040011_INSPECTIONS_20171231

is
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow -tip O Referral O Emergency O Other O Denied Access
Date of Visit: ZI Arrival Time: Departure Time:�jf�� County:
140
Farm Name: SG!// Owner Email:
Owner Name: Phone:
r
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [�] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application field ❑ Other: (%
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DW R) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? ❑ Yes 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
2/4/2015 Continued
Design
Current
Y' Design .
Current
Design Current
Mto
ity
Pop.
as t
V►'et PoultryYM1 _ Cagcity
Pap.
J.
Cttle Capacity Pop.
Wean Finish
La er
Dairy Cow
E
Wean to Feeder
Non -Laver
Daia Calf
Feeder to Finish
,_
Dairy Heifer
Farrow to Wean"
"' Design
Current
D Cow
Farrow to Feeder
D Poul Ca aci
P,a0.1
,
Non -Dairy
Farrow to Finish
'D
La ers
Beef Stocker
^e
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Co—
owTurke
Turkeys
s
Turkey Poults
y
.1-
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [�] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application field ❑ Other: (%
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DW R) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? ❑ Yes 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
2/4/2015 Continued

F,
Wacility.Number: jDate of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. 1 f yes, is waste level into the structural freeboard? ❑ Yes FNoNA [:]NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Struct re 6
Identifier:
Spillway?:
Desigmed 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)
4. 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 p Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): OGtS i1�tq i�-C��1,s_
13. Soil Type(s): 14e -Bt eQo _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
T
❑ 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
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tra
sfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment'?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

aciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo
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:
2b. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 l _ 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
E] NA E] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
E:]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 #): 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:Ili 3 3
Date: �7f
2/4/2015

type of visit: rauompuanee inspecnon V vperanon tceview V ntrucrure Evaluation V teennieat Assistance
Reason for Visit: tEFRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: pl l Arrival Time: Departure Time: County: T1
Farm Name: M(Y'dn" .Sl�lll�l'e 1//1.1 _ Owner Email:
Owner Name: PIQ4au Mika) Phone:
Mailing Address:
Region: 1-pQ
Physical Address: 6 t lQ PW Q"
Hof v-&)
Facility Contact: ej 40- Title: Phone: 7t)q- t - 376 y
Onsite Representative:
Certified Operator: R(lQid-
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes [0 No ❑ NA ❑ NE
[]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes CR No
❑ Yes CR No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current
q7" w) s gn
Current
Design Current
Swine
Capacity Pop.
Wet Po.ultrysCapacity
Pop.
Cattle Capacity Pop.
- ,.
Wean to Finish
La er
Dai Cow
Wean to Feeder
-Layer
L
Dai Calf
Feeder to Finish
'°
Dai Heifer
Farrow to Wean
k}
,..�. � �D'esign
C►urrent
Cow
Farrow to Feeder
D . P,au1#�:`;Ca aci
P.o
Non -Dairy
Farrow to Finish
Qa
Layers
INon-Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Poults
Other
a�,Sa�av ..-wc w
.--.:=. .a"�YIY.E--Cl,
Other
iui^1S]:.,.�.. :.•,.N.A.: :- -t-,
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes [0 No ❑ NA ❑ NE
[]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes CR No
❑ Yes CR No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - Q Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[5jNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there anyyiimmediate threaaak Tob{lic 5ntegrity of any of the structures observed?
❑ Yes
[RNo
❑ 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
E�j 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
to 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
lc 'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[5kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
$j] 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): M Small q r U
A'i
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
[2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EZ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U 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
[53 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design r] Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. 2 Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard Fcr Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking 10 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?
Page 2 of 3
❑ Yes E§ No
❑ Yes [::]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
LGO
NA ❑ NE
2/4/2011 Continued

