090041_INSPECTIONS_20171231

A ��l Al 5 d' () I' �- / -? 6� �
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
090041 Facility Status:
Inppection Type:
Compliance Inspection
Reason for Visit.
Routine
pate of Visit:
106112017 Entry Time: 09:30 am
Farm Name:
Pork Partner; Inc
Owner:
Pork Partners Inc
Active Permit AWS090041
❑ Denied Acxess
Inactive Or Closed Dale:
County: Bladen Region: Fayetteville
Exit Time: 10:30 am Incident 0
Owner gmallo
Phone: [phone]
Mailing Address: 3831 Beulah Rd Clinton NC 28328
Physical Address: 10793 Center Rd Bladenboro NC 28320
Facility Status: Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 33' 47" Longitude: 78° 48' 14"
From NC 211 north by-pass Bladenboro, 1.2 miles west of NC 410/131, turn north on Center Rd (SR11DO) for 0.3 miles. Go east
(right) on dirt road just north of and paralleling Lawrence Brown Rd, road turns north (0.5 miles total).
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other issues
Certified Operator: William A Butler Operator Certification Number. 23269
Secondary OIC(s):
On -Site Representativels): Name Title Phone
24 hour contact name Kathy Barker Phone :
On -site representative Kathy Barker Phone:
Primary Inspector. Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(#):
Inspection Summary:
Calibratin Sept 15 Sludge Survey 10-17-17 #1 0-3.1, P-3.7 36%#2 0-3.7, 3.1 49%
page: 1

Permit: AWS090041 Owner - Facility : Pork Partners Inc Facility Number. 090041
Inspection Date: 10/31/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 7,104 6,400
Total Design Capacity: 7,104
Total SSLW: 213,120
Waste Structures
Disignated Observed
Type identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19.00
Lagoon
LAGOON 1
19.00
31.00
Lagoon
LAGOON 2
19.00
32.00
page: 2

Permit: AWS090041 Owner - Facility: Pork Partners Inc Facility Number. 090D41
Inspection Date: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges $ Stream Impacts
Yen No Na Ne
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did 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 observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Wasia Collection Storage & Treatment
Yas
No Na He
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
■ ❑
❑
maintenance or improvement?
Waste Application
Yea No Na No
10. Are there any required buffer;, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090041 Owner - Facility : Pork Partners Inc Facility Number: 090041
Inspection Date: 10/31/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Xn No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M Cl
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yn No Na No
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090041 Owner - Facility : Pork Partners Inc Facility Number. 090041
Inspection Date: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑01111
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?
❑
0 ❑
❑
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Otdhef Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAMP?
33. Did the Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Type of visit: Q:5rCom fiance Inspection V operation Review V structure Evaluation V I echnical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up Q Referral C') Emergency 0 Other O Denied Access
Date of Visit: r5 Arrival Time: Departure Time: County: 13 t o ew-r Region: ! WO
Farm Name: Poi ELwf te Owner Email:
Owner Name: ���,��L{ate+4rT�{{! Phone•
Mailing Address:
Physical Address:
Facility Contact: !!� Title: Phone:
Onsite Representative: Integrator:y" (� —!57
Certified Operator:Q�. Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
C►►apacity
Current
Pop.
R Design Current
Cattle`, Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
gD
Non -La er
D P-,oult .
I
Ca achy
P,o
Calf
jDairy Heifer
Feeder to Finish
Farrow to Wean
I Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Other
ELOther
Turkeys
Turkey Poults2
Other��
f s
'qy m _
s .a
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
0 Yes to NA ❑ NE
❑ Yes
❑ No
[]' A
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
❑ Yes
❑ No
[ffNA
❑ NE
❑ Yes
[]"No
❑ NA
❑ NE
❑ Yes
6o
❑ NA
❑ NE
Page I of 3
21412015 Contin1J,

Facin- Number: Date of Inspection:
Waste Collection Treatment
_&
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
CB-Na— ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[3-117V-
[] 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
[r <o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[fNo
❑ 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
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E?(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): l7 G.A w[ +L v`[ 0/ ___off
13. Soil Type(s): O
14. Do the receiving crops differ from those desi ated in the CAWMP?
[:]Yes
�o
❑ 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
[rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
J'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r2l o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E!J"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2No
❑ NA
C] 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
[D"'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
o
gNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facifi Number: - Date of Ins ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes Imo'"'o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a Ko ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑Yes N ❑ 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:
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?
CzCbV41 Ib-as'(b
5l4tt- Stla--W7
St..o� rV"00.I sr G J
C
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 2 NNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes KNo ❑ NA C] NE
❑ Yes dNo
❑ Yes Wo
ElYes o
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
C"I wo-,ig- 6 E 51 1
Phone: J ] ` J Y
Date: I SAW
"W—L r
21412015 �-
A

