820274_INSPECTIONS_20171231

2 V
�AM
NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: @ Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency p Other O Denied Access ![
Date of Visit: Arrival Time: c:... Departure Time: County: Region:
Farm Name: lfx�o r� c—v►� Owner Email:
Owner Name: � `l' L, a(;O' Phone:
Mailing Address:
Physical Address:
Facility Contact: fTitle: Phone:
Onsite Representative: L4 Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry,
Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish Z
MQ7eiiigri
D . P,o_uIt .
Layers
Capa ci
P.o
Dairy Heifer
Dry Cow
Non -Daily
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
Other
Other
eys
Turkey Poults
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)?
❑ Yes 1 }bNo ❑ NA ❑ NE
[:]Yes
[:]No
NA
❑ NE
[:]Yes
[—]No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No NA ❑ NE
❑ Yes Fa No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412013 Condnued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 7 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s
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.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes T No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application j�
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 [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 ❑ Application Outside of Approved Area
U. Crop Type(s):
13. Soil Type(s): 13o B
14. Do the receiving crops differ
�s
W 1.
those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes P No
❑ Yes No
❑ Yes No
❑ Yes �] No
❑ Yes No
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
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
No
❑ Yes;No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes toNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
D 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 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes NNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
• 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 D NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey CD 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ ] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments,(refer10.questiod#) Explain any YES' answers'andlor;any adiitaoual�r iftrnendatioas of any other co-,— ents:
x- v. ,. ._ n... ,.� �.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: - /MLIU -1 3 o
Date: 4 411 // �
21412015

l'ype of visit: 0 Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: (/( f j f J Arrival Time: Departure Time: County:��
Farm Name: _ 09121A Owner Email:
Owner Name:(-R-C-L.4 Il Phone:
Mailing Address:
Physical Address:
Region: r�0
Facility Contact: _Do A)I e t..-O Title: Phone:
Onsite Representative: N Integrator: SM3a-tip"l-P—J
Certified Operator: Certification Number: -2Z
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
Wean to Feeder
60
1 INon-Layer
I
Dairy Calf
Feeder to Finish
Z
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ouit .
Ga aci
P,o
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Ocher
Turkey Poults
Other
Other
wd..... _.._ .. ..
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C5 No
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - 'i Date of inspection:
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rV1[V1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
PNo
❑ 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 (Cro/p Window ❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): OOCL t Aay" _40m en�D, A,-
13. Soil Type(s): Ll• ", —b* % - p �C� �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QU No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[g No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RA No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:)Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [—]Maps [-]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Tra
ns
f
ers.
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Candnued

FacilityrNumber: Date of Inspection:
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 W No ❑ NA []NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M 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.
34. 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 5 No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [P No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any outer comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 920� alrb(e Phone:
Reviewer/Inspector Signature: Date: %1
Page 3 of 3 2/4/2011

Division of Water Resources
Fac%lity Number $� - �_--�-l-� O Division of Soil and Water Conservation
Other Agency
Type of Visit: q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 46 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �[JyV� Departure Time:, County:
Farm Name:0, Owner Email:
Owner Name:i Phone:
Mailing Address:
Physical Address:
Region: r"
Facility Contact: 00"/; Title: Phone:
1<
Onsite Representative: Integrator:
Certified Operator: _P4` . C4�, _ Certification Number: t 7i2
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Panitry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
i
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Point .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
JPullets
Turkeys
Beef Brood Cow
time
;&
Other.
Turkey Points
Other
Other
Discharges and Stream imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[�PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
M NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
❑ No
jo NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[P No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
p No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FaciliNumber: Date of Inspection: rfo
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
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
`` cy
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2] 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
N No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Fg] 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 P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW
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?
[:]Yes
® No
T[1]
❑ Yes
No
❑ Yes]
No
❑ Yes [' No
❑ Yes No
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
[:]Yes [P No
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 JqNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F scility Number: - 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi k
❑ Yes
P No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[N 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
[,W No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[� No
❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[5 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
�e or ao other
�._.On"OM
Usedriwtn s of faciIiferto
o better a lam s ltahons (use add tlonal pa�esasnesmmendatins
1; ty xp
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9fo► ts"' V
Date: iY
21412015