Facili Number: Q Li0701,Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[0 Yes
❑ No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
10 Yes
❑ No ❑ NA ❑ NE
the appropriate box(es) below.
LdN Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
TUI No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [51 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ZNo ❑ 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
W No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[RNo ❑ 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
M No ❑ NA l] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
GZNo ❑ NA [] NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Fam, ,h, ar b „ J'e 0 o �a�d ACCvsi-, Q011, 4nt �s Ioo��19 'ew a bvy-el,
Ca►�`ia� mow,a 1 c>n rte, [.J�s WP��� ��
a1. Me—'some e. o pLLs ur m Fns (oo d ars y Q nem wo��e r��,/c
� `� tdK 1'i'x r�,�
p��p .ow���J �o� s�ks cr,� ��y n��a k and p y e vel �s
5 �JMp 6/815 nree d ihf- k s "m M-� @01a of v.2� rcrttf41.� . ��-� wg
San�if.war tiaj �at�rDec- aolX.]
i%e_ rno�41) Icor yie)d1 for hz ay. Calibiwo, Was- )oifdog�ern ao!b, 'ledoore- arsoa, of poY,bl�-o� le�eI
gta��ci no wMJ_ +0 y_i j00d-. We eek d ka�rr�ek , o ear$ 'a Y�ea^1
Sj;d s�r�� �,� int dole i� aa11 C ►d s ha-1�( d�� e ,,% ea-. Te
I' 1 bbl 't= m 4 i1��
1QSfs�rtce 1na�1�i�' �iti� s(�d ro a e b1�e far ex��n�f►09 fP
�al��9ht
Larn a,d-'e(h chetkv L doh )aol y t Recorldr c ftked- I N 11y , _
Reviewer/Inspector Name: Phone: qj�-9 333DOtbLY�
Reviewer/Inspector Signature: Date:djl
Page 3 of 3 0 214/2011

Facility N!Prin(
-00 Farm Name
Permit C '
�O'Afb-%sml Date
�l(01cy
11101
OI NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dro s
r�
A.,, 2 ares Sa f U kA-
oon Name, S forspillway 1 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft Q
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
....Date
Design Flo
Ring Size tin)
��-----�
ikctual Flow
-to ia1���
Soil Test D e � h,
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed_
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -1 Zn -I _Saae>1000
1 in Inspections
Check Lists
Needs S (S-125)
120 min Insp.
Storm Water
Needs P
Weather Codes
Is 9-
.��si������
Pull/Field
Soil Crop Acres PAN Window Max Rate Max Amt
Verify PHONE NUMBE�$ and affiliations
-q a
Date last WUP at farm Lagoon #
:33 xlb0
App. Hardware Top Dike
lop
57s
Start Pump
qt,'a
1*6,3
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
5STV
Verify PHONE NUMBE�$ and affiliations
Date last WUP FRO iFRO or Farm Records
a )
Date last WUP at farm Lagoon #
:33 xlb0
App. Hardware Top Dike
lop
Stop Pump
Start Pump
qt,'a
1*6,3
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac

DEviii
�, .
Facility Number O D'v" an of Water Quality
sion of Soil and Water Conservation
- ,other Agency vaimm
_.
iType of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
(Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
11 1
Date of Visit:4(1 r" Arrival Time: eparture Time: ; County:QN
Farm Name:,, --Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: :. _,
Onsite Representative:
if
Certified Operator: h
Back-up Operator:
Location of Farm:
0)6a
Title:
Latitude:
Region:
Phone:
Integrator: •7 Q�
Certification Number:
Certification Number:
Longitude:
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Design Current..:
Design
Current
p, Design Current
Swine
Capacity Pop.
Wet Poultryk+�:.Capacity
-Pop.=
Cattle, rCapacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
Ep NA
❑ NE
Wean to Finish
❑ Yes
La er
NA
q
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
❑ Yes
❑ No
A .,"
Dairy Heifer
Farrow to Wean
❑ Yes
,.,- Design
Current
Dry Cow
Farrow to Feeder
❑ Yes
D , Poul ,Ca aci
1?0 .
Non -Dairy
Farrow to Finish
O
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees 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
Ep NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
q
❑ 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
[;q NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[]R No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
'J�p No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Pacili Number: ZI - I jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0M 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 q9 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 Q3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EBNo ❑ 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 qg No [DNA ❑ 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? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes � No [:]NA E] NE
F-1ExcessivePonding ❑ Hydraulic Overload E] Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop � Window ❑ Evidence of Wind/Drift ❑} Application Outside of Approved Area
12. Crop Type(s): C[,u'�x.(' GL"�'yyLu.L �s3 / 5•�+
13. Soil Type(s): AeA'
14. Do the receiving crops differ Vom those designated in the CAWMP?
❑ Yes
50 No
❑ NA
[:]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
0 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
T
❑ NA
0 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 C] 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 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ' No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P
No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

1aciliNumber: - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes W No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes §9 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:
❑ Yes �No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ff� No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34_ Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question 4): 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).
-Fl,#,I,t k a 5 lel Gi h v <<r`j3 j ii'i Ca- 'AT • %00/6
o Zo r Sluo! ScvAa,7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �l0 33r33�
Date: L� �7 Z-
21412011
2/4/2011

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral 0 Emergency Q Other ❑ Denied Access
L1 �
Date of Visit: Arrival Time: G ' f Departure Time: G: _ County: s�,` Region: 74!
t �
Farm Name: PiCY.�r-U� Sw X11 VII" Owner Email:
f.
Owner Name:1 v1[�l� 1' «'i j,,'% Phone:
Mailing Address:
Physical Address:
Facility Contact: L�GZ Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� i [� Longitude: = O =1 I =
11
J
Design Current
Design Current
Desigr! Current
Swine Capacity Population
Wet Pou1try Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Dai Calf
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish
❑ NE
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
El Laersi
❑ Non -Dairy
Kj Farrow to Finish y-
❑ Non -Layers
El Beef Stocker
Gilts
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes F No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
EINE
Lel NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
%No
[INA
❑ NE
Page I of 3 12/18/04 Continued

1"acilit7Number: t — Date of Inspection 1WI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P 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: i
Spillway?:
Designed Freeboard (in):
a
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;9 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 *V3 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi 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 E) 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes yspNo [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J'evml 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 ❑ Evide ce of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Gri I ' tW1_{l ci►
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
�]No [_1 NA El NE
t� No ❑ NA ❑ NE
No ❑ NA ❑ NE
Q No El NA El NE
Comments (refer to question #): Explaiiiany YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
r
Reviewer/inspectorName E r Phone: ~ 3P 30n
``
Reviewer/inspector Signature: �- iY Date: (, /�
Page 2 of 3 12/28/04 Continued

1
"cility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'l'No
ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ 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
13 Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32- Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
� ! r ) L�
�4•u yf� 7e.:,V t� M t{ S � /? i- � 1, ► � - �j/t7 +?
2S l SLj "k
�V I���n t� `�"t1 � ►'lC..: Y+�3� ! r��� c ' � t'`r/ i
Page 3 of 3 12128/04

4
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [:1 Denied Access
Date of Visit: �- jn� Arrival Time: L{ Departure Time: County: �� Region:
Farm Name: t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �G �I Title:
Onsite Representative:
Certified Operator: 920A Ivi�
Back-up Operator:
Phone No:
Integrator:�
Operator Certification Number: &L-2
—2
Back-up Certification Number:
Location of Farm: Latitude: E] e =1' ="
Longitude: 0 e = i =66
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
:.D Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J9 No ❑ NA ❑ NE
❑ Yes
❑ No
qNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No UNA EINE
Strucre 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
r
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Y No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo ❑ NA ElNE
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 53 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [P No ❑ NA ❑ NE
[--]Yes [PNo ❑ NA EINE
❑ Yes No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo
❑ 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 Soi
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑/ Application
%Outside of Area
12_ Crop type(s) t E ctV eor tw a � S S 61-a-4 1. �!h Vv h " m{$�a
13. Soil type(s) 44,
❑ NA ❑ NE
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
fp No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
q No
❑ NA
❑ NE
Comments {refer to gpestion #): Explain any YES. ans►+ers'and/or any recommendations or anf ather�comments ,� * -<<
Use drawings' of facility to better explain situations (use additional pages as necessary)
1m cz f + -tf `riffs �1Gs�r� -vt
C` ��pw:� 4 �o�� �c� an -1
Reviewer/Inspector Name w
Prone: O -L 3M
ReviewerAnspector Signature:
Date: i
12/28/04 Continued

