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
[INo
❑ 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
Page 3 of 3 12/28/04

Type of Visit Q PCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : i5 . Departure Time: r County: lis ro— Region: FRO
Farm Name:a w Owner Email:
Owner Name: �Yti Ey�, f S..Z_t 7 Phone
Mailing Address:
Physical Address:
Facility Contact: en tek &rr- 1,37 Title:
Onsite Representative: a en. IV if P ri
Certified Operator: e- Q� �,+ r�-•�s
Back-up Operator:
Location of Farm:
Design 'Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish i
❑ Farrow to Wean i
E2 Farrow to Feeder
❑ Farrow to Finish I
❑ Gilts I
❑ Boars
Other
❑ Other -
Phone No:
Integrator:
Operator Certification Number: at) 4116
Back-up Certification Number:
Latitude: = =d
� Longitude: = ° =I = u
Design Current Design Current:
Wet Poultry Capacity Population Cattle Capacity Population
❑ La er
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dai
❑ 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 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
DNA
ONE
El Yes
[-]No
❑ Yes
[�9.,<�4o
❑ NA
El NE
El Yes
LSNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection =6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[]�No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: �vevla�v
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No ❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ yes
9fjo ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, 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
MI/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
SIV o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
2 o ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes UK ❑ 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 El Application Outside of Area
12. Crop type(s) C0 s f�� �Pr ys sem, l� ,y �. ;mss relec-7
13. Soil type(s) e 4 ,U
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 [+ 14o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Egl'o El NA El NE
18. Is there a lack of properly operating waste application equipment? El6r<o Yes ❑ NA ❑ NE
Reviewer/inspector Name� ;AOR i_ ! - tC+�- Phone: q14 � Isw
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Faeility Number: �+,2 —,23
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [a<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9<o ❑ NA EINE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps Design g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ED -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E?f4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
9 A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9f,Io
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P�o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Oto
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,.�,,/
I�'Ivo
❑ 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
El Yes
--tt
Eko
❑ 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
M*<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Eio
❑ NA
❑ NE
Additional Comments andlorpDra%,ings
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 2 2 Dateof Visit-. lob C Tune: FT—0-0--i GO
0 Not Operational 0 Below Threshold
EtPermitted MCertiified ❑ Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: �z6A ca -.%A �!i..J t:izr VV'*- County: qr�u- wtt�- µ
Owner Name: _ ^-e 5 . S Im. ► W. Phone No:. 173 .3 L
Zaihng address: i N t7 i �- r��� e _ _ f3:,� _ ........ G f? Y f
` r
Fadlity Contact: e -n 07, r- Title: Phone No:
Onsite Representative: G ! e.� _ �, r S Integrator:
Certified Operator: G, If JqAC j�t S _ Operator Certification Number.
Location of Farm:
swine 0 Poultry ❑ Cattle ❑ Horse Ladtude • &4 Longitude • & Ou
Discba�es & Stream Lin
1 _ Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ 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 %No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $,No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t��r CrLots --
Freeboard (inches): ,Zq
12/12/03 _ Continued

Facility Number: ' .- — Z, 2,Z
Date of lnspectiOn 4
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aaalication
❑ Yes gNo
❑ Yes KNo
❑ Yes ELNo
❑ Yes Kj40
❑ Yes R(No
10. Are there any buffers that need maintenancrrunprovement? [:]Yes Z,No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes S[No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type con-' -� , ��' : ��[ �� rte & 0 '4c c�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVAT)? ❑ Yes JK No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZLNo
b) Does the facility need a wettable acre determination? ❑ Yes & No
c) This facility is pended for a wettable acre determination? ❑ Yes OLNo
15. Does the receiving crop need improvement? ❑ Yes ANo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PgNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes X No
roads, building structu r, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes R10
Air Quality representative immediately.
-
�� � oI'°l!salityZu �. �� P��r9 ❑ F'itld Copy ❑ Fittal Notes
e a
}• L{y�� rl�' � r..]o ��� 4�.�2t �'t, C3� t� ��'�ly���� '� L(��'C'-i O-� ��P��� s �D 0 ��"a'`.
Reviewer/Inspector Name ei
ReviewerAmgmctor Signature: Date: t0 4
12112103 f Com

Facility Number: 7.3.'.. Date of Inspection
on
Records & Documents
21. Fail to have Certificate of Covera & General Permit or other Permit readily avaiiable? J.Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU3rchecklistO/,design,/LW, etc.) ❑ Yes J9No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CH No
❑ Waste Applicati*r ❑ Freebo&n O Waste Analya ❑ Soil Sampling�.-'
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;. No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
No G%jrrc�►-#'-rC�-r.� i (i�1r,�� Lr�Ia i�2. /Vii". UO" -,S CAJI-I+ +C 6fC
(ie/ discharge, freeboard problems, over application)
❑ Yes
A No
27. Did ReviewerAkspector fail to discuss review/inspection with on-site representative?
❑ Yes
0 No
28. Does facility require a follow-up visit by same agency?
❑ Yes
INNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PkNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
KNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fait to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted daring this vmdL You wM receive no further correspandea m about this visit.
.�� ..'
oaal Ls aad/orxDrawmg,'j:MJ
W QS�_. Sc".%.�Je_5 Z4 /1 io/c of
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12112103

Site Requires Immediate Attention:
Facility No. ZZ -2Z TZ _
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: E -
•Mailing Address: RD. 2
County:_
Integrator:_ e
On Site l
Physical
DATE: , 1995
Time: Z;d6
Type of Operation: Swine '-- Poultry Cattle
Design Capacity: (2Z 3 FA*-Fg�,A . Number of Animals on Site:
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
Was any seepage observed from thAl
Is adequate land available for spra
Crop(s) being utilized: �r
No
;s)?
r No
Actual Freeboard: Ft. 3o Inches
Yes or(noWas any erosion observed? Yes oR
Is the cover crop adequate? 6es or No
4-!m
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinor
Yes r No
100 Feet from Wells? No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or( to
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orQ
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(5� 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)? �r No
Additional Comments:
/7
Inspector Name
ignature
cc: Facility Assessment Unit Use Attachments if Needed.

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