i ype or v vat: w t-ompuance inspection L1 vperauon nevrew V structure r,vatuanon V i ecnmcai Assistance
Reason for Visit: j! Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region
Farm Name: Owner Email:
2
Owner Name: G Phone:
Mailing Address:
Physical Address:
Facility Contact: A
/t eta--1i Title: Phone:
Onsite Representative:
Certified Operator: t
Back-up Operator:
Integrator 449�
Certification Number: 1-Y212-
Certification Number:
Location of Farm: Latitude: Longitude:
Swine y
esign Current
As
!D—
apacity Pop.
= Design Current
,_.
WeMnuit y Capa.crty.. Pop.
Cattle
Design Current
Capacity Pap.
Finish
La er
Da' Cow
Feeder
Non -La er
- "Z
aDesign Current
Ca ac Pii
Da' Calf
o Finish
-
D . Roul _
Dai Heifer
o Wean
F
Cow
o Feeder
Non-Dairyo
poars
Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
'
Other &'
Turkeys
TurkeyPoints
ther
Other
Dischar es and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes'P No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes j� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
214,12014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
Po
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Zu
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
❑ Yes
9 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
1P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
OpNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CaNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from thost designated in the CAWMP?
❑ Yes
[]05No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
7T'�
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
7�-
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesIslifers
No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
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 [PNo
❑ Yes �P No
[—]Yes P No
❑ Yes No
❑ Yes I No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Wo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 9
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments-A;_1
Use drawinas of facility to better exDlain situations [use additional Danes as uecessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: VM
Date: Cl XS
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 07-. 30 Departure Time: ; dQ County: SvV_AeJ Regionj-#Zo
Farm Name: �-7 Owner Email:
Owner Name:i`G-fit flr� Phone:
Mailing Address:
Physical Address:
Facility Contact: p0 / r Title:
u
Onsite Representative:
Certified Operator: * C"
Back-up Operator:
Phone:
Integrator: /11-0
Certification Number: 179L
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine I Capacity
Cuent�� Design Curre..nt
Pop, ` 4 Wet Poultry Capactty Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Non -Layer
"' :.
Design Current
Ca aCi Po5 .
DairyCalf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
- A,
-
D F P,oulf .
Layers
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
i I
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
-
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 [P No ❑ NA ❑ NE
❑ Yes
❑ No
F] NA
ONE
❑ Yes
❑ No
M NA
❑ 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 No
[:]Yes No
RNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

f
Facility Number: - L Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1%] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
[PNA
❑ 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
(50 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
`P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[5a 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
[j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accceppt_ablleLCrop Window ❑] E�vide7�4L
f Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(sk (S`.cC57u-1 f7d1dA Uzi )'I"
13, Soil Type(s): `31h4t'lph — .9,94
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
[DNA
❑ NE
❑ Yes
[�] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes mo No ❑ NA ❑ NE
the appropriate box. T
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 4 2- - Date of Inspection:
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 T 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 []o No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Cfl No ❑ NA ❑ NE
❑ Yes [�] No ❑ NA ❑ NE
❑ Yes 11h No ❑ NA ❑ NE
❑ Yes yQ No ❑ NA ❑ NE
❑ Yes 1� No
❑ Yes E] No
❑Yes Q]No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: q -' �1-3 304
Date: id,q
2✓412011

Ii ype of visit: V t-ompaance inspection L1 uperation xeview V orructure r,vaivanon V i ecnnical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: flS0 fiJ Region: 14e
Farm Name: h Owner Email:
Owner Name: a 3�� cck_s W Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: o-so g2t\ [ —a 5 if
Back-up Operator:
Location of Farm:
35.0 b(?,
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Title:
Latitude:
3 3 30g
Phone:
Integrator:
Certification Number: g a
Certification Number:
Longitude:
$3
Layer I I Dairy Cow 1I
Non -La er 11 jDairyCalf
Layers
Non -La
Pullets
Other
Poults
Discharges and Stream Impacts DEQII)WR
1. is any discharge observed from any part of the operation? 140V 0
Discharge originated at: ❑ Structure ❑ Application Field FAAer:
a. Was the conveyance man-made? WQ
b. Did the discharge reach waters of the State "M',F"v,WOMCE
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?
Dairy Heiler
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �lo ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑Yes No ❑NA []NE
[:]Yes ❑ No
❑ Yes';D'140
❑ Yes Jlo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] N E
Page I of 3 21412011 Continued