Facility Number: — Date of Inspection 1
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q9 No ❑ NA ❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[f] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V No
❑ NA
❑ NE
Other Issues
A,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[!� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[) No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[5No
❑ NA
❑ NE
Addrtioual CvmmentSAandfor Drav'vngs:
A,
12/28/04

Division of Water Anality
Facility Number �� Q Division pf Soil and Water Conservation J
�— — 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:02,3 Arrival Time: Departure Time: %Q ; County:
Farm Name: Momay, w SI�-kc Fa-rOwner Email:
nwni-r Nsimi • RDNL? ld A MAynn A phanr-
Mailing Address:
Physical Address: n_ t` �n
Facility Contact: Py1� Id M Meda,, _ Title:
Onsite Representative: �Q��ffih� s (.•�4.`'�
Certified Operator: I�D�v` M
Back-up Operator:
Region: FR6
Phone No:
Integrator:-,�j��i�
Operator Certification Number: 1667A
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =I
= " Longitude: = ° =I = u
ign Current
Desrgn Current
Design Current
ne Ca aci Po 'la *on
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
FEI
❑ La er
ElDai Cow
Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
`, z m
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
❑ Dry Cow
❑ Farrow to Feeder
D , Poult`
rY rY _:��5:.
❑ Non -Dairy
Farrow to Finish f�
❑ Layers
Non
Beef Stocker
� El Gilts
-Layers
❑Beef Feeder
[__1 Boars
❑ Pullets
❑ Beef Brood Co
Others
❑ Turkeys
� No
❑ Other
❑ Turkev Poults
❑ Other
Number of Structures:
❑ Yes
fp No
❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EP No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[P 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
IF NA -.
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
El Yes
� No
[_1 NA ',❑
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
fp No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: — Date of Inspection
❑ Yes
Q9 No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
E] No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
'�)NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier; 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[3 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? P Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IR No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
T 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
ER No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commentsElw=mfrcill�_tter
explain sltuatians. (use additional pages as necessary):
5, ,a S cis
5 f rlq-. e c/ f � 4,3u s� 2vag
Reviewer/Inspector Name„
k=�.ss .� Phone: -110 Y
Reviewerlinspector Signature:
Date:
Page 2 of 3 12/28/04 Continued

Facility Number:— Date of Inspection 3 D
Required Records 8 ocuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes @ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(]
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[DNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes." -',b!,' 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
B 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
fo No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fait to discuss review/inspection with an on-site representative?
❑ Yes
[91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�TNo
❑ NA
❑ NE
Page 3 of 3 12128/04

Division of Water Quality
Facility Number 0 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: 0 Q$ Arrival Time: r f? Departure Time: [-0-177-L
CQ County: ✓`"S0� Region:
Farm Name: © wl 1►t h� rn Owner Email:
Owner Name: Ronald s Qin! Phone: &y) 6q`1
Mailing Address:
Physical Address:
Facility Contact: "Id M- / IA22aCph Title: Phone No:
Onsite Representative: t'ict _ Integrator:
Certified Operator: I I Operator Certification Number: 1702
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c 0 =6 Longitude: ❑ e ❑ 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish POO �.
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
ti ..
Design " Current
Cattle Capacity Population
❑ Daia Cow �+
❑ Dairy Calf
❑ Daia Heifei
❑ Dry Cow '
❑ Non -Dairy
❑ Beef Stocker
i
❑ Beef Feeder
❑ Beef Brood Cowl
Y,
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes �d No ❑ NA ❑ NE
❑ Yes
❑ No
Ep NA
❑ NE
❑ Yes
❑ No
ENA
EINE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
[;JNo
[:INA
❑ NE
[:]Yes
[jNo
[:INA
❑NE
12/28/04 Continued

Facility Number: — Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [--]Yes ❑No O NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
A6
Spillway?:
13.
Designed Freeboard (in):
Observed Freeboard (in): 30"
14,
pp�$�
o
Do the receiving e cr�?ops'dif el= t�frm those designated in the CAWMP?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
15.
Does the receiving crop and/or land application site need improvement?
6_ Are there structures on-site which are not properly addressed and/or managed ❑ Yes
ANo
❑ NA ❑ NE
through a waste management or closure plan?
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
q No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
J@ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
18.
9. Does any part of the waste management system other than the waste structures require ❑ Yes
A No
❑ NA ❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
O.No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
El No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CpQ &ejnU,40 0455 y.�Snit, &a4., 0041"
A6
13.
Soil type(s) �;
14,
pp�$�
o
Do the receiving e cr�?ops'dif el= t�frm those designated in the CAWMP?
F-1 Yes
CoNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
T No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
C� 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
9No
❑ 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):
I
A6
Reviewerlinspector Name Phone:0/0 -7
Reviewer/Inspector Signature: - Date: C 30 QS
12/28104 Continued

Facility Number: — Date of Inspection l 4001
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes Wo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (R 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32_ Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33_ Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes *No
❑ NA
❑ NE
[I Yes
19 No
El NA
El NE
❑ Yes
[9 No
❑ NA
EINE
❑ Yes
1No
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA EINE
❑ Yes
[JNo
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
12/28/04

Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:a� f gOb Arrival Time: � Departure Time: ��� County: Region:
Farm Name:fn Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:�
Onsite Representative: 1 Integrator:
N
��1�6 L qOZ
Certified Operator: Operator Certification Number: �J
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F--1 0 = d = Longitude: = ° = f ❑ "
Design Current Design Current Design C►urrent
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
,.,
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑ Nan -La er ❑ Dairy Calf
❑ Feeder to Finish. ❑ Dairy Heifer
❑ Farrow to Wean Dry PouttryN.: ❑ Dry Cow
❑ Farrow to Feeder
' Non -Dairy
arrow to Finish a—� ❑ La ers El Beef Stocker
El Gilts n -La ers
El Pullets El Beef Feeder
El Boars ❑ Beef Brood Co
_ ❑
Turkeys w,
❑ Turkey Poults ,rr r m
❑ Other ❑ Other Number of Structures: I 1 I
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
El Yes
Lallo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
RNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
N NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C&No
[JNA
❑ NE
other than from a discharge?
Page I of 3
11/18/04
Continued

Facilityumber: — 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 [P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Uj3Wo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PdNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1
4. Does any part of the waste management system other than the waste structures requireNA NE
maintenance or improvement? ❑Yes No [:1[:1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EP No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
//��Wi��ndow r � Evidee�nce of Wind Drift /❑^ Application Outside of Area
12. Crop type(s) 1S2�JV/ 1Vt Q l7� VS5 r~f�,�, _ ifag"/. S1t'1. 17+r, 0
13. Soil type(s)1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`1l No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
bd 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):
{ � c 4 S tJY
SCu t �`p� �'N h `wl t IJ/A 1 701•+ I'M�
Reviewertinspector Name j Phone: �33
Reviewer/Inspector Signature: Date: 1 0
Page 2 of 3 121NA4 Continued

a Facility Number: —I j Date of Inspection 1 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C9 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists C3 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
`p No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
EINE
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
[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
`I•' No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[P No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit
ompliance 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: -0 Arrival Time: ; , Departure Time: (j D County: An -5 V-
Farm Name: `n iia �`+''~" Owner Email:
tl
Owner Name: �t??_�'!rl l�� /%7 O �' w Phone:
Mailing Address:
Phvsical Address:
Facility Contact:_ S i�Z r-- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: fi'K D
Phone No::
Integrator: moi? ,
Operator Certification Number: 16,a ,a %.;Z --
Back-up Certification Number:
Latitude: =0 =
o❑d[ Longitude: =0[=i 0[=i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puilets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
L Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
[9No
❑ NA
EINE
❑ Yes
W No
❑ NA
EINE
❑ NA
EINE
❑ Yes
G�No
❑ Yes
W No
❑ NA
EINE
[--]Yes
&No
[]NA
❑ NE
12128/04 Continued

r'
Facility Number: — %% Date of Inspection G
7 mow ��r�}p�'-,.Gut �S
��OUH °� ���J`; n�3 A�2 �C� S'iC�,C • !
Waste Collection & Treatment
yG y.i.. Phone:
Reviewer/Inspector Signature:
Date: �— /t'n -U G
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
El NA El NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
JZ No
❑ NA ❑ NE
Stru ture I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
f
Spillway?: 1::
Designed Freeboard (in): ci o
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[U 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
ONo
❑ 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?
KYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ff No
❑ NA [I 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
El NA E] NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside
of Area
12. Croptype(s) '&rr ntol e . lY / yam Oyrp�-4l1_l //
13. Soil type(s) �,_ Z / 73 p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
Z No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA ❑ NE
Comments (refer to',g6estioa 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):
7 mow ��r�}p�'-,.Gut �S
��OUH °� ���J`; n�3 A�2 �C� S'iC�,C • !
Reviewer/Inspector Dame
yG y.i.. Phone:
Reviewer/Inspector Signature:
Date: �— /t'n -U G
12/28/04 Continued
'3a

i
Facility Number: Date of Inspection l� D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IR3 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections P Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EM 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
RNA
❑ 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
ZNo
❑ 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
O 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
5 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
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
Addici a'IiCo�mments and/or Dri•a iags:�; w
A 6; Lt.., X-1, V rte.
_jr C=llal% lr� �d5�7ra�>Nr�L�
a a%Q'/C ?"J'"�
Xy,�lavle- /"Zf ua Cop ©� rr��
,on a"'Tol a L'
12/28/04

D V H _/i
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral *Emergency 0 Other ❑ Denied Access
Date of N"isit: I 011Y145— I Arri,,ai Time: <S'Z'� Departure Time: County: &gA4se.cJ Region: rlz-
Farm Name: /"v r;S w,�'�, C_ Yo" a� -% Owner Email:
Owner Name: /Po.-7g'/'>c_ l /t'%arao.v Phone: *50") .97;7j
Mailing Address: L'y 73 __ i c— Qe119
Physical Address: D.'V //V'f
Facility Contact:
Title:
Phone No:
Onsite Representative: ��s. %1, -- Integrator:
Certified Operator: /Sante fo� I`%�< %�j7o, s¢,f Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o =I
0 Longitude: ❑ ° ❑ ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
® Farrow to Finish .200
❑ Gilts
❑ Boars
Other
❑ Other
101 -aver
❑ Non -La e[
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ® Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifeti
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Yes ❑ No ❑ NA ❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[] No
❑ Yes
❑ No
Qa NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

S
l
1
Facility Number: e) // Date of Inspection a? !y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):lf
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
El Yes E] No El NA EINE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? (K Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [3NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
W NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
❑ NA
W NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[M NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
(L] NE
Comyaneuts (refer to question # ):_• Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (iuse.additional pages as necessary): s
e
/— /{ fe",vuc. woo OO SyJ:.%gS row ��`P o� dijfe fu fo e I4y
Reviewer/Inspector Name ori• �c,C�e Phone: loC
Reviewer/Inspector Signature: Date:
12/28/04 Condnued

Facility Number: ��/ — �/ Date of Inspection lY
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ®NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No ❑ NA [2NE
the appropirate box. ❑ WUP❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes ❑ No ❑ NA ® NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[9 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
Q NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
BNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[A Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
W NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
® NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
Additional) Comments and/or Drawings:
C p c r
12/28/04

1
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I t Date of Visit: Time:
--
=Not erational Q Below Threshold
Permitted ® Certified © Conditionally Certified [] Registered Date Last Operated or Above Threshold
Farm Name: M r- n S,. tr .n ('raeh.,& Count:
Owner Name: Ro-ys a,.11A p Phone No: ItA je t;-/ -51 - -
Mailing Address: V G
Facility. Contact: h Art c..Q.t Wo nj&eN Title: Phone No:
Onsite Representative: lz "C4A _ n ✓`c r. n_ Integrator:
Certified Operator: t2,rncj>'t Me, Operator Certification Number: t'(a e, TZ
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude ' �• �»
Design Current
Swine Capacity Ponnlation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish ab /
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps10
Design Current Design Current
Poultry Capacity Population Cattle Ca acit• Po ulation
❑ Laver ❑ Dairy
❑ Non -Laver ❑ Non -Dairy
Other
S Total Design Capacity
Total SSLW
1L Subsurface Drains Present Li Lagoon Area I
No Liquid Waste Management Svstem
Discharges & Stream impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprats Field ❑ Other
a. If discharge is observed, was the convevance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated floes- in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? IN Spiliway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 47-
05/03/01
❑ Yes �@ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 19 No
❑ Yes ® No
❑ Yes M No
Structure 6
Continued

Facility Number: — If Date of Inspection `
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [ANO
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 Q9 No
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes MNo
8. Docs any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
allo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
elevation markings?
❑ Yes
EgNo
Waste Application
❑ Yes
[3No
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[BNo
H. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[�JNo
12. Crop typeSer G_V
® No
21.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14 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
[Z{ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[3 -No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ffNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc,)
❑ Yes
[3No
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
[D No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
`❑tNo
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
C2�,No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EqNo
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers andlor any recommendations orany other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}: [] Field Copy ❑ Final Notes
i
6,"r u1 C'. d e, � t : ti 1 0-71%- 6j
Reviewer/Inspector NameNMI
Reviewerllnspector Signature: C, Date:
05/03/01 t Continued

Facility lumber: — Date of lnspectimi 12-114L4 f
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt. ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
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.) ❑ Yes ® No
31. Do the animals feed storagc bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No
05/03/01

W 1�
State of North Carolina
Department of Environment,
<11 Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
November 17, 1995
Mr. Robert J. Watkins
Route 2 Box 362
Wadesboro, N.C. 28170
SUBJECT: Animal Feedlot Operations Site Visitation
Morven Hog Farm
Anson County
Dear Mr. Watkins:
On November 14, 1995 an inspection was conducted of your animal operation by the
Fayetteville Regional Office with the assistance of Mr. Robert Horton, DC and Mr. Lin
Taylor, District Technician, Brown Creek Soil and Water Conservation District. The
inspection, attached, revealed that the waste holding lagoon at the Morven Hog Farm had a
freeboard level of approximately two (2) feet.
If you have questions regarding this matter please do not hesitate to contact me at
[phone].
Sincerely,
2( C
Paul Rawls
Environmental Specialist
Attachment
cc: DEM Facility Compliance Group
Joe Glass, Land Quality
Lin Taylor, District Technician
1706 Mm v sad
wadebwc, N.G 20170-9142
Wachovia Building, Suite 714, Fayetteville, North Carolina 25301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

T y
Farm Nan
Mailing A
Integrator: WAPhone:
On Site Representative:. Phone: C7d4) Y�ta - RS -1I
Physical Addressk:ocation:_ S2 i1 a4
Site Requires Immediate Attmtkm:
Facility No. gi _r1
DIVISION OF ENVIRONMENTAL MANAGFIAEN't
AND AL FEEDLAT OPERATIONS SITE VISITATION RECORD
DATE.• ,:, er14 , IM
Tiox: �s-�io
Type of Operation: Swine ,g Poultry - Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE, DEM Certification Number. ACNEW
Latitude: • Longitude: •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard:_ 2 Ft.___Inehes
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No (Seepage Was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or (& Not Evaluated)
Crop(s) being utilized: (Spray Field or cover crop was not evaluated) mr. ,fks C Ifft L 1Y _ !2"JD WA 6,.J6
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No r
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No*
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, ordther
similar man-made devices? Yes or(o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure. land applied,
spray irrigated on specific acreage with cover crop)? Yes or No(Waste management records were not
Additional Comments: _., . _ _ reviev2d)_ .
This iaas a very brief Inspection. a more thorough inspection will be condugted in the future.
Please contact.DEM should condition arise that poses a danger to surface waters.
* This farm was not located on a USGS TOPO map to determine `.'Blue Line' status.
If you have questions concerning this report please do not hesitate.to.contact theinfector
at [phone]. Please contact the 'Inspector if the above information is incorrect.
Inspector Name
cc: FUMY Assessment Unit
�3i oats
signature
Use Attachments if Needed.