(?6
Type of Visit: OlCompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaintt ^O�Follow-up 0 Referral ,0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I k " "B Il' I Departure Time: l� i ` �� CountyRegion:
L
Farm Name: po k-�, o(.r _ __ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: tj i k6,' ' - Title: Phone.
Onsite Representative: t Integrator: - 49
Certified Operator: r / Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
�O
Non -La er
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oultr.
Ca _aci
to ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
9
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
LjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes CNo ❑ NA ❑ NE
❑ Yes ❑ No [5NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No Q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[—]Yes
❑ NA
ifVNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Faci Number: - Date of inspection: t
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a•Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [a-N7C' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3T)-
5. Are there any immediate threatstothe integrity of any of the structures observed? ❑ Yes © ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [3-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes La"O ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E 1`6 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D_1Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C15� N WL*7 C-1- 1 I G� KAJ P11-10, S
13. Soil Type(s): C.
or
14. Do the receiving crops differ from those/esignated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes U?Ko ❑ NA ❑ NE
❑ Yes IJ o ❑ NA ❑ NE
[::]Yes Fio ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes D'No ❑ NA ❑ NE
❑ Yes [3"No [DNA ❑ NE
❑ Yes O Io [DNA ❑ NE
❑WUP ❑Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ 1Vo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5 '3 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facilih Number: I - 7T I Date of Inspection: Gn
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M"No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 6/No ❑ NA ❑ NE
the appropriate box(es) below.
M 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EoCo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ 0<
❑ 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
To
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Efilo
❑ NA
❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
CEO]ZNo Yes❑
NA
❑ NE
Comments (refer to question #): Explain any:YES answers and/or any additional recommendations or any other coinments
Use drawings of facility to better explain situations_{use additional pages as necessary}
cr"C6-l0-1 - C(`I(--ILf
r
Reviewer/inspector Name:
Phone: '(_-% S-
Reviewer/Inspector Signature:
Page 3 of 3
'A I "C�
Date: G
2/4A14

0
A
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine � omplaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Oi Departure Time: County:�,�
Farm Name: p l �� �� ,~j� t ifsn G, Owner Email:
Owner Name: , r)-,-, pQ'trr Phone:
Mailing Address:
Physical Address:
Region: f7'i)
Facility Contact: Tie:� h e , Phone:
OnsiteRepresentative: �`� Integrator: %zw'-p 7j/aLCJ�.
Certified Operator: '�j-�� Certification Number: ��'�2LL,
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
7j OqCGIJ
Wet Poultry
Layer
Design
CaMW pacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Non -La er
D . P�oul
I
Design
Ga aci
"
Cticrent
P_o
Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
-
Turkeys
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
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [—]No
D Yes ZLNo
❑ Yes g No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
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.)
E[No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 3 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
EgNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pg No
[DNA
❑ 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 Avolication
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 [A 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 12.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reaoired Records & Documents
[] Yes 1!9 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EEL No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 54-No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ 0 Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: 42-
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 [a Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes P5 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 n No ❑ NA ❑ NE
[:]Yes allo DNA ❑ NE
[:]Yes Callo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes D5 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes " No ❑ NA ❑ NE
y-r-C.rna LU1 +-�100
34. Does the facility require a follow-up visit by the same agency? 3 , qyV- 0 J p_ 0 3 Vb ❑ Yes W No [DNA ❑ NE
Commenf !(refer and/or "any additional recomthendations_or...any other comrnentsi� "
Use drawingg!of facility(o better explain situations (use additional pages' as necessary)
aH.c_ c-0-=►5-r-- Lf L-; ►Ab u,Sf -el ez(_
e2 v-Z0 JI- f .
­7
` SsFew rn d s 1 rv/� r- wmbfr : h _VW o L at VD-5 C2 � d ,e 5 ;
9"1i�'tr5 7_' r- %-5 �.L"�apl ��l ✓adiz
GDvr.,-mil ; � w d ; 04.
Ct
cz/y'7z� a s �K
L�c�T`�
ra����b�
21 N o [. Ufok- .va-^tr SSG✓li S FJ� /a.�i'� /�%�i 7���.�i �`Z �,�~
$1 Oct i-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date. �l4 �333�
21412011