Facili Number: -xn% Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;214No ❑ 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 ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0No
❑ 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 ;2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P`1Vo ❑ 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): 1 b, Y S a cJV_-Z>
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'[2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L-e'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONO
❑ NA
❑ NE
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I4o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
hlo
❑ 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 ONO
❑ 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 J2!r]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
DNA ❑NE
Page 2 of 3 21412011 Continued

Ficili Number: -ant jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 E;rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditons related to sludge? If yes, check ❑ Yes 12tlNo ❑ NA ❑ NE
the appropriate box(es) below. Wl LAI� -3 013
❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j2fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ,I -No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�no
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
530fVo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C2'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
pit
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Use drawings of facility to better explain situations (use.additional pages as necessary).,:.,_ y
Comments (refer to question # •..Ex lain an YES answers and/or an additional recommendations dr an other comments.
an 9L-3)-15--
�� r )3 Al
1 N 1,33 N- a o r y
p- 1 ' �3
Q.IJ�✓' LfAc'*-
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3 '�-
Ja,,r.k.�:r � tT CL
J - J
L Ne- or NK o "y
Phone: i q '7 1 !n(a3
Date:
21412011

(Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11111,7/1�1 Arrival Time: 7DO4-- Departure Time: • ; County: Region:r�A0
Farm Name: "J-—)2yA V /✓� Owner Email:
Owner Name: \ 1 " Phone:
Mailing Address:
Physical Address:
k
Facility Contact: (,( Title:
Onsite Representative: u
Certified Operator: rpi �.sC
Back-up Operator:
Phone:
Integrator: n 1
Certification Number: [ I Z�
Certification Number:
Location of Farm: Latitude: Longitude:
My De�si ' Current
Design
Current
Design Current
Swine ir-Capacity Pop.
x
Wet P,c►ultry Capacity
g_
on.
Cattle
Capacity Pop.
Wean to Finish
Layer
Non -La er
.I_.
Dairy Cow
Da' Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
2
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
I
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
jPullets
P Beef Brood Cow
il
Turke s
Other
Turke Poults
Other
Other
_ ...:,.,:­.,_
Discharees and Stream lmuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
5a NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
C53 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
P No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes
a. If yes, is waste level into the structural treeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No NA ❑ NE
StructT6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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?
D Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
T[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
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
[PNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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 ❑ Evr4j
ce of Wind Drift[:] Application Outside of Approved Area
12. Crop Type(s): LeaSklraQ �}' 's)1 sm' Q
13. Soil Type(s): P
jq,f2jVoj—eL*)JVn' Y
H/Gfv
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
D NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�TNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
�No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E� No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[0 No
❑ NA ❑ NE
the appropriate box.
TT
❑W11P ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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: -9 f7ff jDateof inspection: z,
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes IF 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? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes CpNo ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P;4)No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
[] NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[P No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
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
4No
❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1p No
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any addrtionai�recommendahons or any Cher comments
Use drawings of facility to better explain.sit'uations (use.additional•vaues as necessary) ;.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'it0`09 33W
Date: 1/1 7 !2-
2/4/2011

