040010_INSPECTIONS_20171231

x;
acility Number,
�r
y Type of Visit: Compliance Inspection
Reason for Visit: • Routine 0 Compl
0 Operation Review 0 Structure Evaluation 0 Technical Assistance J
aint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access iJ
Date of Visit: Arrival Time: Departure Time: d County: 4ht O y1 Region: -__
Farm Name:5 Owner Email:
y Owner Name: tot,&
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
U
Phone:
Phone:
Integrator: 5j,,„t -9\e_O�
Certification Number:
Certification Number:
Latitude: Longitude:
Design
Cl�lrrent
, Desiign
Current
Design
torrent.
Mto
Ca tact
P h 1
Po P
V4 et Poul "
fiY
'Ca "� cat '
a( ty
P6o P•
t a ie
Ca a i-
P h'
P-
Layer
DairyCow
r
52,0
Non -La er
DairyCalf
Feeder to Finish
�
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D r P,oult .
Ca aci
;Po
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
113eef Feeder
Boars
Pullets
113eef Brood Cow
j _ . E
iiq'
Turkeys
Other
Turkey Poults
Other
x.��.l;V 1.+x�'.Lxl Ats�: rxLYxr�E i:.-_err
3i.eanx�x
:•
�i:"
Other.
u[..�t s'..':IIII �� '�'.��
E '!:
�i�.
WVIWWMx4•Mlfi(QEr rl.arm�.li!q:iHh�
- rn..sau':._".:IiEI�ID[
l�6Y8JYntl�ilA®IM I:JY9�e'iL.d
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
WNA
TM
❑ NE
❑ Yes
❑ No
NA
0 NE
[:]Yes
❑ No
Fa] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of ins ection: 17-1 t ►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes f�] 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):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 101
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? TT
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
N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
B 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
[PNo
❑ 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 ❑ 1-ieavy 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): we
f
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
n 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
NkNo
❑ NA
❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ Yes
[3No
❑ 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
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 LW
No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: - Date of Inspection: 9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes &No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [$] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes fp 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
(�rNo
❑ 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
C6ihrh*iN'refer to lUsedrav4n(is of facility t �bette a plain ssiu ti©rts (use add'tio, al pales as neces endahons or an other coinmeots.
y y
Reviewer/Inspector Name: �6.,+ 1' ' 4,�
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Ii ype of visit: ® Compliance inspection U Vperation Keview U structure Evaluation_U Ieennical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /iL J/� Arrival Time: Departure Time: County: ��
t.
Farm Name: Q (,(4,5; _ t��� ��rL(/1'`
W1 Owner Email:
1_. J
Owner Name: �(,(,t� t -h" Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: VO4 otkr':j Title: Phone:
Onsite Representative: 0 Integrator: �m 1 *4'elel
Certified Operator: k Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
. ti
WettPbaltry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to finish
La er
Non —Layer
"' "
D . P,ault .
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
I I
Design
Ca aci
Current
P,o P.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
`
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Outer
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
0 Yes
�No
❑ NA
❑ NE
Discharge originated at: [I Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[�j NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility *slumber: JDate of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in}:
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 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): PSrL�4kI
-
13. Soil Type(s): qc
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
D 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 P 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 IF
No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P
No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Racili iliumber: A jDate of Inspection: t! Zg
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EA No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 CAW MP? ❑ 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 f: Explain any YES answers and/or any additional recommendations or an other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
V4)'q-q0q/ (Ce")
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3of3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
q No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
Phone:
Date: /1/Z4,//-b
21412015

type of Visit: ip Compliance Inspection U Operation Review U Structure Evaluation (J'hechnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : 0 a, Departure Time: f a : o o� County:
Farm Name: LGt �5 �� yi►�'yt,• _ Owner Email:
Owner Name: �tu5 tke,- G✓,h41" _ Phone:
Mailing Address:
Physical Address:
Region:
Facilit
y Contact:LDt.c.r S r L�-�-2-Q Title: Phone:
Onsite Representative: U Integrator: 41
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
- Design Cnrrent Design Current
Swine- Capacity Pop. Wet Poultry _ Capacity Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
1 INon-La er
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , Paul .` u Ca aci Pao
Layers I
Gilts
Non -Layers
I
Boars Pullets
Turke s
Other _ _- Turkey Puults
Beef Brood Cow
Othcr Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ 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 P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �5 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes `r No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Nbuber: -n Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
10 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M1 No
[DNA
❑ 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?
1f 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
�g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F] 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
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):Sli
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
K 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
10 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
[P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Al,7eements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes No
❑ Yes No
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility NuMer: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
rM No
Pj
❑ 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 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
7
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)
77��
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
rp 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
EP No
❑ NA ❑ NE
33. Did the RcviewerlInspector 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
EP No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %%O — 33zv
Date: / z/ 7 /
2/4l2014