1
� tvision of. Water Qta'ality , '�
Facility Number ®Division of Soil and �4'ater Conservation
Other Agency_
Type of Visit: ()-Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: altoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: // Arrival Time: D: vo Departure Time: County: s&eje.•^--
Farm Name: 9✓ I Lz !1s C Owner Email:
Owner Name: _PQ4_1 l�� v•r-tS �Y �G• Phone:
Mailing Address:
Physical Address:
Region: F9 D
Facility Contact: W I . e.�:--L. r/ Title: Phone:
Onsite Representative: �_5A —C _ Integrator: _MC1,1wI1
411
Certified Operator: i��.-cam Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design` Current
Swine Capacity Pop. Wet Poultry1 Capacity Pop. Cattle
can to Finish / o -/fliZI Layer airy Cow
Design Current
Capacity Pop.
Wean to Feeder
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P.oult . Ca aPo .
La ers
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
`
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ 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
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
JNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
(25-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ;��No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ 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
S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
g Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [allo ❑ 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): �e / 0 U �/`�j -r �,j / �rS G we
13. Soil Type(s): C � / , / /--
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 70 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes allo ❑ 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?
Reauired Records & Documents
❑ Yes CE No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
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
� No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
0--Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JKNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes $D 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:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
31 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 I!g No ❑ NA ❑ NE
❑ Yes C& No ❑ NA ❑ NE
❑ Yes 5� No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
[:]Yes ®.No
❑ NA ❑ NE
❑ NA ❑ NE
[:3 NA ❑NE
Comments (refer to question #): Explain an YES answers and/or any additional recommendations or any other comments.-_ N
Use drawings of facility to better explain situations (use additional pages as necessary): �,mct
�� �Jry car
"'�r i L
Reviewer/Inspector Name: -; —,' Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: p2 z
21412011

'1
Type of visit: Qompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name!( Jai p!S Z77'y'c, Owner Email:
Owner Name: � eft -p,:, r-j�j �- i� .-r-7h a< Phone:
Mailing Address:
Physical Address:
Region: �fZa
Facility Contact: ;,,r- Title: Phone:
Onsite Representative: <<- Integrator: �Jtti`L
Certified Operator: Certification Number: p23��v
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design. Current Design" @tirrent
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pops
Cattle Capacity Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
I JNon-Layer
Dairy Calf
Feeder to Finish 71011
��-
Da' Heifer
Farrow to Wean
Design _ Current-
D Cow
Non -Dairy
Farrow to Feeder
D . P,oultry Ca act Poi
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection:
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[0No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
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
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
E�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 XQNo ❑ 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): 5 rin l& /�7.�-ram
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Callo
[:]Yes allo
[:]Yes [&No
❑ Yes EINo
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes (INo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - = jDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes Eg No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/orany additional recommendations or any other comments , ,l
r
Use drawinas of facility to better explain Situations (use additional pages as necessarv).
// -S P /`Y ! F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0
Date: — 13
21412011

11
Date of Visit: - Arrival Time: O D Departure Time: ; 3 County: 4?5jcxgj6-K Region: 144�Z
Farm Name: rfC Far'-t-AL-r-4 ,�� Owner Email:
Owner Name: P I -A "! , Phone:
Mailing Address:
Physical Address:
Facility Contact:` %�irs �/ % Title: Phone:
Onsite Representative: �Jtte-�� Integrator: f
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C**opacity Pop.
Wean to Finish
La er
JNon-Layer
j
Dairy Cow
Wean to Feeder
0p 11
Dairy Calf
Feeder to Finish
Farrow to Wean
rrent
Mi
Dairy Heifer
D Cow
Farrow to Feeder
U , PnultrvPao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
O.the
ITurkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®No DNA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
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
[S No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: -I Date of Inspection: Q--
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 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
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.)
Mo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes la, No ❑ NA ❑ N E
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
t@ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 � No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eg 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?
❑ 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
Lg[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. W Yes ❑ 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
Pine 2 of 3 21412011 Continued

Facility Number: Cy - Date of Inspection: P7--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No eN�A ❑ NE
+ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A -No 18 A ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[]Yes
® No
❑ NA
❑ NE
�] Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Q�No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 101 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 14 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes R1 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer ;to question ft E-xplai any YES answers and/or;any additional recommendations or any other comments
Use drawings of facility to better explain`situations (use additions t aaes as neces§ark).'
A IR?4 le,%l
7-11
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q -L 3 3 a
Date:
21412011

Type of Visit �mpliance 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: i Jc7 County: r Region: f TQ
Farm Name: r r Owner Email:
Owner Name: rp K tzi _�� G• Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: _/i?G4007"-41-
Certified Operator: _ !/y! II ; a�-L !� c -�/ Operator Certification Number: 4zja69
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E__1 o E--] ` =" Longitude: ° = I = u
. _ Dp tg Curre Current
,Depstg nt
t y Pslg ty purrent a
$wine Ca ae� 1pulaiion Wet Poult . Ca aciPo ulation Cattle Ca aci Population
ty
'
❑ Wean to Finish
10 Layer
❑ Dairy Cow
s:
® Wean to Feeder
%/4
700D
10 Non -Layer
❑'Dairy Calf
Feederto Finish
- ❑ DairyHeifer
❑Farrow to Wean
__
Dry Poultry` ❑ D Cow
F ❑Farrow to Feeder
-` Non -Dairy
n ❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts❑
Non -Layers ❑Beef Feeder
El Boars
Pullets
❑Beef Brood Co
Other Lws-:
❑ Turkeys
❑ TurkeyPoults
.4-: :
Other
❑ Other Number of Structures:
FD❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5[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 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
JR3-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;&No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): } g
Observed Freeboard (in):
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 EgNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes RNo ❑ NA ❑ NE
❑ Yes (ZkNo ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19No ❑ 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 [K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PINo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes C-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)r-
13. Soil type(s) G' jv Z ��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
R1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
5�No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes
W-No
❑ NA
❑ NE
Reviewerfinspector Name € Phone:
Reviewer/Inspector Signature: Date: � ��j —.-� //
Page 2 of 3 12128104 Gomfnued

r
Facility Number: — Date of Inspection
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 appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Cl Yes allo ❑ 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
NNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
OLNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ 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
❑ Yes
[R: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?
[I 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
R No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
21 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
I Z128/04

f
FaciLty'Nu!nWr, 9 f
Type of Visit O4 ftpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01(0_Utlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Datc orvisiu 3r-1 D Arrival Timer Depanure'Cime: 3D Counh: h 1 C!L Region: ��
Fat -in Name: FOf' !k_ z? e 4 S -Trit r, Owner Entail:
Owner Naine: ��fk iaa� ,-r s /�i9P_.. Phone:
Mailing Address:
Phvsical Address:
Faciliity Contact: w<<11 i aaqciKt4_z­— -l''it/le: Phone No:
Onsite Representative: e u /`Oi _—i'I_ integrator:
Certified Operator: _ J1 rA'►^—_ a t�{//� _ Operator Certification Number:
Back-up Operator: cL. ( Daz r- Back -tip Certification Number:
Location titFarni: Latitude: ❑O E_1' ❑" Longitude: ❑o [=§
Swine
Wean to
U Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
%%dam 3"SrOO I ❑ Non -Layer
Dry Poultry
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
❑ Daig Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiTy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Covid
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 � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D�No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: - Date of Inspection —3 J O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stricture 2 Structure 3 Structure 4 Structure i Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �/2-
Observed Freeboard (in): 3 T 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,K 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 Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions"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
IR No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[AND
❑ NA
❑ NE
maintenance/imptovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil types)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[] Yes
JgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�Z 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):
p2 J, U ti1
01
fee,' : n >r
LI:
Reviewer/Inspector Name Phone:lp�-�i� 3 3
Reviewer/Inspector Signature: Date: 2 /�
I2/2SIU4 Continuea

Facility Number: — Date of Inspection -�3l
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? RYes 107o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 19 Yes PEKZ ❑ 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
Ballo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E.No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®, No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
91 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
KC No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12128104

� 1lgs 5 h i l o TV
%Division of Water Quality
Facility Number q 0 Division of Soil. and Water Conservation
0 Other Agency 11
Type of Visit .1$ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: a^ /7 County: Y[ Region:
Farm Name: Pc 4 PAtfL. lie, �- Owner Email:
Owner Name: P&k Paf�$1 [ Phone:
Mailing Address:
Physical Address:
t
Facility Contact: 1 Title:
Onsite Representative: S
Certified Operator: h4 6 1'a.
1-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
dna,Pr Phone No: 49! Lt3 q3
Integrator: /rphj Q
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` = Longitude: = o = 1 ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Ekl
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 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
H No
❑ NA
❑ NE
Cl Yes
'UNo
❑ NA
❑ NE
12128104 Continued
z

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E�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): a
Observed Freeboard (in): gib
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tj�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
CijNo ❑ 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
CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
CRNo ❑ 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
99 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JE�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops�differ from those designated in the CA W M P?
❑ Yes
R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�allo
❑ 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 MAW S Phone: [4,313W X.3333
Reviewer/Inspector Signature: Date:
121281011 Continued

Facility Number: Oq— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
- the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UjNo ❑ 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
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
WNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
qNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
$jNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®-NO
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�TNo
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
❑ Yes
R-No
❑ NA
❑ NE
Additio7--A
na1,CbmmenN an-." Drawm s
1? Fes'
�al�Sl�$' .st�(�e siwve ,e-d A- ieaa
Cali bte4i w; [I be- n�lPd i� a© ro .
E ,.f
Zh�a�a)I SO `F1* 7 (Dqu) . Pose Ure4 lewb o, Q609-oil aw
Aso field (� s shor�t� �n 2 w y(.
Page 3 of 3 11/18104

Facility No. 0q G04I Farm Name / F'erf you Date
Permit COC
OIC_ NPDES (Rainbreaker PLAT Annual Cert )
FB Drops
Spillway ���---
Sludge Depth (ftL 1/16
Calibration Date
Design Flow
MUNCIE. Lrr,������■�■���■i■�
Soil Test Date �1II4
pH Fields
Lime Needed
Lime Applied uXor f
Cu Of }�y1�L�•� la�
Needs P
Crop Yield 0�-K J410yi-
Wettable Acres ✓
WUP ✓
Weekly Freeboard �r
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box o incinerator
Analysis-DateWaste
©m .�r;��
�l:
►�r.�
f/ R &iw- f
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
e- S
D3
—SP
r
G
'
7
r-}{
5-
S
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 1103 Date last WUP at farm
FRO or Farm Records
Lagoon #`�
Top Dike 5a
Stop Pump qb!
Start Pump �$
1,7�+
App. Hardware

r
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i I �y�,, Arrival Tijrne: q.c Departure Time: County: Region:
Farm Name: �1•U/1k- orr • 71 c, Owner Email:
Owner Name: W Mwt B h ne• O_ 8' r q3_
Q3 Oh
Mailing Address: 3 3 V c i 83 h
Physical Address:
Facility Contact: Title: Phone No:
1vr'ct, �1
Onsite Representative: Integrator: NN'{Q�Yn
Certified Operator: MC�l .. Operator CertificationI/Number: o-}c3a
14k-up OpeatobO � 1tT' Back-up Certification Number:
1 -6t; sy 01 Wfn Gtr lbaa%y AWA QNYR
Location of Farm: Latitude: o ' Longitude: ° "
Design
Current Design Current
Design Current
Swine Cap�cty
Popviation Wet Poultry Capacity Popiation
..�
Cattle Capacity PapulaHon
❑ an to Finish
❑Layer
❑Dai Cow
Wean to Feeder
❑Non -Layer
❑Dai Calf
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry,P;onitry
_
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
Other v
- ❑Turke s
' El Turkey Poults
❑ Other
1! " ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5J�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 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
MINo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
19-No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

* Facili t}' Number• Q `00qDate of Inspection 0
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 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: a
Designed Freeboard (in): , Q
Observed Freeboard (in): 4o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop typep
s) �M(14ayo Gfm 43&w (6foxf)' S[ 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ER No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
bg No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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 ZTnan. h�1•fQ Phone: lO— 433-333-3
Reviewer/Inspector Signature: Date: m Ili)
V 121281041 - Continued

Facility Number: Date of Inspection 1 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CKNo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Eff No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
(SNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�;tNA
❑ 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
❑ Yes
JR 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
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CRNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
N'No
❑ NA
❑ NE
Comments and/or Drawings:
a�, Yvos�e,�! AtnalysiS 94� of-Frorna�s Ins�n�l�fl~ aDo J
Analysel are. Jooat-. -'Fotiwo rnw+hs e065 dt esca of k
ay, Ca It�r�1�'a, dcx+e 1oIo3io(,will ntek4obe_dve_ b Oc`rapoe,
a�. s vd Swvt d me.`9Or' a00% 1 P1aW8 cSsty Sh -"-
L��i�t►�r�tzvle = y.o � La� � /
PQ,r w .�,- r 1` Zole. below 4 f +will i*V-clea,o�'f~
12128104

"'iSOa- 4316
Facility No. _gyp, 00L, I Time In q� I Time Out Date's ; 7 r oe S'1�7 6a;
Farm Name fUr P $ I r►e� Owner
Owner BIMS Address & Phone Cell Phone
Site Rep Integrator HIP Operator 14jfi6&AW No.
Backup No. BIMS OIC No.
COC Circle: General or NPDES (Rainbreaker PLAT Annual Cert )
Pop, Type I Design I Current I Pop. Type Design Current Pop. Type I Design Current
L_ T3MO I L .1—. d
IBM
Slud - Survey Date
S"-Tv Y— Y'A r/ ">11 `- io +r
yl 1w Kew- ► "'--'y�4 Sf (M-11 �
Soil Test aDAI8 Crop Yield _L 120 min Inspections
PM Fields ✓ Lagoon Rain Gauge Transfer Sheets
Lime Needed —014 R&I— Weekly Freeboard Spray/FB Drop
Cu Zn fl�khob*Rainfall >1"
Wettable Acres 1 in Inspecti s
W UP I.,**- Coe m4avly a-)
h 2e��
Club-roo �ia�,
• Ili
/
la
Pull/Field Soil Crop Pan Window
.`g64
-�� -
Comments

a
(Wivision of Water Quality
Facility Number U E -1 �_� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit tD-Co-mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 41foutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1� Arrival Time: Departure Time: ��S County: c-A t&1r_­L- Region: fl_ A
Farm Name: - Owner Email:
Owner Name:Tet/2t ✓ _�is G . Phone:
Mailing Address:
Physical Address:
Facility Contact-
; gg, + ,Slg� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
tto �
Phone o: (a `+� l7
Integrator•
Operator Certification Number: 42?_&2?
Back-up Certification Number:
Location of Farm: Latitude: =0 01 =u Longitude: [=o =, = «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non-Layen
❑ 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
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 C.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
99 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Ej
Facility Number:—
t
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): �/2
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
El Yes El No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes JKNo ❑ 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 0 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 ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
gNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) t-
13. Soil type(s) C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JgNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9 No
❑ NA ❑ NE
18. [s there a lack of properly operating waste application equipment? ❑ Yes
12 No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a� dVr_-Aj___
0, f- r YPX/
n / _
Reviewer/Inspector Name Jlx-
B^-+ Phone: g'/D lD
Reviewer/Inspector Signature: Date: y'�aip7
rZ./ZG/UV q-0"Isn"C"

Facility Number. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JO No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 19Yes 2 No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JR No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
f &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
J9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ECompliance Inspection Q operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: .' 0 Departure Time: County: Region:t?
Farm Name: DTI T a! �f1 L iC!; �i1 G . Owner Email:
Owner Name: PO CL Pcxr7—n wry Phone:
Mailing Address:
Physical Address:
Facility Contact: wr l b ak-t- B.6&1.--/`- Title: Phone No:
Onsite Representative: se."� Integrator: 1je�a&
Certified Operator: -S�" �� Operator Certification Number: 12 7.12 1. 9 _
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ d 0 tl Longitude: 0 0 ❑ ` ❑ u
INC.-tirren'
Design Elva
esign Curren
Swine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ We to Finish
❑ DairyCow
Wean to Feeder
EOMM"oEnLa er
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry '
❑ Layers
❑ Dairy Heifer
El Dry Cow
El Non -Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
El Turkeys
Other
❑ Turkey Poults
❑ Other I I
Number of Structures:
❑ Other
IPA
Discharges & Stream Impacts
'_ a �!
1. Is any discharge observed from any part of the operation?
❑ Yes
a No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
J4 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
allo
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2g No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: -
Date of Inspection ®(a
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: 0"
Spillway?: !`' d- a�
Designed Freeboard (in):
Observed Freeboard (in): 3�L
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No
❑ Yes 0 No
Structure 5
❑ NA ❑ NE
❑NA ONE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JR 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 t ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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) 1� r��i/71L1�o� �'rri�7� I11fSCG1 �'s�a-zr�� 4y1PrS�e-d _
13. Soil type(s) G P
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EX No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [KNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes LKNo ❑ NA ❑ NE
Comments (refer to question #): Explain:any:YES answers and/or any recommendations*or=any
Use drawings of facility to better explain 'situahons. {use addEt ooual pages as necessary)_
other comments A�
i
Reviewer/Inspector Name d,:
Phone: 970 —4�T3—.3 T DO
Reviewer/inspector Signature:
Date: OCR
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection y—_
Required Records & Documents
19. Did the facility fail to have 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 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis f & 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 b4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No S&NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F1No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 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
91 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
0 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
[R 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
CR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JD No
❑ NA
❑ NE
Additional Comments.anftr Drawings:.
Page 3 of 3 12128104

Type of Visit a Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: I iQ-Z%- 03 Arrival `Time: / d a Departure Time: County:
aleJ-
Farm Name: Afg_LL�A1,f r-5�✓G �..V• Owner Email:
Owner Name: `fj DI'1<-__k4AfCYS Phone:
Mailing Address:
Phvsical Address:
Facility Contact: /Su f/G✓ Title:
Onsite Representative: T r�
Certified Operator: r t11�% �.A=_ ��✓
Back-up Operator: V► t+. Auv d e-AJ
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Phone No:
integrator:
Region: A-�-
Operator Certification Number: Z _32
Back-up Certification Number: �?$
Latitude: = o 0' E� u Longitude: = ° = { =1 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
11 ❑ La er
on -Layer
Other
❑ Other-
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of. Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes 9No El NA El NE
❑ Yes
(d No
❑ NA
❑ NE
❑ Yes
CO No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
J9 No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 09- yc Date of Inspection Ve-ZI -
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?: p
Designed Freeboard (in): -�—/
Observed Freeboard (in): _ -3:!
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
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 X 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 K 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 19 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 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
R3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JX No
❑ NA
❑ NE
men re any SES answers and/or anyecom�mendations or any other comments.
Use drawl gs�o�fRacrn situations. (use`don gages.as necessary):
Reviewer/inspector Name l
Reviewer/inspector Signature:
jC : , e j/e a; .. Phone: NAV f 46
Date: 1,0_Z6
I2/l8/04 Continued

i
L
Facility Number: Q Date of Inspection 0- U `Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
EN No
❑ NA
❑ NE
El Yes
El No
®NA
El NE
❑ Yes
❑ No
N NA
❑ NE
El Yes
❑No
XNA
El NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
❑ No
[9 NA
❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes [X No ❑ NA ❑ NE
❑ Yes [9No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9No ❑ NA ❑ NE
❑ Yes [dNo ❑ NA ❑ NE
Additional Cotnnilents and/orr Dra`wings.'
12/28/04

r
(Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit & Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: N 1 -Y Time: % 3v
Q Not O erational Q Below Threshold
&I Permitted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name. { Q r �C �a +--� +,ems ...T .^..� ,�_.. _ .. _..� . County: .,-j5 ia ill-V _ ._........ .. �. 1pa.._.
Owner Name: Ph C41 ta' le 8 - 'i 3,9 3
.............._........�......W..._..._.........._.r..........�................. one No: �.....................................
Mailing Address: . ._ ...._ ..w_3 $ 3 � .- -��5� � n �'�.v�• __,� � i �4
_
Facility Contact: /.�.. _ ... Title:. .... __ Phone N*:
Integrator: .. rnSJ! r f'` •= . �.. y °.! ? r' ....�_�..
Certified Operator:... W!., .!..G.t►Y!. ,.. _ �ye`f ��a Operator Certification Number:.4 0?307e4
Location of Farm:
PdSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 < " Longitude • 4 «
DesigaCiirreat,' Dl53gfi Current
Swine Caoacitv..:Pennlatien-Poultry r Caaacitv�. Porialatien Cattle„, _.. _ Cans"s
Wean to Feeder
,nq
-
:'
Layer
El Feeder to Finish
❑ Non -Layer
Farrow to Wean
Farrow to Feeder
Other
Farrow to Finish
Total D-s
' . =_
_ fir
Gilts
Boars
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? LZA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1................ ....... ...................... ..... ........ .....- ---................... .........�.._..... ...__...
Freeboard (inches): d Al <r
12112103 Continued

Facility Nnmber: — Lj/
Date of inspection !/ /1?�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any st actures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
l 1. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &-f-p"uala_R.PgaZ_C�1 I resG�CQ a TQzr�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor lssaes
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes P No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes it No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes W No
❑ Yes ® No
❑ Yes [!,No
❑ Yes Q9 No
❑ Yes Ij No

` Facility Number: -. SI/ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? [9 Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes a No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [M No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss reviewfu speection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes ® No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ® No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. o - q I Oct - 4-3
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
SLtc. 3 'f•..,.�g .
DATE: 7,t �s , 1995
Time: Lk'- 0 5
Farm Name/Owner:
Mailing Address:,
1,r. AdAt S�sa-.
County: tsA DEN
Integrator: C-A TZI Io Phone:
On Site Representative: Uon Phone: R.t.o Six- -- --X 1
Physical Address/Location: SR I t a _> %-J UC- Z.t t k 55
o 1 t r. -
Type of Operation: Swine Poultry Cattle
Design Capacity: -2-- Number of Animals on Site: O Tom• s d�-t"e..
DEM Certification Number: ACE,.--DEM Certification Number: ACNEW
Latitude: Longitude: ° —
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient
(approximately 1 Foot + 7 inches) es or No
Was any seepage observed from the oon(s)? Y
Is adequate land available for spray? Ye or No
Crop(s) being utilized: c p G 1
0
t freeboard of 1 Foot + 25 year 24 hour storm event
A tual Freeboard: ';k Ft. & Inches
es oi No as any erosion ob5cved9 Yes or 0
Is the cover crop adequate? Yes r No
L
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell in 9 "e,�or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or to
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: No Yes or
Is animal waste discharged into water of aW state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management r (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: �j N"V"'s let V 4
�y
Fo I— CkK k. Cre�ci{: o r. - lL V �J`� i �..j �-o c�lte..CJ►
LA" 7- Q6.b� {�{'
Y `-
`
L b `r
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

FORTE CAROLnU DEPA27 K—R�r-7 OF LVr--F-L0N-X-2=-, REAL = & NAT',ira.L. AD_-SOunCS
DYYIs=C .N 0? MrrZ— Oh.-7N--AL
Fayetteville Reg'_ccal Office
Animal Operation Co--?lia.ce Inspecticr. Farr
`N'm,-ZR
All questicns answered negatively will be discussed in s-fficient det__I in
the Co=ments Section to enable the del.ed Pe=ittee. to perform the appropriate
ecr_ect_ozs:
SFL`T2C7ti I
P.-'--al O=eration Tvoe:
Ec;ses, cattle, :rive pcult--y, or sheep
E'ZC 'ION II
Y I N I C0 4Tj S
i . Does the n= er and tyre of anmal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 bids with liquid vase
system)]
2. Does this facility meet criteria fc=
Animal Operation gEcISTRATTON?
3. Are animals confined ned fed or maintained
in t'sis facility for a 12-maath period?
4. Does this facility have a gnrn= AN72.Ax,
WA.STZ x8McamzNr »m
5. Does this facility maintain Waste aanagement
records (Voluaes of marura, lard applied,
spzay irrigated on specific ac=eage With
specific cover =op)7
6. Does this facility meet the SCS
setback criteria for neig:'..�c:_: g he•.i.ses,
wells, etc?

FOR= CAROLMNA DEPARMC—M ; OF MrZR0NY_M%, E?A.`,' & NATURAL RZ50 R=5
DIVIS=4N 0? ZVM6_ Ma'r�_AL MAUXAp-M'?�c�
Fayett2VIIlle Rey_cca? Office
Animal Operation Co-_plia.=e Taspecti= Paz---
.K.►r�I
A1l. questions answered negatively will be d{sc-- sed in s::Fficient detall in
the Co.L.ine-•its Section to enable the deer.ed Pe=ittee to perf:ora the appropr ate
Corrections:
Ani=al Onaratior. Type:
Ecrses, cattle, wire, poultry, or shaep
S2'Iax II
Y I p I Co?^s'�s
1 . Does the n er and type of areal meet or exceed
the (.0217) criteria? [Cattle (100 head),
hcrses (75), swine (250), sheep (1,000), and
Poultry (30,000 bird- with liquid Waste
systen)] `
2. Does this facility meet criteria for
Animal Operation R90,.STRI4TI T?
3. Are animals confined red or maintained
in t'iis facility for a 12-month period?
4. Does this facility have a CERTZFTM SAL
WAS Z MlrkGZMMCT PLAN?
5. Does this facility maintain waste management
records (Vol=es of manure, land applied,
spray irrigated oa specific acreage With
specific cover crop)?
6. Does this facility meet the SCS mini
setback c=zterla for meig:3cri:7 hcases,
Wells, etc?
A1l. questions answered negatively will be d{sc-- sed in s::Fficient detall in
the Co.L.ine-•its Section to enable the deer.ed Pe=ittee to perf:ora the appropr ate
Corrections:
Ani=al Onaratior. Type:
Ecrses, cattle, wire, poultry, or shaep
S2'Iax II
Y I p I Co?^s'�s
1 . Does the n er and type of areal meet or exceed
the (.0217) criteria? [Cattle (100 head),
hcrses (75), swine (250), sheep (1,000), and
Poultry (30,000 bird- with liquid Waste
systen)] `
2. Does this facility meet criteria for
Animal Operation R90,.STRI4TI T?
3. Are animals confined red or maintained
in t'iis facility for a 12-month period?
4. Does this facility have a CERTZFTM SAL
WAS Z MlrkGZMMCT PLAN?
5. Does this facility maintain waste management
records (Vol=es of manure, land applied,
spray irrigated oa specific acreage With
specific cover crop)?
6. Does this facility meet the SCS mini
setback c=zterla for meig:3cri:7 hcases,
Wells, etc?

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