". - 7' Division of'UVater uahty :. - _
Q
Faeili Number ® � O Dtvisian of Soil and Water Conservation
DQ Qther Agency
Type of Visit: J# 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 0 Denied Access
Date of Visit: IA Arrival Time: Departure Time: 6Z' County: Region:
Farm Name: L,t��jy�� Owner Email:
{,g,�i� Q
Owner Name: �j�jr2,p� �` ut$2�7 Phone:
Mailing Address:
Physical Address:
Facility Contact: —j?pu q Title:
Onsite Representative: N
Certified Operator. mwk T.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: /78 azz
Certification Number:
Longitude:
Design Current
Design. Current Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop. Cattle Capacity
Pap.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
p
Dai Heifero
Wean
Design " U ent
D Cow
o Feeder
E
Dreg P,uult >Ca
a_ci P,o ,
Non -Daily
o Finish
La ers
Beef Stocker
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Other. +
TuT Points
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes ❑ No
[—]Yes No
❑ Yes No
Z NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 99 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: —
�No ❑NA ❑NE
❑No �jNA ❑NE
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 Vn1No ❑ NA ❑ NE
(i.e.., large trees, severe erosion, seepage, etc.) `P
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes [P 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 EP No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes qNo ❑ 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
( No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 4 Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ 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
Vg No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes In 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 Pq No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ig No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Nacil4 '!Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 09 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EpNo
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 [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[9NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ly No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
tp
❑ 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
tp No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
EP No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments refer to question ft Explain any YES answers and/or any additional recommendations or4ntiter comments.
Use drawings of facility to better explain situation's (use additional pages as necessary)
�
Reviewer/inspector Name: e4?0 6"_MalfYJ
Reviewer/Inspector Signature:
Page 3 of 3
Phone:g
Date:
21412011

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: Q Arrival Time: Departure Time: / 0 r County: _ _ SON Region: FnOW
Farm Name: P•Q I� Case Q Fa,--m Owner Email:
Owner Name: �'} R'� Phone:
Mailing Address:
Physical Address: -) f
Facility Contact: Aot ,`� te-f'Y►Ctn�l Title:
Onsite Representative: p tAA'4-j
Certified Operator: '3_05ffln P-+ Case,
Back-up Operator:
Phone No:
Integrator: ��7 r+-h �r,✓�t:✓h
Operator Certification Number: 11$22—
Back-up Certification Number:
Location of Farm: Latitude: E-1 e = ' = u Longitude: = ° = ` 0 "
Swine
Design Current
Capacity Population Wet Poultry
Design Current
Capacity Population
Design Current
C•aYt1e Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer 1
❑ Dairy Calf
Feeder to Finish
El
❑ Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑
❑ Gilts
❑ Boars
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?
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 �INo ❑ NA ❑ NE
❑ Yes
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?
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 �INo ❑ NA ❑ NE
❑ Yes
❑ No
� NA
❑ NE
❑ Yes
❑ No
� NA
❑ NE
� NA
❑ NE
❑ Yes
❑ Na
El Yes
WNo
El NA
❑NE
❑ Yes
91 No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: Date of inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
A NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
►i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
bNo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 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
T No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
f3 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
n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[j5 No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes nNo ❑ 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
11 ElApplication Outside of Area
12. Crop type(s) COQ&-W &C.M41, cl-mo r4al') , 5M 1 GY-414 Qt�f��'
13. Soil type(s) /ugrfv/p--
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
�No ❑NA [I NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
I? No El NA ❑NE
[INo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES rs answeand/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}:
Reviewer/Inspector Name i'7 Phone: 2KC-`13 3 -33co
Reviewer/Inspector Signature: a2 Date: D
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 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 El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes i9 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 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
[P No
❑ NA
❑ 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 fait 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
99 No
❑ NA
ElNE
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
[P 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
to No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
iFaC�IIity Number .2 rl O Division of Soil and Water Conservation
Other Agency
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: P1 Arrival Time: '3 Departure Time: Qf = County: dN
Farm Name: Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: T6<cl A '�C^00141 Title: Phone No:
Onsite Representative: t! Integrator: fW — TJn
r04>.1 LLC-
Certified Operator: '7�SP�flt �• Operator Certification Number: l ea ;L
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ET = u Longitude: = o= t 0 u
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
S'b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Dairy Cow
❑ Non -La er
❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Layers
El Stocker
n-Lers
❑ N
El Beef Feeder
Nets
❑Pullets
❑ Beef Brood Co
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 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?
A
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
1P NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
91 NA
❑ NE
❑ Yes
Q�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: A
Date of Inspection Labilea
�1y
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 FONA ❑ NE
StItcture i Stnteture 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Slfillway?:
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
PNo ❑ 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 ElNA ElNE
maintenance/improvement?
{
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
SPNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [!)Application Outside
of Area
12. Crop types) CA &W G1P ntuOa V-7 55Qr_a rftcre.), Ssi4,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWN J
❑ Yes
Q9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination % ❑ Yes
�9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
I & 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):
Reviewer/inspector Name Phone: 10'Yp3'334V
Reviewer/Inspector Signature:I Date: 1/ O19
12128104 Continued