�1
Type of Visit: 4V Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County.,4J%gAl
Farm Name: L��S/��f-CQ 1/'M Owner Email:
Owner Name: L.0tAf'5 irk .e Phone:
Mailing Address:
Physical Address:
Facility Contact: Lo L4s W ,-Zw Title:
Onsite Representative: N
Certified Operator:
if
Phone:
Region: 10(20
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
-}�
Desi n Currentt- Y K Design Current Design Current
g
�tWet
Swine Capacity Pop. Poultry Capacity Pop. Cat#!e Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
3 rz
INon-Layer
Dairy Calf
Feeder to Finish
"" '
Dairy Heifer
Farrow to Wean
Design Current
Dr. P,oul Ca aci P,o .
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
113eef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes [)3 No ❑ NA ❑ NE
Discharge originated at- ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No MNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ ?NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued ,
/ `A

[Fadlity Number: - p Date of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PUI No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
n No
P0NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 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?
❑ Yes
*No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� 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 ❑ Eviddennce of Wind Drift ❑ Application Outside of /Approved Area l
12. Crop Type(s): T`25�-+2f a�flre 1 1" La 1 5" La. S 1 ca-� 6� ► 6gvt , ram'-I4
13. Soil Type(s): k" v 4 e P L-0 "1
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 fait to secure and/or operate per the irrigation design or wettable
❑Yes
� Na
❑ 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
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� 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 T 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
�I

it'acili Number: - Q Date of Inspection: $ ( Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �5 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 (P No D NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ea No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes (�j No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
Comments (refer to question #l: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
■m
Phone: 9/0 -M -3J0
Date: 2 3
21412011

Type of Visit: 0 Compliance Inspection n 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: 3ML.1j* I Arrival Time: :,gyp+ Departure Time: County: �i1K7]AJ
Farm Name: L (U tip Q e M Owner Email:
Owner Name: �iCju S il�r_pj� - Phone:
Mailing Address:
Physical Address:
Facility Contact: ��.j i,)l Title:
u
Onsite Representative:
W
Certified Operator:
Region:
Phone:
'
Integrator: M Wr f Jr lL�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren#
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry.
Capacity
Pop.
Eattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La Layer
Da' Calf
Feeder to Finish
a
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D F-.1'oult .
Cajp aci
op.
Non-DaiEy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharzes 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 W No ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
❑ No
T
0 NA
❑ NE
[:]Yes [:]No
❑ Yes Ut No
[—]Yes No
® NA ❑ NE
❑ NA ❑ NE
❑NA []NE
Page I of 3 21412011 Continued

lFacjhty Number: - 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
[ja)NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2qo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Qa 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
EA 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
j,� 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
M No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
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 . dow ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): PQ-'�
S
13. Soil Type(s): In
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
[�o No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CpNo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
M 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 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 [P No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaeMity Nutnber: ID2te of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
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?
Uomments (refer to quest!
Use drawines of facility to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any Y r,b answers
situations fuse ad,
any
as
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�] NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes h No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
ons or any other comments.
Phone: g1a-03-330a
Date: 2, 41V
21412011

Type of Visit: 40 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; OQ a Departure Time: D _ a County: PV&,0fJ Region: _
Farm Name: Ld uA's _ i<y 1y1:"Tee FacI'1^ - Owner Email: --
Owner Name: W 14-s W Phone:
Mailing Address:
Physical Address:
Facility Contact: VA, �i Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
p
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . il' uIt
al
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes `fw No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No [�j NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
Pi No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
Page I of 3 21412011 Continued

!Facility Number: - Date of Ins ection: (o /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No o 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
1P
❑ 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 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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
R9 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.)
1'
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �SC"t �f-fR.Y,� , 5a21Lea.,
13. Soil Type(s):--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V 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
�]j 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 `P' 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 JU No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Condnmed

