040014_INSPECTIONS_20171231

i Iypu ul v Wll. W %.umpuance lllspecilull v vpera[lau mcvlew LJ 31ruclure cvalualluu V I ccuulcal Asslslauce
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: � Departure Time: County: A?,SL_ Region:
Farm Name: ?OyI _5 q�.EL i�r/rq Owner Email:
Owner Name: 4'.. P' A � Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: �/+2,d✓
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Disc„h_aEges 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?
Page 1 of 3
-ti
❑Yes "�No 0 N E] NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
[—]Yes
G� urrent
M'O NA
Cun�{'fit
1
Curren
No
T�No
Design
❑ NE
Design
Design
EK
Swine
Capacity Pop.IN
Wet Poultry
Capacity Pap. 1:
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
DesigN Inut
CMap
D Cow
Farrow to Feeder
D Point .
Ca ac;
-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
a;,,:,
U.
Disc„h_aEges 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?
Page 1 of 3
-ti
❑Yes "�No 0 N E] NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
[—]Yes
[] No
M'O NA
❑ NE
❑ Yes
No
T�No
❑ NA
❑ NE
❑Yes
❑NA
❑NE
21412015 Continued

Facifi tuber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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
4 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
S. 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)
T
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
[9 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 Crop Wiipdow ❑ Evid nce of Wind Drift ❑ Application Outside of Approved Area
12_ CropType(s): lfl
13. Soil Type(s): _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ 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
[� 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 [)q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes $] No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility'Number: /e/ _ Date of inspection:11 41
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? D. Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EpNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes y No ❑ NA ❑ NE
and report mortality rates that were higher than normal? TT
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 00 No ❑ NA D. 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
[q No
❑ NA
® NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
1� 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
P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
09 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
%No
❑ NA
❑ NE
06tel, Ca�'1-5S
-70q, q 7 <-2q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
2Z�c"U
Phone: q10 -3 ?
Date: f
, �/J' -7
21412015

i ype or v Es t: w uompuance i nspecuon v vperanon xeview V Ntructure Evatnaaon V i ecnntcai Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ®Q County: AwSoej
Farm Name: Ti►v� Owner Email:
Owner Name: acre S 4j Phone:
Mailing Address:
Physical Address:
Region: FW -0
Facility Contact: Title: Phone:
s
Onsite Representative: � � Integrator: �-h f
Certified Operator: Certification Number: I{72
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
9 >�Desrgn Currept.;x
,
Design
Current
Design Current
Swine. Cap ty - Pop.
171'et l'Oltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ No
NA
Dai Cow
Wean to Feeder
Non -Layer
❑ No
NA
Dai Calf
Feeder to Finish
`,_:::3
DaiTYHeifer
Farrow to Wean
❑ Yes
DesignCurrent
j�bNA
T❑
Dry Cow
Farrow to Feeder
D , Poult ,
Ca aei
Po
Non -Dairy
Farrow to Finish
❑ Yes
Layers
❑ NA
❑ NE
Beef Stocker
Gilts
T
Non -La ers
Beef Feeder
Boars
Pullets
Beef Br---
roodTurke
Turkeys
s
Other
Turkey Poults
Other
Other
Discharees 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 DWQ)
❑ Yes
❑ No
NA
❑ NE
e. 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
j�bNA
T❑
❑ 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?
T
Page I of 3 21412011 Continued

liacili .dumber: -1q, IDate of Inspection:
❑ Yes
FjNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
J�j No
❑ NA ❑ NE
the appropriate box.
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
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Identifier:_
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA ❑ NE
Spillway?:
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
Designed Freeboard (in):
,ro
2/4/2015 Continued
Observed Freeboard (in): .42# k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej 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 4fi 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
29 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(g 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
t] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.❑ Yes T No [:]NA [—]NE
❑ Excessive Ponding ❑ Hydraulic Overload [j Frozen Ground E] Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift p Application Outside of Approved Area
12. Crop Type(s): C9,rH �it•R1g, Sd-, L'2's _ —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qg No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes MNo ❑ NA [:]NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FjNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J�j 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
'K 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
W No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
,ro
2/4/2015 Continued