Facility Number: —qLj I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1PNo ❑ 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
[4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
yNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
le 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
1�No
El NA
El NE
Other Issues
1
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ERNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
09No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 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: ' Q Departure Time: County: �ps�N Region: A40
Farm Name: k CzSa., r!M Owner Email:
Owner Name: �OS.P�P h 9. caI .. _ Phone:
Mailing Address:
Physical Address: r
Facility Contact: P� p, A) t efw%or% Title:
Onsite Representative:
Certified Operator: O 1. 1z. CA
Back-up Operator:
Location of Farm:
Phone No:
Integrator: U,
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c= 6 06 Longitude: ED° 0 I= u
Swine
Design Current , #tgn�;Current -: DesigM Current
Poultry city
Capacity Population Wet ,,Cap Population Cattle Capacopulation
x
❑ Layet ❑ Dairy Cow
❑ an to Finish
❑ an to Feeder
n-La er ❑ Dairy Calf
Feeder to Finish
3 _­, ❑ Dairy Heifer
*`� "'� i _ ❑ Dry Cow
out
Farrow to Wean
❑ Farrow to Feeder
NEl Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
_ _
❑ Other
❑ OtherNumber'of Structures:
- :- -
�:.# - -
-
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?
El Yes [&No El NA ❑NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes
❑ No
IONA
❑ NE
❑ Yes
❑ No
EANA
❑ NE
❑ Yes
❑NA
ElNE
❑ Yes;No
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

C
Date of Inspection
Facility Number:
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
M NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
d] 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
99 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
fftNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA El
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes � No ❑ NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $ No ❑ NA ❑ NE
maintenance/improvement?
I i . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEl Evidence of Wind Drift
//�� El Application Outside of Area
12. Crop type(s) CMS+0drrBU sn J Q @OS , (64wp_ J. S M - Cw-a; . Dues
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C •No.
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
b9No
❑ 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
q .s ,F ) F4 ' _ answers andlorkany �ecomm 'an othe coins
Commes#a� u
kIA40
ex tarn sttuano s:.(ase addrtronal�pagesQas necessary)ns�or au at eshon # �
�< er comure
Use drafacilr to better
:.7k. '! ;:r:'�:+.n
Reviewer/inspector Name � �� Phone: 9/4~L/,3333490
Reviewer/Inspector Signature: Date: / O
Page 2 of 3 12128104 Continued

Facility Number: $ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�iNo ❑ 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. ElWUP ❑ Checklists ElDesig
n ❑Maps ❑Other 91
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes P 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
ED No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[No
El NA
El 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
fRNo
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ 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
Z '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
t3No
❑ 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
ER No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
S,No
❑ NA
❑ NE
and/or
Page 3 of 3 12128104

Division of Water Quality
Facility Number M_2 0 Division of Soiland Water Conservation
- J 0 Other Agency
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: Arrive! Time: =/ .� Departure Time: ��County: �Region: !"T"
Farm Name: ✓`
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 7,1144 14/' Title:
cQ
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
o
Latitude: =
Owner Email:
Phone:
Phone No:
integrator: �r"� J'T� r
Operator Certification Number: i?�i��'
Back-up Certification Number:
0 « Longitude: = ° = ` = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co d
I
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 13 No ❑ NA ❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
17O50W
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
12128104 Continued