%eility Number: - Date of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Ej No ❑ NA [] NE
❑ Yes n No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
F�61 No
❑ Yes
No
❑ Yes
® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: G%10 `�% ;7367
Date:
21412011

- � Division of Water Quality
F
ility Number d O Division of Soil and Water Conservation
Other Agency
Type of Visit a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 2' D Arrival Time: Departure Time: I Iv County: Region: r-14Q
Farm Name: s_� �_ f-rQ�N� Owner Email:
Owner Name:S �' w �Q Phone:
Mailing Address:
Physical Address:
����
Facility Contact: f' Title: Phone No:
Onsite Representative: Integrator: Iq ,
v
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =1 ="
Longitude: 0 e = t = "
Swine
Design ' C>urreot
Cap acirty� Population
Design Current
Wet Poultry Capacity "Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
1110
❑ Layer
❑ Dairy Cow
Wean to Feeder
1 51717
Non -Layer I I
Dairy Calf
❑ Feeder to Finish
-'
Dairy Heifer
❑ Farrow to Wean
Dry Poultry r "*
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
m x;_ .
❑ Turkeys
❑Turkey Points
❑ Other
❑ Other
Number of 5true#ures:
Discharjes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
5PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
*No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continuer)

FacilitrNumber: - /0 Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NNo ❑ NA ElNE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No VVNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Atructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
q s
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
`
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ep 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?
t
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside
of Area
/Window
12. Crop type(s) ��yCi-cQ LP' 5 5 t"r'a
C/
13. Soil type(s)r . '7'� ti�f4 o — �Oh" CC:o.,-,P/e]C
- — -- - -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YESEanswers and/or any recommendations oryjany otheyrttcomments.
.Use drawings of_facility to better explain situations. (use additional pages as necessary):
Reviewerllnspector Name h19krW10Phone: q1, - y!d-53360
Reviewer/inspector Signature: Date: 9-2T--70
Page 2 of 3 12128104 Continued

a
Facility Number: — O Date of Inspection D
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3WNo [INA ElNE
El❑ El ❑Maps El the appropriate box. WUP Checklists Design 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
r-2 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
1p No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
12 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
k] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
[M 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
P No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Qther Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: II ()Q l Arrival Time: Departure Time: `Gb County: 4W50 /✓ Region: FAC
Farm Name:�r ` r m Owner Email:
Owner Name: Lot.c 5 6,Wt`tl � Phone:
Mailing Address:
Physical Address:
Facility Contact: �0 t.U' S i�p Title: Phone No:
Onsite Representative: t{ Integrator: A4u.A0 W �^ _
Certified Operator: Operator Certification Number:
/b68 5---
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ` u Longitude: = ° 0 4 0 "
oilLjg'Itft_sjtg ,Current Design Current Design Current
Swute Capacil?op elation Wet Poultry Capaty Population Cattle Capaty Population
❑ Wean to Finish ❑ La er ❑ Dai Cow
Wean to Feeder r2G ❑Non -La er ❑ Dai ry Calf
Feeder to Finish ❑ Dairy Heifer
� ❑ Farrow to Wean Dry Poultry ❑ Dry Cow
f ❑ Farrow to Feeder
❑ La ers ❑Non -Dairy
�' El Farrow to Finish ❑ Beef Stocker
❑ Non -Layers
❑Gilts
El Pullets ❑ Beef Feeder
Boars ❑ Beef Brood Co
❑ Turke s
he
❑
,
�' ❑ furke PouIts
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�TVo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
T NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
q,NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
q No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
fpNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: — C 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 F9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
In 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
VNo
❑ 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
PNo
❑ NA [:1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
11] 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
PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�No
❑ NA [I 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) pktu (� r�J t S �4�
PAI 114 , Oi n� �'/r�►nitj
—
13.
Soil type(s) iJl 4-e- 93n � , 6y jn _
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NP4o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
14LNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
10 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
W,No
❑ NA
❑ NE
18.
Is there a lack of property operating waste application equipment?
❑ Yes
[P-No
❑ NA
❑ NE
Reviewer/Ins ector Name IL: ' r;. ' . Phone: !D D27
P a s
Reviewer/Inspector Signature: Date: !
Ana'. 7 of ? 12/2R/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents ► I
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 09 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes S No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
TNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E -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
24No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
+No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
L
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
t-No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IfINo
❑ NA
❑ NE
Page 3 of 3 12128104

W Division of Water Quality ..
Facility Number Q Division of Soil and Water Conservation
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: J Q Arrival Time: � Departure Time: -.� County: SpnJ Region: CIQD
Farm Name: 01.45 i ►�-L�rQ QY✓i Owner Email: p, !
Owner Name: L.OLde, B. wt�^ Phone: CqOq)6f7`99,eq
Mailing Address:
Physical Address: ,, .. II
Facility Contact: LoU;,S W J aLyP4 Title: Phone No:
LI
Onsite Representative:
Certified Operator:
Back-up Operator:
N
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o =1 =u Longitude: =° =' EJ "
Design Current Design Current := Design Current
Swine Capacity''Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El other
a. Was the conveyance man-made?
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑fC
Be
ef BroodCo r;
Number of Structures: s
a
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 1�jNo ❑ NA ❑ NE
❑ Yes
❑ No
rNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
(9 NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 1 B
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
N NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[!4 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
Nd 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
L9 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 Pfl No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IM No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
n Outside ofAccentable Cron Window n Fvidence of Wind Drifl n Annlicatinn Outside of Area
12. Crop type(s)
13. Sol] type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
DJNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
NNo
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question ft 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):
r
Reviewer/]nspector Name p M e Phone: 10 3300
Reviewer/Inspector Signature: Date: j O
1212810 Continued

w
Facility Number: q — Date of Inspection 1 OB
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ZI No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�g No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
� No
El NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
b 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
Vjwo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
[I NE
Comments and/or Drawings:
12128104

•
.=a
Division of Water Quality
IF�cvliy Numr �� O Division 9OiS"onseryation
0 Other Agency
Type of Visit • Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 09_,/�m Departure Time: County: �o/�- _ Region: HV
Farm Name: o(k //11 Owner Email:
Owner Name: wfS W,r ) AtJ Phone:
Mailing Address: R�• �; �2X %9 W"S" �[�C_a,(6170
Physical Address:
Facility Contact: 6Lkl� LdtN"9—ak Title:
t{
Onsite Representative:
Certified Operator: ll
Back-up Operator:
pp Phone No:
f" l integrator: _y✓$� !! _
Operator Certification Number: p B�
Back-up Certification Number:
Location of Farm: Latitude: = o = & ❑ •1 Longitude: = ° = I ❑ u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacety Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
53 Wean to Feeder
10 Non -Layer I
❑ Dai Calf
El Feeder to FinishEl
.��
�' '' " ` ° ` ' '' r
Dairy Heifer
El Farrow to Wean Dry Poul#ry
El Farrow to Feeder
El Farrow to Finish ❑ La ers
❑ Gilts ❑Non -Layers
El Boars El Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other IEI Other
El D Cow
❑Non-Dai
❑ Beef Stocker
El Beef Feeder
El Beef Brood Cow
- -
Nurn er of Struc#ures: E
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
[a NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

.i f�
Facility Number: Date of Inspection t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
[?NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes K1 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 Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 03 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes 0 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
r L
12. Crop type(s) ' W S b C' (0 to"- 1 e5F
l3. Soil type(s) tgk6 � V'
�T Ina
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 W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
El Yes No El NA ❑NE
❑ 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:(/a
Reviewer/Inspector Signature: Date:5-1
Pale 2 of 3
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wio ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
23 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P 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
P 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
[19 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
"�O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V1 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

5
Division of Water Quality
EMU NUM etr � � 0 Division of Sail and Water Conservation MMUMAN O Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: / ; 49 I Departure Time: ! i y County: 7(7b4 Region:
Farm Name: ^�jt.LiS w jL--Fr"r<,.-- FizZP7t- Owner Email:
Owner Name: rf Ls U% ) ^rE roe- Phone:
Mailing Address:
Physical Address:
Facilitv Contact: -e— Title:
Onsite Representative: --�d:✓ __
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: A04lL�I�
Operator Certification Number: 1 d G15_
Back-up Certification Number:
Latitude: 0 o = 1 ❑ Longitude: = ° = I 0
di
Design Current.Design Current
Capacity Population Wet Poultry . Capacity Population
I
❑ Layer _
v S ILI Non -La et
❑ Wean to Finish
EWean to F
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-La Non -Layers
El Pullets
❑ Turkeys
El Turkey Po Its!
El Other
Discharges & Stream Impacts
l . 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?
Cattle
Design Currenil'r==
Capacity Population:.
f
El
Dairy Cow
❑
DairyCalf
El
Dairy Heifei
El
Dry Cow
El
Non-Dairy
El
Beef Stocket
El
Bee f Feeder
El
Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �{
I
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 ANo ❑ NA ❑ NE
[:]Yes
RNo
❑ NA
❑ NE
❑ Yes
91No
❑ NA
❑ NE
❑ NA
[I NE
❑ Yes
� No
❑Yes
gNo
❑NA
❑NE
❑ Yes
JQ No
❑ NA
❑ NE
12128104 Continued

T .
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes �No El NA El NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: Yei
Designed Freeboard (in): 1,9
Observed Freeboard (in): 3)1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1�lNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes
tR No
❑ NA ❑ NE
8. Do any oft he 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
fK No
❑ NA ❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
K No
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r,m /S�%> .t s /fit/h,pf //7k:5G. e :r / Cv - A'"
s
13. Soil type(s) A ; �-� J'l i^ f / © Y� a.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[:]
Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better eyplain situations. (use`additional pages as necessary):
Reviewer/inspectorName ve (�' �....� Phone: y�GyL_
Reviewer/inspector Signature: Date:
12128/04 Continued

T. .
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 91 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes 29 No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IR Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking aCropYield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
_9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
51No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
91 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
M 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
fiN No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
j4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Of��' ir- �d �-` _ rPI uJ e rafts d-� ry / 7, Cu�
12/2&04

Type of Visit ® Compliance Inspection O Operation review O Lagoon Evaluation
Reason for Visit e Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date aif Visit: Time:
L_ ro Facility Number
Not Operational 0 Belau►• Threshold
0 Permitted ©Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: .��
Owner Name:
Mailing address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° " Longitude ' �• OK
Design Current
Swine Canacity Population
® Wean to Feeder
3 3 o.o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Poods 1 Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle capacity Po ulation
❑ Laver I I JEJ Dairy
❑ Non -Laver I I IEJ Non-Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present li1J Lagoon area `I" 5nrav Field Ares
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen ed, was the conveyance man-made? ❑ Yes ❑ No
b- if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system' (if ves, 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 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5, Structure 6
Identifier:
Freeboard (inches): 3 2
05103101 Continued

Facility Number. — 10
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reuuired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gomtnents {refer'fo,'question #) Explarn any^YES'snswers and/o? any r&6rnd endations4or any other commence F�
Us&r rawrngs of fac$rty to better eirphun ssteiabons.�(use additional pages�its necesl
!N�WsM
27,:`is�.klrv�ita. a
7
Reviewer/]nspector Name
Reviewer/]nspector Signature: Date:
O5103101 Continued

iz.-=: �_:..:. ,* e '.�-�. _ ..e e'?:_ z• s :i , ..?�: is _:.�" --� � . -� - � � .. " ... ... �" � ._.. .... �,....�,., . .� �.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit ®Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
not O erational Belnw Threshold
® Permitted ® Certified C''ofnditio�+naliv Certified ❑ Registered Date Last Operated or Above Threshold
Farm Name: _ LA-) LA .S 1�11 .� I- s�rP_C._Trn Count-: f 2ts
Owner lame: L[2 b. i C lflnj.nC Z Phone No: ` 65
,Nlailing address: -- 2 +3 ok : BSI kJ r, de Ci _0 r7 111
Facility Contact: LnLk s" l�, n Aft-r- Title: Phone No:
Onsite Representative: L..Ouis W Integrator: (',r rpn I I _„
Certified Operator: Lb uls_ .__(may„}j_q 1�o e _ Operator Certification Dumber: L, �S
Location of Farm-
0
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 0" Longitude C ' 1
Design Current
Swine Canaeity Ponulation
® Wean to Feeder
' D
3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acih• Population
❑ Laver I I 1EE11 Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I I I IL Subsurface Drains Present IILJ Laeoon ? tea ILJ Spray Field .Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System
Discharges g Stream Impacts
I. Is anv discharge observed from any part of the operation:' ❑ Yes (LNo
Dischame originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharz. is observed was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (Ifyes, notifi� DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in sal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ER No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ER No
Haste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

r
Facility Number: — o Date of Inspection
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? El 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 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes P No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 91 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes QjNo
12. Crop type a Sr t'e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [�] No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes � No
16. Is there a lack of adequate waste application equipment? ❑ Yes [23 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[� No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[PNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
N No
(ie/ discharge, freeboard problems, over application)
23_
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[INo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
SA No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
refer to u °dam an YESns"`4 rsor an reeommett` El Cony ❑ Final CLUsledraw
mmence lotions o" an
'other comments.
( �� q liyy yings of facility to better�ezplam situations .(use addtteonal pages as necessary .
t Notes
_sill
Reviewer/Inspector Name
Reviewer/Inspector Signature: e. Date: !( O
05103101 Continued

•
Facility Number: - i p I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. 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.)
31. 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 ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes &No
❑ Yes KNo
❑ Yes PNo
❑ Yes ❑ No
05103101

1
State of North Carolina
Department of Environment, kT
Health and Natural Resources A
• •
Fayetteville Regional Office
James B. Hunt, Jr., Governor ID
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
July 17, 1995
Mr. Louis B. Winfree
Louis Winfree Farm
Rt. 2, Box 389
Wadesboro, N.C. 28317
SUBJECT: Compliance Inspection
Louis Winfree Farm
SR 1627
Anson County
Dear Mr. Winfree:
Thank you for assisting in a cursory inspection of your farm on July 14,
1995. Please find enclosed a copy of our Compliance Inspection Report for your
information. It is the opinion of this office based on the information
provided and observations made during the inspection that the facility is in
compliance with 15A NCAC 2H, Part .0217 and the Animal waste Management is
being properly conducted.
This office requests that you maintain a copy of your certified waste
management plan and waste management records at the farm for future
inspections.
If you have questions regarding this inspection, please do not hesitate
to contact this office at [phone].
cc: DEN Compliance Group
Sincerely,
Paul E. Rawls
Environmental Specialist
Wachovia Building, Suite 714. Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10% post -consumer paper

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH 8 NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Farm Name/Owner
Inspection Date
Farm No.
1
Louis Winfree Farm
July 14, 1995
N/A
Filing Address Facility Telephone Number
Rt. 2 Box 389, Wadesboro, N.C. 28317
All comments will be discussed in Section IV of this report.
�1 tWITAI
Animal
Operation tyke: SWINE
SECTION II
Y 8 Comments
1.
Does the number and type of animal meet or
exceed (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
x
2.
Does this facility meet criteria for Animal
Operation REGISTRATION?
T
3.
Are animals confined fed or maintained in this
facility for a 12-month period?
x
4.
Does this facility have aRTIEIED_ANIMAL WASTE
MANAEEMENTP
X #1
5.
Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
XT

Administration and Program Management Y Commits
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc. _x_
SECTION III
fie d 5ite Managem utt Y y Commients
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of USGS Map
Map Blue Line Stream? — X
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream? #2
3. Does the facility have adequate acreage on
which to apply the waste? _x_ _ —
4. Does the land application site have cover
crop in accordance with the CERTIFICATION PLAN? — _#3
5. Is animal waste discharged into waters of the
state by man-made ditch, flushing system, or
other similar man-made devices? X
6. Does the animal waste management at this
farm adhere to Best Management Practices (BMP)
of the approved T ? _x_ —
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approx. 2.5 ft.) X
8. Is the general condition of this animal facility,
including management and operation, satisfactory? _x_ —
SECTIONComments
1. Farm has a certified waste management plan based on comments by Mr. Russell
Sikes with the Anson County Agricultural Extension Service.
2. A detailed inspection of the spray field was not conducted at the time of
the inspection.
3. The certified waste management plan or the spray field was not reviewed at
the time of the inspection.

Inspection notes:
This facility consists of
4 barns, 3800 total swine.
Nursery operation
1 lagoon +/- 4.5 acres in size
Lagoon Location
Lat 34 02' 21"
Lon 80 03' 45"
Photo Time 10:22
This lagoon has a spillway design
This farmer grows for Carrols .
+/- 2 miles North of the intersection of SR 1645 and SR 1627