Facili Number: - Date of Inspection: 12 Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No [-]NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I No [] NA ❑ NE
the appropriate box(es) below. ]�
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes M No ❑ NA [] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CA No ❑ NA ❑ NE
❑ Yes T 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
Gomments (refer to question # -. Ex;p: in any YES answeronal recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary,}.
AcAr-6h 9.o',r)'eSo n
-�Oq-995-OL13&
,An��-eta �L�I�Sov�
70 q -qSS --7 2-9g
�A��4 1Maxbte -&4-
910-62,L fOLN CCf_10
Reviewer/Inspector Name: V-0LL-__L� { w Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

Type of Visit:omm�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: W outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a0 Departure Time: County: 0-4 h
Farm Name: `� Owner Email:
Owner Name: T'l-�t� Phone:
Mailing Address:
Physical Address:
Region: P126
Facility Contact: ° ' �� Title: Phone:
Onsite Representative: ( _ _ Integrator:
Certified Operator: tgcfmf Certification Number: 1 / 1 lilt`3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desiga Current
[:]No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wcan to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
C_ urrent
Cow
Farrow to Feeder
RE -9- P.o
Ca aei
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Points
Other
d0ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (]f yes, notify Dl
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [11,Ncr— ❑ NA ❑ NE
❑ Yes
[:]No
[J d
❑ NE
❑ Yes
[:]No
[J'�TA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [3 -No C3"NA ❑ NE
❑ Yes E3 -Tl ❑ NA ❑ NE
❑ Yes ET qoC ❑ NA ❑ NE
2412014 Continued

prr t
Facili Number: - Date of ins ectio •
Waste Collection & Treatment k
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [34?9 ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):r r t
Observed Freeboard (in): )'J-Ttq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [21,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
Q. -Nb
❑ NA
❑ NE
8. Do any of the structures lack adequate markets as required by the permit?
❑ Yes
[g -Ko
❑ 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
[t31Fo
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[]! l�o
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R]�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [g -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
l2. Crop Type(s): J d., S G 0
13. Soil Type(s): KACL /' 1e_ T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10^ ❑ 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 [g X6 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑�i6
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
QKo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[9 -'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]! l�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2>d ❑ NA ❑ NE
F-1 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [; o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;VNo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Faefty Number: - Date of Inspection:
CENo
❑ Yes
[!rNo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
It
❑ Yes
�No
❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
03-K°
❑ 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
[E3 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
D,leo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [}-Ko— ❑ NA ❑ NE
❑ Yes [3'1Go ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes 9 -No ❑ NA ❑ NE
❑ Yes
CENo
❑ Yes
[!rNo
❑ Yes
�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #1) Explain any YES answers and/or any, additional recommendattans or any other cowmen
Use drawings of facMo. to better explain 'situatsans (use. ad
[Ltional pages as necessary).
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: M` 3 3 3
Date: _ 10 ROO
2/4/2014

IT
State of North Carolina F15WA
- Department of Environment.
Health and Natural Resources •
Division of Water Quality
James B. Hunt, Jr., Governor [D1HHNF;Z
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
DIVISION OF WATER QUALITY
March 24, 1997
Mr. Boyd Collins
Deep Creek Farms
Route 3, Box 143-A
Wadesboro, NC 28170
SUBJECT: Annual Compliance Inspection
Deep Creek Farms
Registration No. 04-20
Anson County
Dear Mr. Collins:
On March 20, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the Deep Creek Farm swine facility. 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 was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. As discussed on-
site during the inspection of your waste treatment facility the following require attention:
I. The required mimimum freeboard is seven (7) inches for lagoons or holding ponds with
spillways. Your facility had approximately seven (7) inches of freeboard at the time of
the inspection and requires immediately att+entm.
During the inspection you mentioned that after waste application your holding pond began
to function poorly resulting in odors. Pumping smaller volumes more frequently may assist
in maintaining a healthy bacterial action in your waste storage facility. The district NRCS
office, Agriculture Extension office, or the Division of Soil and Water have specialist
available to assist you with this problem and in upgrading of the existing waste storage
facility to allow for additional storage and treatment volume. Please contact a technical
specialist to discuss possible options for consideration at your earliest convenience.
P.O. Box 29535. fowl FAX [phone]
Raleigh. North Carolina 27626-0535 V� An Equal OpportuNtY/Affirmative Action EMPIOYef
Telephone [phone]% recycles/10% post -consumer paper

Page 2
Deep Creek Farms
March 24, 1997
If You have any questions concerning this matter, please call Robert Heath at (910) 48&
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Chris Walling - FRO DSW
Robert Horton - Anson Co. NRCS

Route #3, Banc 143-A
wadesbaro, NC 28170
Fckuuy 28,1997
Mr Kea T. Stevms
DFHNR Div. of watcr Quality
P. O. Brno 29535
Raleigh, NC 276264D535
Subject: Notice of Deficiency
Deep Creek Fawns
Rogistratiar► No. 04-20
Dear W Staves:
RECEIVED
MAR 12 1"T
FRAEGY
G. pFFiC
On F&nmW 7,1997, we pm*ed our Doan suffiiaim* to avoid any party of
dis�
The lagoon was ra-rospacted the fi0bwb* week by The Faycuevffla Regional office and
kmd too be pwnped to toes sdWfiofim

State of North Carolina
Department of Environment,
Health and Natural Resources
Division -of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
DIVISION OF WATER QUALITY
February 8, 1997
CERTIFIED MAIL P-424 423 417
RETURN RECEIPT R ZUESMI)
Mr. Boyd Collins
Deep Greek Farms
Route 3, Box 143-A
Wadesboro, NC 28170
SUBJECT: NOTICE OF DEFICIENCY
Deep Creek Farms
Registration No. 0420
Anson County
Dear Mr. Collins:
On February 6, 1997, staff from the Fayetteville Regional Office of the Division of
Water Quality inspected the Deep Creek Farm swine facility. It was observed that the animal
waste lagoon was within one (1) inch of overtopping. Should this occur, the result would be
a discharge into waters of the State, namely Rhoddy Creek, resulting in possible enforcement
action by this Division.
According to our conversation with Mrs. Collins on February 6, 1997, she stated that the
lagoon would be pumped as soon as possible (possibly as early as February 7, 1997) to
prevent a discharge. The lagoon level should be maintained to allow for adequate freeboard in
the event of a 24 hour twenty five year rain event. We recommend that future application
events are carefully monitored and scheduled during appropriate weather conditions to avoid
run-off problems. The Division recommends that you contact the district NRCS office
immediately to initiate the preparation of an approved Waste Management Plan for this
facility.
Please notify this office in writing within 30 days at the address below as to the actions
taken or proposed to be taken to resolve this deficiency. Nothing in this letter should be
taken as absolving this facility of the responsibility and liability of any violations that have or
may result from these deficiencies.
P.O. Box 29535, 1411kAW4 FAX [phone]
Raleigh, North Carolina 27626.0535 Nvf An Equal Opportunity/Affirmahve Action Employer
Telephone [phone]% recycles/ 10% post -consumer paper

Page 2
Mr. Collins
2/8197
If You have any questions concerning this matter, please call Robert Heath or John Hasty
at [phone].
Sincerely,
Kerr T. Stevens
Regional Supervisor
cc: Operations Branch
Central Files
Chris Walling - FRO DSW
Robert Horton - Anson Co. NRCS

% • M Y3 j m� ©1 I 1 of 1'f
Dwision ©t Wate Qaaltty �j [
Facility Number y ®Division of Soil and Water Conservation
® other Agency
Type of Visit: e5 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 0 Denied Access
t7-1/
Date of Visit: Arrival Time: Ll iros Departure Time: County: Region:
Farm Name: /q? # (T Owner Email: S (UK
Owner Name: Phone:
Mailing Address: ILL WfArookee Vd, I"llme: JVC<3'K11(
Physical Address:
Facility Contact: aam.l 14 y 1148 Title: vyll
Onsite Representative: J&xln A_11,Ckz°�
Certified Operator: �fnry 8, Cp libC J6yiA Tuckf/'
Back-up Operator;
Location of Farm:
Phone: 70q- x4.)— a W9r _
Integrator: H_
tZU�l �q 77
Certification Number:
Certification Number: 92 7 7 H a
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
C@ No
Design
Current
Design Current
Swine
CapacityPop.
Wet Poultry
Gapacit
I'.o
7-VINPop.
Wean to Finish
❑ NA
❑ NE
La er
❑ Yes
[] No
❑ NA
Dai Cow
Wean to Feeder
Nan -La er
I
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
alf
Feeder to Finish
$
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
`'
Da Heifer
Farrow to Wean
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Design
Current_-
Dry Cow
Farrow to Feeder
D , Poult .
Ca aci
Po _°
Non -Dairy
Farrow to Finish
Layers.
t
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
��Ijiljrj]21 111111, 111 111,1131��i�
iTurke s:
Uther
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C@ 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 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
bd No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ig No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
[Facility Number: - Date of Ins ection: 1106
❑ Yes
a] No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
0-91
❑ NE
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ef No
1p 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
❑ NA
Identifier:
Reguired Records & Documents
Spillway?: �^
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
12 Yes
❑ No
❑ NA
Designed Freeboard (in): S.3 (J►�I
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
®' Yes
❑ No
❑ NA
Observed Freeboard (in):
the appropriate box.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®' No
A
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)!
21. Does record keeping need improvement? If yes, check the appropriate box below.
V
vf'��
❑ No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
�
❑ NE
waste management or closure plan?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic 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 outer than the waste structures require
❑ Yes
NNo
❑ 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
CZ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
a] 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
D NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
12 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.
OWUP ❑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 awaste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections 9SIudge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
k NA
❑ NE
Page 2 of 3
2/4/2011 Continued

r
• Facility Number: Q -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ No ❑ NA ❑ NE
❑ No ❑ NA NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
f5i No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[5j 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
5?"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
10 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V No
❑ NA
❑ NE
^W y �h,e1 -�ior, bac s;d�e 0-(�L lay oar ond-Bolsa? rlvyr.
, 1+ w Mff�e soi l f,Pi-b
aD 13 Sol GhQ j�frJ d IOC ►ld}- c�h0 �qj'�" b`''�` Zinc �H�e(J W�'e l o+�f
{cam�r)� bac�t �{_ These re s o f Q�'� be Cann lo.
y y
Wade a V ypj Welocd- VQS or MI"011r (0a days
W c�0 , Ple4je o, �+a�je p1c� war reda►e �� roeo't�co1
hall n , dole sr� ce $ - �l e� e ab � how m,e �d d p
y, As n leve r&,,4 NA +no w eo6t)-dor ood_ weflc-d d ian�J,
sl �d,. v� 5%eds �re x&Ar Iry —e don e, b�-4 n �- rvor ked u�o, Tom f'
j Ia von s rqn is r) 0 CPQ Lma�14 ofloalaoly+o pro yc ala9;lf rt�t 1Jo�,reo l eio�
`� cj'�-ca �ewag, �- 'elm t1-, Dvei h awe a0o t m V1,
01c, ch e_ -�I led, &4-o(L)f'n9 ASP�'-#7 0-,. GUS'
a� own�sfi i -Forte 1 �.: near fi I Ind ova pr��ro�� %y &*Jet� ^ ,
fre? l4, J-ha,dJ- earl aura, yfrft�me Cl)rr�,`�owoo­ hap be& jh 1
OrocesY A
le_&40 Pdmfd own arsoa, 0.i' pow%ble— , 'gilds h i,e_ cin "`i-- rnoa-fvo -'610 I
nr io fedVte sl,,tge M a yev IrMMVIftMI ayt rianl 6,e cot(
Name: 1`/► /1n Jr h.D i Pr
Reviewer/inspector Signature:
Page3 0 3 U
AjdiH 17osabep nofch plod w r eoryj
Phone: 910-q33-3364 ( J
Date: 'rig, &
2/4/2011

Faciiidy No. 04-0014 Farm Name VPpA? (1�Pe Date
Permit COC O C� V f NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S for spillway__. 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Slud a to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date 1 2 3 4 5 6 7 8
Ring Size in
Design Flow m
Actual Flow
Design Diam. ft
Actual Diam.
Soil Test Date 301--Culrtilk8 O 0) Crop Yield
pH Fields h*F Wettable Acres
Lime Needed 04 WUP _
Lime Applied Weekly Freeboard
Cu -I Zn1 in Inspections _
Needs S (S-1<25) 120 min Insp.
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
- �' - �..� * .: jy^Ta�r ••roti �'7rdr,:��� i �.. i.L^-.7�^"1r:: -�-
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
DdoalaVp
i
A;
Verify PHONE NUMBERS and affiliations
Date last WUP FRO .31a FRO or Farm Records
Date last WUP at farm Lagoon # :.J * X IK -
App. Hardware Top Dike 100
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac

�iype of visit: w i:ompuance inspection V vperanon xeview U btructure tvaivanon v ieennical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 6 Arrival Time: e;F3.a Departure Time: 'p: County Region:Ago
Farm Name: _�� fes/ �G �Tyiwt 5 Owner Email:
Owner Name: ZZ e%p11�t s Phone:
Mailing Address:
Physical Address: Q
Facility Contact: /� /�> C,//,A S Title: Phone:
Onsite Representative: It Integrator•Q h ��
Certified Operator:
I
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Design
Current i*
Design
Current _ f Design Current
Swine "`
Capacityi
V
Pop. - � 'VVetPoul
Ca acity
Po .Cattle~ �Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
n -- _„
Wean to Finish
❑ Yes
Layer Dairy Cow
Wean to Feeder
❑ NE
on -Layer
- Calf
t Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
—Dairy
Dairy Heifer
Farrow to Wean
❑ NE
� -5
Design
Eurrent R D Cow
❑ NA
❑ NE
�s
❑ YesNo
Pi
Farrow to Feeder
[:]NE
It
F.—Op F.-Op
F
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
[]Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
T
❑ NE
e. 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
0 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
❑ YesNo
Pi
[:]NA
[:]NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facility Amber: - Date of Insection:
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 1 Structure 2
Identifier: I
Spillway?:
Structure 3 Structure 4 Structure 5
Designed Freeboard (in):
[�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
[§No ❑ NA ❑ NE
E] No V]NA ❑NE
Structure 6
❑ Yes F] No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (8 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
111ti 1
13. Soil Type(s): &G(. 11
14. Do the receiving crops differ from those designated in the CAWW? ❑ 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 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes In No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [5D 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 EF No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 3 214/2011 Continued

i
FaeWty Amber: jDate of Inspection: 3
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 E�j 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?
Comments;(refer to question#)::•Explain #ny YES answers and
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [�[ No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
(54 No
[DNA
❑ NE
❑ Yes
® No
TD
❑ NA
[-]NE
F] Yes
No
❑ NA
❑ NE
MOM recommendations or a
S necessary,.)•.
St, Q SLV t1Pr„ Vt.,.-J -ib 1c c o;ll I -e4 •
ll I�l I
• C�L[tib,iii,�Oc1 .5�,p;�ij � �`' co e�^':� iAa� pi.;w�.�tnJq
1
rt<ir/liC-4''
Stu« ' rz_VVI 0AX
-v 6Q_l�e�-lel
44, P mss s
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 611v 433- 33x0
Date: 7 / b 7'
2/4/2011

rr
Type of Visit 40 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�,J'�J� ❑ Denied Access
Date of Visit: Arrival Time: V4�r Q Departure Time: ; County: 7 1 ' Ot"JSLRegion:
Farm Name:
Owner Name: 1 C__ 14
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: //- � J CO�zLIs Title: Phone No:
Onsite Representative: Integrator: 5: 3X 1T �'WF�LLC"
/ 7
Certified Operator: It Operator Certification Number:
Back-up Operator:
Location of Farm:
0
Latitude: =
Back-up Certification Number:
Longitude: 0 ° =' = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [.No ❑ NA ❑ NE
❑ Yes
❑ No
E�a NA
Design Current
Design Current
Design Current
q NA
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer I
I
❑ Dairy Cow
❑ No
❑ Wean to Feeder
JE1 Non -Layer I
❑ NA
❑ Dairy Calf
❑ Yes
Feeder to Finish 1 P2 a 84<
❑ NA
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
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 [.No ❑ NA ❑ NE
❑ Yes
❑ No
E�a NA
❑ NE
❑ Yes
❑ No
q NA
❑ NE
P NA
[:INE
❑ Yes
❑ No
❑ Yes
E11- No
❑ NA
❑ NE
❑ Yes
ERN.
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facrlity Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��[r
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 Q No ❑ NA ❑ NE
❑ Yes ❑ No [)�NA ❑ NE
Structure 5 Structure 6
❑ Yes FLNo ❑ NA ❑ NE
❑ Yes PNo ❑ 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?
El Yes 19 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �j No ❑ NA EINE
(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 W 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) 11
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 acre determination ?
❑ Yes
q, No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
fjNo
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
E 'No
❑ NA
❑ NE
I Reviewer/Inspector Name _ �� Phone: C p- q 3 33a I
Ij _
Reviewerllns ector Signature: � /j/l`1 r Date:
Page 2 of 3 f 11/28/04 Continued

` Facility Number: 14 — Date of Inspection tt
Required Records & Documents
19. Did the facility fail to have 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 V9 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
91 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P 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 fp No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
M NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes1�No
[INA ElNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
E�3 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 12/28/04

i
IType of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: —� Owner Email:
Owner Name: _ �f `- ` !' s Phone: _
Mailing Address:
Physical Address:
Facility Contact: r► 'J
, Jeftdr 5 Title:
f'i
Onsite Representative:
Certified Operator: 14
Back-up Operator:
Region: --
Phone No:
Integrator:
Operator Certification Number: 75�
Back-up Certification Number:
Location of Farm: Latitude: ED o =I = " Longitude: = o = I = N
Design Current
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
I�Designurrent
Design Cnrrent
Swine Capacity Poputa6on
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
a. Was the conveyance man-made?
❑ Dai Cow
❑ No
❑ Wean to Feeder
❑ Non -Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Calf
❑ No
Fecder to Finish
❑ NE
❑ Dairy Heifer
El Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
[3NA
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Yes
❑ Turke s
❑ NA
Qther
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
56 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 DWQ)
❑ Yes
❑ No
M 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
[3NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'M No
❑ NA
❑ NE
other than from a discharge?
12/2$/04
Continued

r `
Facility Number: — Date of Inspection
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 ;D NA ❑ NE
Strt}cture i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
41, 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fpNo [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes P No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Gwd RLA w- Co
❑ 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) rfsgw cA&)
_
13.
Soil type(s) _& I
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No ❑ NA
❑ NE
15.
Docs the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1� No ❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
M No ❑ NA
❑ NE
Comments (refer to giiesho #) £xplam any YES answers and/6r ani recommendations or any other comments .
Use dra.3ings of facility to bekter egplain,_situAons. (use additionalpages sa necessary): :
7 -eft ,
Gwd RLA w- Co
Reviewer/inspector Name
_
Phone: - 3- 3G1�
Reviewer/Inspector Signature:
Date: D
11/18104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I 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 ❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[;�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
f 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
U No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej�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
{MNo
❑ 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
E6 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f.No
❑ NA
❑ NE
A'd titYoaal Comments and/or Drawings
AL
Fir
12/28/04

e
Type of Visit ®-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t'(j'pD Departure Time: % County: z&_Sg'^-- Region:
Farm Name:Owner Email:
Owner Name: //. �D +/�,� Cod, rl_5 _ Phone:
Mailing Address:
Physical Address:
Facilitv Contact: f� _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =' = Longitude: = o ET = u
r -Design : . Current Design Current Design Current.
Swine Capacity: Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
fA Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry`
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes DdNo ❑ NA EINE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
1:1Yes
nj No
❑ Yes
Q! No
❑ NA
FINE
❑ Yes
[Q No
❑ NA
❑ NE
12/28/04 Continued

' r
Facility Number: — / Date of Inspections
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LSNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other � y
21. Does record keeping need improvement'? If yes, check the appropriate box below. El Yes 910 ❑ 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
JKNo
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
r No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(K No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
El NA
El 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
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comm6.fi6 andlo ,:DraWiugs
12/28/04
12/28/04

� f
Date of InspectionG�
Facility Number: 4f—
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
LS�No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: "11
Spillway'?: VAS
Designed Freeboard (in);
Observed Freeboard (in): ,� y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
14 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
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
Q4 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
5&No
[:INA ❑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
12. Crop type(s)ZS U
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
54 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![--] Yes
54 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
C_e;"�0_/_ -
Reviewertinspector Name Y✓�' ff s `" >#f > 4fi4'; F� Phone: 5%O-- q�
Reviewer/Inspector Signature: Date:
12128/04 Continued

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 f❑ Denied Access
Date of Visit: W_Crv_k
Arrival Time: A QAo = /►. `Departure Time: County: S'�"' Region: r 000
Farm Name: " + m r Owner Email:
Owner Name• L', y u co [fl [ ris Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
u
Onsite Representative:
Certified Operator: u
Back-up Operator:
Phone No:
Integrator: MUX 9fV4Jt
Operator Certification Number: 17579-A
_
Back-up Certification Number:
Location of Farm: Latitude: ❑ a =I = u Longitude: =0=;
o=` = "
P'Gsign Current
cp2actty Papulation
Wet Poultry
Design CurrentDesign
Capacity Population
CurrentSwine
Cattle C•apa.city Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
a. Was the conveyance man-made?
❑Dai Calf
Feeder to Finish
W NA
1p
❑ Dai Heifer
Farrow to Wean
D Poult
�'
r "'SIR
❑ D Cow
❑ Farrow to Feeder
`�4`-
El Non -Dairy
❑Farrow to Finish
❑ La ers
❑ Yes
El Beef Stocker
ElGila
❑Nan -La ers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Feeder
El Boars
El Pullets
❑ NE
❑ Beef B rood Co
Other .
El Turkeys
El Turkey Points
❑ NA
❑ NE
❑ Other
❑ Other
Number of Structures:
Page I of 3
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
'P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
W 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
P3 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Kft 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) F:e(> 64th
13. Soil type(s) :�.kb
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
Q4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Facility Number:ILI Date of Inspection jfilE� I
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
PU No
Waste Collection & Treatment
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5dNo
[JNA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
T No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
C%NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
$1 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
[]Yes
[SNo
[JNA
❑ NE
through a waste management or closure pian?
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
IQ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Kft 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) F:e(> 64th
13. Soil type(s) :�.kb
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
Q4 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
IT Does the facility lack adequate acreage for land application? ❑ Yes
PU No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5dNo
[JNA
❑ NE
SffAjj _[J_�eS on 64Ck_5"tP 4 (a�Cvoln �u� 6Qt.V, 5f t aj'd
u.nA are— Lard ,
Reviewer/inspector Name I JV Phone:
Reviewer/Inspector Signature: Date: a
Page 2 of 3 12128104 continued

Facility Humber: — Date of Inspection L `1
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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JgNo
❑ NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
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
[K No
❑ NA
❑ NE
Additional Gvmmenf§ and/or Drawings
nk
.�
Page 3 of 3 12/28/04

Oh
• Division of Water Quality
111 Facility Number j 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Oc Gw Departure Time: rd County: —sYJuyy Region: ER -0
Farm Name: V CZ IIJ 5
Owner Name• y� Coons
Mailing Address:
Physical Address:
Owner Email:
Phone: d Sq
64 ws 6/qac
Facility Contact: LIowd CO� �IhS Title: Phone No:
Onsite Representative: integrator:
Certified Operator: li Operator Certification Number: r�sa
Back-up Operator: Back-up Certification Number:
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
Latitude: 0o
[= i= is Longitude: =0=1
0=1 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I[] Layer
T� ❑ Non -Layer
Dry Poultry
❑ La ers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy I-Ieifei
E]Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ED
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 glNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
(PNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
EINE
❑ Yes
PS No
❑ NA
❑ NE
12/28/04 Continued

11. is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes VINO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) 1;%C4.4 C1:Www�
13.
Soil type(s)
Facility Number: —44 Date of Inspection 0
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
Waste Collection & Treatment
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes]
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
DoNo
[INA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[9NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Is there a lack of properly operating waste application equipment?
❑ Yes
1P No
❑ NA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 010
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
1P 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
�4No
❑ 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
El NA
E] NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes VINO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) 1;%C4.4 C1:Www�
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
A] No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
1P 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 ` + jV�p(`%( Phone: U ��
Reviewer/Inspector Signature: Date:
12128/04 Continued

M
Facility Number: L4 — 147 Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 ❑ NE
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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
F No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KINo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
[j 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
V] 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
(d 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
F1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: Arrival Time: bP,` M Departure Time: County: Region: r=&Q
Farm Name: >A-1 �/— Rb_MK # Owner Email:
Owner Name: ! +,fid t [ aft,7S Phone:
Mailing Address: +ahs6ro / 49170
Physical Address:
Facility Contact: Title: Phone No:
t
Onsite Representative: Integrator: „LWo
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
= « Longitude: = ° FT = "
Design CurrenE
Swine Capacity Population
❑ Wean to Finish
Wet Poultry
❑ Laver
Design C•urrentt Design Current
Cap i o�pulahon � Cattle Capacity Population
❑ Da' Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
Dry
❑ D Cow
❑ Farrow to Feeder
Poultry
`❑
Non -Dairy❑
Farrow to Finish
❑ Beef Stocker
❑ Gilts
I
❑ Beef Feeder
Boars
❑ Beef Brood Co—
1 — %7.. [ ..amrOther
Number of`Structures: EE
Laers Non-Laers PulletsTurkes Turkey Ponits
❑ Other
❑ Yes l
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'? (!f 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?
No ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑Yes [:1 No ®NA ❑NE
❑ Yes ❑ No V NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes P
Page.1 of
No
❑ NA
❑ NE
11/18/04 Continued
I Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0

Facility Number: — Date of Inspection T�
❑ Yes
[)d No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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 PNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ Yes
P No
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
P No
❑ NA
Observed Freeboard (in): ag
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
KI 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 EINE
maintenance or improvement?
Waste Annlication
lb. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[19 No ❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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
[)d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V) No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer to question #)' Explain anv YES answers and/or any r�ecomEnendations or any otherkeomments.
Use drawings.of facility to better explain situations. (use additional pages as necessary) -a
Reviewer/Inspector Name j
Reviewer/Inspector Signature:
Page 2 of 3
"4 a-'� Phone: C 3304
Date:
12/28/04 Continued

Facility Number: Date of Inspection .S %
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VTo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 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 M 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
E 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
Cd 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
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
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
C�No
❑ NA
❑ NE
Page 3 of 3 12/28/04

It--......x'-_.k'a...,_ ...... ... ♦�,-- ­�­1 „�'As!'.::'if .� .-,.,.Y - s'....`.._ -n. ri..�- >�. •._..iw^a✓.'. =1{
Type of Visit Q) Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification Q Other. ❑ Denied Access
Facilitt- Number Date of Visit: Time: f f : t:O
F57Mverational 0 Below Threshold
Permitted ® Certified [3 Conditionally Certified Registered Date Last Operated or Above Threshold:
Farm Name:1�, Cs-rnGIL f7-& i County: _ ,S:Tt.� 1:7 0
Owner Name: Rn U CA C. i 1 Phone No: „%SAF '.S -� 54
Mailing Address: 213 ROK 143-A -C - zr IR—
Facility Contact: Iia -'A C a i[ i n Title:
Onsite Representative: Q o u
Certified Operator: _ 13y �4 A (Z:, (1 1 M
Location of Farm:
Phone No:
Integrator: Ch.1`aro I I_ ,L
Operator Certification Number: / '2-;Y L,2
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' Longitude �' �• fes'`
Design Current
Swine Cgnarit Pnnnlstinn
❑ Wean to Feeder
Feeder to Finish I P8
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Po ulation Cattle Cmacitv Population
FQLaver ❑ Da
❑ Non -Laver ❑Non -Dairy
El Other
Total Design Capacity
Total SSLW
Number of Lagoons 0 --1s ubsurface Drains Present Jla-Laeoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 5�No
Discharge originated at: ❑ Lasoon ❑ Sprav Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c_ If discharge is obsmed. what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
?. Is there evidence of past discharge from any part of the operation?
El Yes PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1KNo
W'a a Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SDiltwav ❑ Yes jQ No
Structure l Structure 2 Structure 3 Strucuue 4 Structure 5 Structure 5
Identifier:
Freeboard (inches):
OSIV310I Condnued

FacilityNumber: — 14 1 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 as
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 1z fj.> G l�
❑ Yes q No
❑ Yes ®,No
❑ Yes ® No
❑ Yes No
❑ Yes P No
❑ Yes V9 No
❑ Yes P No
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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on-site representative?
❑ Yes No
❑ Yes 99 No
❑ Yes 15d No
❑ Yes No
❑ YesNo
YM
❑ Yes PNo
❑ Yes [�j No
❑ Yes P No
❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [S No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit

f
Facility Number: — j4 1 Date of Inspectinn I `—
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?
28, is there any evidence of wind drift during land application? (i -e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
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?
Additional Comments and/or.:Draµings.
05/03/01
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes © No
❑ Yes No
❑ Yes ❑ No