Facility Number: -��
Date of Inspection 7 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 JW NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes DO 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 F�Ij No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R 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 W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El 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/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �VMI' da C?C) r S,K. 6. owwa
13. Soil type(s) Fa� �� �j D G
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 9 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
LKNo
[INA
ElNE
18. is there a lack of properly operating waste application equipment? ❑ Yes
ja 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 Phone. /v 3 4D
Reviewer/Inspector Signature: Date: 711W,01
12128104 Continued

Facility Number: — Date of Inspection 7 07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �fl No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )0 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
V) No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
q3 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EpNo
❑ 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
W No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P9 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
[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
J] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
F9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

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: f 0 Arrival Time: i Departure Time: County:
Farm Name:� C se—, ca t`'L Owner Email:
R. Owner Name: ^ d'y cq� Phone: _
Mailing Address: 10B 4Jq 40b64. CL1.c4-t Al C a��3
Physical Address:
Region:
Facility Contact: ?�Aq Title: Phone No:
Onsite Representative: �1 �SPL, Integrator:
Certified Operator: 1 Operator Certification Number:a�-
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: r—1 n � ' a W Longitude: = o =' = u
Design Current Design C•ttrrent
Design Current
Swine
C►►opacity Population "Wet Poultry C►opacity Population
..__
Cable C►apacity Populatiou
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
O 1700
❑ Dairy Heifer
El D Cow
El Farrow to Wean r Poult
�ry y
❑ Farrow to Feeder
�
❑ Layers
❑ Non -Dairy
El Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
❑ Turkeys
Other_:
S•xY
❑
❑ Turkey Poults
❑Other
'.
Numliefof Structures:
Other
I
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
[8 NA
❑ NE
❑ Yes
❑ No
[)PNA
❑ NE
❑ Yes
❑ No
[rNA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
Page I of 3. 12128104 Continued

Facility Number: 0,2_—;2 1:7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
-143 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
09 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): TE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1� 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
EoNo
❑ 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
W No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�No.
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Sane Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) 4e4- t(1 Q aA, Owsed
13. Soil type(s) (hap I p B
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes to No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
[PNo El NA El NE
[9 No ❑ NA ❑ NE
1P No ❑ NA ❑ NE
[PNo ❑NA ❑NE
LL
Comments (refer to question 9): Explain any YES7answers and/or any recommendations or any other comments " w
Use drawings of facit�to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name F I Phone. D 3_3 60
Reviewer/Inspector Signature: Date: l
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes R No ❑ NA ❑ NE
the appropriate box. ❑ VIUp ❑ Checklists ❑ Design ❑ Maps
p ❑ 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
[P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P 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
�j No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
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
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings: " $
Page 3 of 3 12128104
Page 3 of 3 12128104

IType of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance ' I
Reason for Visit ! Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 Lf `e� Arrival Time: Departure Time: County:�Q Region:
Farm Name: . _ZaseaA _� _ arm ___ — _ ___ Owner Email:
Owner Name: Tog, Phone:
Mailing Address: „ 10 179% f-1cz166n &Wll ._. _ G�.:, ___ NL �83.R
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: jD e: Integrator: /_.Lem;,e
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = o = ,
Design Current Design Current Design Current,.:
Swine Capacity Population Wet Poultry "Capacity Population Cattle Capacity .Population ::.
❑ Wean to Finish
❑ Wean to Feeder52f'
i
eeder to Finish 7S6O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars j
Other
❑ Other
❑ Layer
❑ Non -La ei
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 -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
r
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?
J
❑ Yes EKo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q"No
❑ NA
❑ NE
❑ Yes
2%
❑ NA
❑ NE
12128104 Continued

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: 1
Spillway?: hd
Designed Freeboard (in):
Observed Freeboard (in): DS¢
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 L'TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 91go ❑ 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 [ o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
R-ggo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Ueriiev-la _. ,nuf'� Orr-nln
13. Soil type(s) AgoQ ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[9-d
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Q+fo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA 2-NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA D-NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ o
❑ NA ❑ NE
Reviewer/Inspector Name L Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: g,� — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropiate box. ❑VIP ❑ Che�ts ❑ D$Ren ❑ NPs ❑ o;hd
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ VV°asteApp4ea6tm. ❑ 33"ee oard ❑ Vilaste Arrdfy`sis ❑ Soil Analysis ❑ WesWTfM9 eTs ❑ Annual Ceffcation
❑ Rainfall ❑YStocking ❑ Q"rYidd' ❑ 12444muttinspeetiens ❑ Monthly and I" Rain Inspections ❑-Woagwr2-ade
22. Did the facility fail to install and maintain a rain gauge? G�Ies ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ErNE
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
2rNo
❑ 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
ONo
❑ 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
ONo
❑ 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
ONo
❑ NA
❑ NE
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�'�[ U.•
12128104

Type of Visit &11— mfpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number rf Date of Visit: 3 b Time: / � +
Q '"Not Operational O Below Threshold
UW,iii�_tted ©E�riified Conditi
ioonally Certified 0 Registered Date Last Operated or Above Threshold: ..... __._._....
Farm Name: ._ C'Q .... r.4r.:..................._ �..._.._ .. ....._ County:
_... �`} .......... ..�'�
1 qq,,��
Owner Name:...__.'. .... `�� ..._ ........._ _......_ ......_.... _ .... Phone
�rNo: ......!l..D�-`
Mailing address: Jogf4......tj te>I-- � �!k
Facility Contact: Title:Phone No:
'�
Onsite Representative: — _ R_ .... Integrator:
Certified Operator:.---�-- _7 ._._._w... W ....._ _ .._w_. Operator Certification
Location of Farm: /
Ej4w'ine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �` �"
Wean to Feeder
MYcaer Finish
?o
a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes U-Ne--'
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EI-M
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier _.. w..._ ,.... _.............. - - - ............... ..........
_ .......
Freeboard (inches): 31
12112103
Continued

Facility Number: Date of Inspection a a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes B-o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
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 maintenancelimprovement? ❑ Yes 0<0
8. Does any part of the waste management system other than waste structures require maintenancerirnprovement? ❑ Yes L7kvo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes CrNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;-90�
❑ Excessive PonnJd�ing ❑l PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type lX-�' �t <W+1d1 d Ikit'i
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 attor 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? (i.e. 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? 1f yes, contact a regional
Air Quality representative immediately.
i t,.r,-� fire � cc�S �� y- �,.•� o .. � s�
Reviewer/Inspector Name
❑ Yes �o
❑ Yes P-Mdo
❑ Yes rNo
❑ Yes
❑ Yes
❑ Yes ❑ No
❑ Yes BNa-
❑ Yes Imo
❑ Yes M-Nu--
❑ Yes No
Final Notes
Reviewer/Inspector Signature:
Date:
12112103 1 Continued

Facility Number: — Date of Inspection ELM
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
OeJ WIT, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? 1f yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
es
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0410
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Mwo
33. Did the facility fail to conduct an annual sludge survey? es ❑ No
34. Did the facility fail to calibrate waste application equipment? es ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [� o�
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

V V
Division of -Water Quality,. _
Q Division of Soil and Water.Conservation -
Q Other Agency -
(Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit PA-EIIRoutine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number
Z Date of Visit: Time: 3:'3Q Printed on: 7/21/2000
�Permitted
0 Not O erational Q Below Threshold
0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ................
Farm Name: OSG/jf�.-. ,!Q County:...... ................. .......................
....... ................ 0-A.`.'-...--...................... J
Owner Name G{!� Phone No': `Qe Sff
d. i._ .......LT ............ ..........................................
Facility Contact: ......... Pf.................................... l'itle:..............-.- ........ Phone No: ......... ..........................................
�—�
Mailing Address: ........ .....t 44�`-....4�71'pt...I.l�.�t....... z���,F7...
Onsite Representative: ,.•,•.....t tJZt: integrator:%................................_....................
Qr................................................................. ............
/ ....
Certified Operator•...........�4.................................... Operator Certification Number:....-..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 =i Longitude a C�` 66
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 2 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity Z Teo
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons L
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area
❑ No Liquid Waste Management System
❑ Spray Field Area
Discharges & Stream Impactti
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed. was the convevance man-made''
❑ Yes
No
b, If discharge is observed- did it reach Water of the State'.' (If yes, notify DWQ)
❑ Yes
No
c. If dischargc is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon sy,,tem? (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
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
[:]Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches): 4�
5100
Continued on back

Facility Number: —2 Date 01' Inspection s Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[ yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(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?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yeso
ro
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10- Are there any buffers that need maintenance/improvement?
❑ Yes
No
KNO
l I- is there evidence of over applican n? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Q�
❑ Yes
12. Crop type Irl�1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
PNO
14. a) Does the facility lack adequate acreage for land application'?
ElYes
b) Does -.the facility need a wettable acre determination?
❑ Yes
qNo
c) This facility is pended for a wettable acre determination?
❑ Yes
AINo
15. Does the receiving crop need improvement'?
❑ Yes
[(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
k1lo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes1''No
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yeso
fNo
21,
Did the facility fail to have a actively certified operator in charge?
[I Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes
&j'No
23,
Did Reviewerlinspector fail to discuss review/inspection with on -site representative'?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Vqo
o violatigris;or dtf cier�c;ies were nofec. during #his:visit: Yoh will ieceiye Rio: #'u'her: -
correspondeRcabouf this visit:: ::::::::::::::::::::::::::::::::: : e
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):
a�-►n Iav !r as 64- we / ivta «t la iR eql Ak
►A
Reviewer/Inspector Name S
Reviewer/Inspector Signature: �� _ Date: �Q �% 5/00

.r
Facility Number:: SZ — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or helow kes fNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? El Yes
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
3L Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes POO
❑ Yes ''No
❑ Yes No
[]Yes No
❑ Yes ❑ No
Additional omments an orDrawings:
i
y
5100

w�
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVMOI`NMENTAL MANAGEMENT
ANDAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. 8 1 , 1995
Time: 2 a
Farm Name/Owner: -TDM (o
' P;''c_r,a►ra C.aSQy C_
Mailing Address: 1 10 W QS� q trove. S� . i1e..w n Grove, r)c a S 3(0(0
County: �_. SG�m p So r'_
Integrator. FL.,wc Phone: 510 -S54 -oa i%
On Site Representative: ' c. C Phone: a--S - U
Physical Address/Location: `.1 rri;1� 14J,A Rf, ZO 1 or,
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 246*0 N hN Number of Animals on Site:-141-0
DEM (ertifieation Number: ACE DEM Certification Number: ACNEW
Latitude: 3'' LI ' 10.7 " Longitude: W 7$ 4 RD ' .4 "
Circle Yes or No
Does the Animal Waste Lagoon hay sufficient freeboard of l Foot t 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Froebvard:�t. Inches
Was any seepage observed from the lagoon(s)? Yes or® Was any erosion observed? Yes or i 10
Is adequate land available for spraor No is the cover crop adequate? or es No
Crop(s) being utilized- C t`w�
Does the facility meet SCS minimurn setback criteria? 200 Feet from Dwellin s r No
100 Feet from Wells
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Ycs orNo%
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No 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)? Yes or No
Additional Continents: rZQ5
Inspector Nance -
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

r REGISTRATION FORM FOR ANIi^AL FEEDLOT OPERATIONS
Department of Environment, health and Natural Resources
Division of Envi-ronmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of'cattie, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are ser•,ed by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM_ Please print clearly.
Farm Name:
Mailina Address.
County:
Phone No.
iv
Owner (s) Name: _ 30selek Ri J,c.sr1 G4s t-.z --
Manager(s) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) O
Latitude/Longitude if known: ,P Lj:-/J(r-2 -a0- O
Design capacity of animal waste managem nt system (Number and type
cf confined animal (s)) SO. Ferct.Q�r i-o x;sb,
Avera-ge animal population on the farm (Number and type of animal (s)
raised) : a4�0 kC.—I r"Je,- +0 '-, -- - -- -
Year Production Began: 1122 ASCS Tract No.:. 'f
Type of Waste Management System Used: p�
Acres Available for Land Application of Waste: cr%-5
Owner (s) Signature (s) C% DATE: 0-
DATE: