090045_INSPECTIONS_20171231

_ -
=ci
i�, - ®Other Agency
Type of Visit: om nee Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: `lt{ Departure Time: x County:' 12 c/Cc ( Region:
Farm Name: R L -?-- Fa.,rxts L LC- Owner Email:
Owner Name: le Phone:
Mailing Address:
Physical Address:
Facility Contact: av`+l S 13ao I -A i Title: Phone:
Onsite Representative: 1 Integrator: f " f�` S
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
do r.1
Certification Number: !� 7 Z'
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
Wean to Feeder
Feeder to Finish
b
ppb
Farrow to Wean
Farrow to Feeder
D . Ponitr.
Design
Ca aci
Current
P,o
Cow
Non -Da'
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Caw
Other
Other
- r. ..
Turke s
TurkeyPoults
Other
Discharees and Stream Impacts
i . Is any discharge observed from any part of the operation? ❑ Yes [�❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [f IAA ❑ 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 0 No E j N ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ENo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faci�i Number: - i IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [I-bio—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-K7C_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 21f W -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [Zla?6- ❑ 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 [r '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 M`ee ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0-1qo_ ❑ 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 [�-1 0� ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �o ❑ 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 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 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
[]-1do`
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
YesgApAo
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Tlq-o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LS11u
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�J
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�-I�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E�J ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q-No— ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑"Iqo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ivo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facigty Number: - 5 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ _N1,o ❑ NA ❑ NE
y
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �`1 oo ❑ 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 e<o— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�o ❑ 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?
0 Yes [:,X1 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ED-Ne- ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
0 Yes
Eg-Nn
[] NA
ONE
❑ Yes
u go
❑ NA
❑ NE
❑ Yes
Oslo
❑ NA
❑ NE
-2- U _ L(, 9 �� -3. 7-L,
L'AffJ
'1 �"r U �r-c�Q c��-�o log
C 4 "A't/6"'e C'f-W
Reviewer/Inspector Name:
Reviewerllnspector Signatut
Page 3 of 3
Phoneooa
Date: i
21412 15

C�J1)ivision of Water Resources
Facility Number yS ® Division of Soi! and Water Conservation
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
treason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 a �L_ Arrival Time: Departure Time: t County; tea_ Region:
Farm Name: r—ge it r. G Owner Email:
Owner Name: FUc ✓m- Phone:
Mailing Address:
Physical Address: }}
Facility Contact: elTitle: _ �,�} r rT Phone:
Onsite Representative: Integrator: 5tlei
Certified Operator: CS'— Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
-
Design Current
Design
Current
Design Lurrent
Swine ; :
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
(Layer
Dairy Cow
Wean to Feeder
LENon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultr.
Ca aci
$o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther-VI=- ��
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ®No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No
[] Yes EigNo
❑ Yes E3-No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3
e
21412015 Continued

Facility Number: - Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: F, ,.
Spillway?:
Designed Freeboard (in): _ r�
�
Observed Freeboard (in): rZ'o `)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes f !.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 [Z 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 E, No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F;1 No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 7
9. Does any part of the waste management system other than the waste structures require axes 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 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): /5r2ejM t?Jet hyrV�Srd %
13. Soil TYpe(s): �y0, r' s _0 ^f j / i nh f / a u rr�-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ^MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0—Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes E9,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 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �;LNo
❑ 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 5jNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Wo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: (n 3 C)— f 71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®,.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M--No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
f�r Ta 6''
7-5
7
qvi,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ Yes [E No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes rNo 0 NA ❑ NE
[:]Yes 64 No
❑ Yes Ej� No
❑ Yes 29-No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 2/0—_3to
Date: _b /
2141201 S

S' 3--.� 3 -,70/b
Type of Visit: om Hance Inspection C5 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: nJ Arrival Time: % Departure Time: ' 3 County: Region:
Farm Name: �j rQe'n' /�G Owner Email:
Owner Name: /;K >-a/rm l % C. Phone:
Mailing Address:
Physical Address:
Facility Contact: Z L 'f Title: Nwo e / _ Phone:-lo%JT�—
Onsite Representative: G�—
Certified Operator:
Back-up Operator:
Location of Farm:
s�
Latitude:
Integrator:, J
Certification Number:,9z�f�
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
11
Design C*urrent
Cattle Capacity Pop.
Daig Cow
Dairy Calf
Wean to Feeder
INon-Layer
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Q
Design Current
D ROnI Ca aei P,o
I ILayers
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Lit
Boars
Other
Other
Pullets
Beef Brood Cow
Turke s
Turkez Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JR] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 tAYo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412014 Continued

Facility Number. - Date of Inspection:
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
WCA Yes
[—]No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[;q No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
��f@
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f1 /3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg No
❑ NA
❑ NE
(i.e., Iarge trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R 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
fo 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): s[h�r�1 C�u r/��rir [ �i✓SGLI v/ Tr�s+:X�d�-y'1-"",
%��r�
13. Soil Type(s): _461n a✓=n ��DI`r'S_ �- / / i�r)lr-
�ArwA
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
io No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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
R 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. ED Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard 60 Waste Analysis Moil 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility number: - Date of Inspection: i /d
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vj 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 fZ 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
f_-
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 CAVrW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes JZ] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
EK Yes
❑ No
❑ NA
❑ NE
�
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3 r
Phone:
Date:-
2/4/2014

Facility Number: — I Date or Inspection "6
C1i1
for
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0�' � � ✓ / lf'�-r %�! �7/('./!�� I/� Yam` � r�
fA
7/25/97

,/ l-I.S-
Type of Visit: ADTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4EY-fCo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; o Departure Time: 3 ! 3 County: Region:Q
Farm Name: ELL I,ry Farm J4f, Owner Email:
Owner Name: )'5'ro . G Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: &D4.e,,v1ed`- Phone:
Onsite Representative: Ste_ Integrator:
Certified Operator: -If- Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrentQ.
Design Current
Desigt, Current
Swine
Capacity Pop.
Wet Poultry Capacity
a
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11 INon-Layer
I
a' Calf
eeder to Finish
/ GD
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,o_ul Ca aci P.o
Non -Dairy
Farrow to Finish
ILayers
—
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
tithe
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
5�4_No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
23-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E2� 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:a
Spillway?:
Designed Freeboard (in): �}!
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z 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
[DNA
❑ 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?
S-Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 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): _—/7
13. Soil Type(s): _ x/ ' �•wr_.L /��_n S,%Tk /7'!/�%�Y.
_
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
S No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
l8. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
[-]Yes C&No DNA ❑ NE
19. Did the facility fail to have the 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
allo
❑ 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.
aYes
❑ 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
2, No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes fC No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

-[Facility Number: jDate of Inspection: —t/7 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes V�No ❑ NA ❑ NE
❑ Yes No
[:]Yes ® No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain :any:YES-answers and/or any additional recommendations oranyother comments .3 =: F>
Used swings of facility to bettei ;ezplaiw tuat►oos (use additional pages as necessary).
l't-CLoi�— SCrrc �
T�
s' /72�ccJ /
�dr✓L (tea : �'�i �'"„ �QS�t� 5 t S ; l J� •'xa•� �t J�f-,.�
L
m61-n
f� y
Reviewer/Inspector Name: Phone: jp y 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

i ypc ui visit; %,-r-ompuance inspeeuon l.J vperanon xeview V arrucrure nvamanon L,j r ecumcni Assisrance I
Reason for Visit: Routine 0 Complaint . 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l/ 2— Arrival Time: !7 Departure Time: County: Region: t7
Farm Name:CG Owner Email:
Owner Name: Dx yi,;�.:� 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 4p 11 Ir-e-
Onsite Representative: Integrator:
Phone:
Certified Operator- , Certification Number:
Back-up Operator;`; -
Location of Farm:`
Latitude:
Certification Number: 22
Longitude:
Design Current
Design
Current f
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop:
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
Non -La er
I
Dairy Cow
Dairy Calf
cZ
Feeder to Finish p
Dairy Heifer
Farrow to Wean
Design
.Current -
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,o_uI
Layers
@a aci
plan.
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
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 J4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No ❑ NA 0 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 F1 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 5�,No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: /
*� Waste Collection & Treatment
I 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1ID No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the 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 EgNo ❑ 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
[�4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
EjqYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
S No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EA No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
®, No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
J, Yes
❑ No
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard R 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
P!jNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: ZF- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [SNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes & No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other 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)
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
[3 NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA [] NE
❑ Yes [,No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? EaYes
(refer to
se
fn
Erecomn
21 No ❑ NA ❑ NE
M No ❑ NA ❑ NE
[RNo ❑ NA ❑ NE
9: u - ❑ NA ❑ NE
©v�✓`jr�� �''�e�s T i
7
&/,./
r �l�� r n srs
G{
ir�--�
1U`►) 1�iouJ u� i �- �rljipy p2p/S I
/T/L�•ti rJ�r-R /7'147!l1Yp� �—,S�!�j�'�t.'�Or� � a�vZ �3 �cr1- . /ijD� t'�
1'J01V Fa r k'L o F V"'t' ,¢,zdlys;s /==0 '­ `57 ""6
Reviewer/Inspector Name:
Phone: '170—y3,3 330n
Reviewer/Inspector Signature: Date: //-7-,;�p /y
Page 3 of 3 21412014

type or visit: we-it-ompuance inspecnon v uperanon Keview V anmcrure r,vamanon v i ecumcai assistance
Reason for Visit: 4&1outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ='1?D Departure Time: ,'�r� County:
Farm Name: Fig y- L L G Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Phone:
Region:
Onsite Representative: ijl�c �G Integrator: lrrp�y
Certified Operator: _54rrlZ:_ Certification Number:
Back-up Operator: td aGq6.S Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Laer
DaE Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
O
Dairy Heifer
Farrow to Wean
Design
1DrvCow
Farrow to Feeder
D , I;ou1
Ca aei
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
-
Other
Turkey Pouets
Other
Other
Dischmes 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 (g No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ 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 5, No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 54 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

>~acili Number: - Date of Inspection:
Waste Collection & Treatment
`+ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:raK
Spillway?:
Designed Freeboard (in): j 1
Observed Freeboard (in): 42 n-
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CK 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
Ca 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?
C& 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g 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 ®'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
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.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ 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 VLSoil 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 Dg No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: /3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffi No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge?
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?
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?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
CM No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments;(refer to question>#): Explain any YES answers and/or any additional recommendations.or any other comments._;. _ �'
Use drawings of facility to better explain situations (use additional pages as necessary). . .
miqw
Tj«,fC Jr.
U pD F�Dr 7 d— I;L-
r.�yr/��
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: DC�
Date: ._3 -- / .3
21412011

Type of Visit: 49OComptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: C— / i Arrival Time: Q `. CEO Departure Time: �/J : 3� County:
Farm Name: Owner Email:
Owner Name: ,%JfJ��., _ram T r Phone:
Mailing Address:
Physical Address
Region:
Facility Contact: jj h; %��STi�- Title: 6�,Gvh Yr Phone:
Onsite Representative: Integrator: lwpee
.11 le
Certified Operator: U rq Certification Number:
Back-up Operator: 0141 -+ e1ae p1j Certification Number: �g
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
ji I IWean to Feeder
Current
Pap.
Design Current
Vet Poultry Capacity Pop.
esign current
Cattle Capacity Pop.
DairyCow
er
EEJ
Dairy Calf
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
Design Current
u1t r Ca aci P,o
Layers
jNL
Dairy Heifer
D Cow
Non -Dairy
Beef Stacker
Farrow to Finish
Gilts
ers
Beef Feeder
LEI
Boars
Beef Brood Cow
Other
ther
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ®No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [&No
[:]Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 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 [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ) 9 ���,}1
Observed Freeboard (in): _ y 1 —c
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes El No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[Z 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
treat, 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
V1 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
/J ❑ Application Outside of Approved Area
12. Crop TYpe(s) r//rr u.,i I /�u �rsT`�C/ / �'r . Y /i�?nsG4!
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
D Yes
Cia 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
IR No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection: j -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
' . 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [4 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 ERI No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Ed No ❑ NA ❑ NE
❑ Yes tj�_No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
JZJNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
DUo
❑ NA
ONE
Comments refer to question )• Explain any YES answers and/or any additional recommendations or an * com:m'_
�. entsr awnI ofao;etterex lain situations (use additional pages as necessary).Usedrfchty
`LL
X �cr o f ra s �- r• =�"` �''``- �-� }a `-v- d- In Ow L,,*aov, 6,-�s 7T6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: - i/J'3r332C)
Date:
21412011

4�
'l
Type of Visit Compliance 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 ❑ Denied Access
Date of Visit: � Arrival Time: >l • Qa Departure Time: �;2! County: 5 429kLl— Region:
Farm Name: Ej2, 6 4 a!z �a� ! L_ L C Owner Email:
Owner Name: C n O—�b i�r'�' Phone:
Mailing Address:
Physical Address:
Facility Contact: o O h +•+ lT� r—✓"J Title: _ &-, 0? r.. r Phone No:
Onsite Representative: S do u Integrator: lW11,11,eV"`—
Certified Operator: Operator Certification Number: �'9_
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o [= ` = Longitude: Q o = i = "
Dest n
g
Swine Capacity
Currerit r..
Population Wet Poultry
Design Current
Capacity Population
Cattle
Design Current
Capacity Population
ElWean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish %O
❑ Dairy Heifer
❑ Farrow to Wean
_ DryaP©ultry
❑ Dry Cow
❑ Farrow to Feeder
_ 2
El Layers
ElNon-Dairy
❑ Farrow to Finish
El❑Gilts Non -Layers
El Beef Stocker
w
�' ❑Boars
El Pullets
❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
.'
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J.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
Jallo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JO No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: � Date of Inspection O�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P •No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in): — / 9�_.. /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (3 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 [ANo ❑ 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? W Yes []No ❑ NA ❑ NE
&. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5d 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 rpmyes El No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DdNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. IS Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
SPAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JA No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?0-yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2 .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
RC No
❑ NA
❑ NE
Comments (refer to quest a #) Exp,aro oy YES answers andior any fecommendations or any other comments.
x�y
Use drawings of;,facdity�to.,better egplam s�taarions. (use additional pages as necessaryJ.
.
7/1 /lBr.�-L ��.-�r� Nru/ !�t'�-� �T� •-� �-C�ir�ir+� % � �a� / D•
�
Reviewer/Inspector Name_ Phone: 97D'�133
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
i Re uired Records & Documents
• • 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
® Waste Application Weekly Freeboard � Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
® Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
.Yes
❑ No
❑ NA
El 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
V No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 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
[XNo
❑ 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
W 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
BNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
&tYes
❑ No
❑ NA
❑ NE
1 ��a� rrvas ki 0LAe,-_s
Page 3 of 3 12128104

y.5
Type of Visit {9FCompliance Inspection 0 Operation Review G-51—ructure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 01follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
]pate of visit: ��/ Arrival Time: Departure Time: : / j County:
Farm Name: _ ��X�.�n� _ Owner Email:
Owner Name: �7t .� /% G , _ Phone: _
Mailing Address:
Physical Address:
Facility Contact: —Title: Phone No:
Onsite Representative: Integrator: TJ-tLui/�
Certified Operator: %-tom Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 = = Longitude: = o ='
= 11
Design Current
Design Current
Design Current
Capacity Population
Wet Poultry Capacity Population
Cattle Gap,ty Population
an to Finish
toww
❑ La er
❑ Dai Cow
an to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ Da' Heifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑Non -La ers
❑Non-Dai
❑ Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
FoGilts
Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
[.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E3-do
❑ 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?
ayes ❑ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
E Yes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 StructureR
Identifier:'' bo
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 19 19
L
Observed Freeboard (in): / torr�rlJ : fi S �i i •+.. `?'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Cl Yes allo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
® Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ElNo ElNA :F-NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes PgNo ❑ NA f�.NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No ❑ NA EZNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No ❑ NA Q NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
aNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ No
❑ NA
JEZNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
4,NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
?9,NE
►i ' ice !✓� /l%v,, 4;�O� / ,
�/ �J � r r O✓- l-sr�H't�>/' � P T✓i°"'s��"sr /'�✓9'"`.�! // L� %�I'��p4� �
Reviewer/Inspector Name 442� I Phone:
Reviewer/inspector Signature: Date: 4Z $—'0/ /
Page 2 of 3 12128104 Continued

Facility Number: � —�3' Date of Inspection
Required Records & Documents
19- Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes ❑ No ❑ NA L2-NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ENE
the appropiiate box. ❑ WuP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 63�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA E3�NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
EWE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
93 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[RNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
$NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Z�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
B-NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
1
ZI NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
E5NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
®-NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M-No
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
CRYes
❑ No
❑ NA
f>NE
t
Additional';Commeots;andUorMDrawtngs
71, ,v rv. 3&J-_da -- o A/-4i~ JFW LoO w - 0 7-0,, p, �
_
`
7 dG 2077�y�-WaAe Irv$<,• � �-J�" � v?T u� r,-
I
c)WQ Gv % I 1 �r�� ct j''al f� - ct—
eZZI
Y11411-t— YCI
y/vu� ' �17Gusss� T�s � d-ol�� � 7 ; �� f� t-��. / �/ix� �/`ou: ✓,,.d
i � c� Sr� r' � �.�- lv� l� T.�� �5 %✓�e»,.� J�t� Qc-! l � a, %S
Hw
Page 3 of 3 12128104

14
t
Type of Visit ttfompliance Inspection O Operation Review 0116tructure Evaluation O Technical Assistance
Reason for Visit O Routine ® Complaint O Foilow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1.� Arrival Time: Departure Time: G i County: Region: /c-AZ-7
Farm Name: k!1 >���hrc- Owner Email:
Owner Name: �`bk 1 �- Phone:
Mailing Address:
Physical Address: ..�� //``
Facility Contact: !/OX -1 fTn,,L_�.,- Title: �✓` Phone No:
Onsite Representative: Integrator: ZTur
Certified Operator: S'�u _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =' =" Longitude: = ° = f = "
Design
Swine Capty
Current Design
Population ijltry _Capacity
Current Design
Population Cattle Capacity
Current
Fopulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
pry Poultry
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures: a
❑ Layers
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
El Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Boars
Other
❑ Other
I.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 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
❑ 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? 0 Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ,J9 Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure Structure 5 Structure 6
Identifier:. $
Spillway?:
Designed Freeboard (in): / 17 / g
Observed Freeboard (in):
� G nravfc �/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [:]Yes 9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ® Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA KNE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA J.NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [9,NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [SINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ No
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ NA RNE
❑ NA 0,NE
❑ NA .KNE
❑ NA S.E
Comments (refer to question #) lxplain. any YES:;answer�s antVor�anyecommendaiivns ar any outer comments.
aUse d wtn of factuty to bettertexplatn sttuattonsi (use addttto tal pages. as necessary.,):
_ a
c� 7h,:''olnv��+r I�►�+�� / f�.5 ,'.. rim . ����: rya J!,>��% �,k/
A,
7— 4oki Td 8` -ry /o k.,d�
Mow
7—o b,-- 1wrn!�xgnel -I g hr Surr � iJ'i �o✓!��%
Reviewer/inspector Name Phone: 91,a1r rgD '3ro
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection "1099
Required Records & Documents
r
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ❑ Yes ❑ No ❑ NA aNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA JR NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA JQ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
® NE
21
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
PINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
rvl NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
j4NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
EqNE
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
CIE
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
ONE
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
aNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
[[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ayes
❑ No
❑ NA
❑ NE
Additional Comments anwor-Drawin s
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit
ommp�pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
l 40"u- tine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ' /Q Arrival Time: I t Departure Time: ` County: Region: E l�
Farm Name: Je7 =6 CS fie l Owner Email:
Owner Name: f-t69 /J Phone:
Mailing Address:
Physical Address: I
Facility Contact: )�a-r 91 d A ,Title: Phone No:
Onsite Representative: (/�f'/rl�ci� __ arol Integrator: /na"Z01 1
Certified Operator: l n LJ�1�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E:] o ET
EJ u Longitude: [=° [= L= U
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
ID Layer
I
I
❑ Dairy Cow
El Wean to Feeder
❑ Non -La er
I
I
❑ Dai Calf
ceder to Finish
D
E]Daixy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
El Farrow to Finish
❑ Layers
El Beef Stocker
❑Gilts
❑Non -La Non -Layers
❑ Beef Feeder
_
❑ Boars
❑ Pullets
1013eef Brood Cowl
❑ Turke s
Other
❑ Other
❑ Turkey Pouets
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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?
E-Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C'No
❑ NA
❑ NE
other than from a discharge`?
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
Identifier:
Stnicture 2 Structure 3 Structure 4
Spillway?:
DesiLmed Freeboard (in):
Observed Freeboard (in): 3
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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes PS 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? �j Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ER 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 [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) `
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? t} Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination - ❑ Yes
XNo
❑ 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
SNo
❑ 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):
o� Sew 14f r--°
ReviewerfInspector Name � Phone:
Reviewer/Inspector Signature: Date:
I LLA/U4 "nrinueu

Facility Number: — !' Date of Inspection
Re uired 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 19 Yes f.No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. E9 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application 9 Weekly Freeboard ❑ Waste Analysis E9 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[B 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
BNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
10 Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
J l f
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o
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1 7 W,111-r�c.� `t c f'%" ,�ca ✓�Tn`—,
12/28/04

o�oF w A rFR pG Michael T. Easley, Governor
William G. Ross Jr- Secretary
North Carolina Department of Environment and Natural Resources
p Coleen Sullins, Director
Division of Water Quality
January 2, 2009
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Harold Allen
4047 Marsh Rd
Bladenboro NC 28320
Subject: Inspection Amendment and Clarification
Elden Hester Farm
Facility No. 09-0045
Bladen County
Permit No. AWS090045
Dear Mr. Allen,
This is clarification of several problem areas of my inspection of December 31, 2008.
Please file the enclosed inspection revision with the rest of the inspection.
I checked with our Raleigh office and you do NOT have a sludge survey exemption form
on file. You can either file for an exemption for 2008 OR conduct one as soon as possible.
Basically that would be a late survey, and you should do another one in December 2009 (unless
you are granted a rare several year extension). You do not have to use this Sludge Survey
Extension form, but can send a plain language request for an extension. Either way, you MUST
send a COPY of all pages of the sludge survey for both lagoons (including a "map" of areas
sampled). Please keep the original on the farm.
Also our computer system shows both you and your wife as invalid Operators in Charge
(OICs) as of January 1, 2009, due to lack of continuing education credits. If this is the case (and
it may not be), you have until January 31 to obtain the necessary credits or you can retake the
OIC exam in March. One problem is that the computer list was posted on Oct 28,so will not
reflect changes since then. Another problem is that not all continuing education courses will give
you animal waste credits. If you check the invoice for the $10 fee to renew your animal waste
license, it should have on it the credits you need and when they are due. If you have any
questions you should contact the Technical Assistance and Certification Unit (TACO) in Raleigh
directly at [phone].
1 was unable to find any animal waste continuing education courses being offered in
January on the TACO website. However, due to the number of farms in this section of the state,
it is possible some could be offered. The other thing to watch is whether you could get enough
credits to be legal in only one month. Please check with your county extension agent.
The next exam is on March 12 and the application has to be in Raleigh by Feb 10, along
with the $25 fee. The two closest exam locations are Kenansville and Raleigh. An application is
enclosed and I filled out some of the top portion from our computer records, since you might
have trouble locating your earlier exam date. The Commission should accept your earlier ]vo^tiJtCarolina
JVafurally
North Carolina DWQ/Aquifer Protection Section 225 Green St./ Suife 714 Fayctteville, NC 28301 Phone [phone]
FAX [phone] Internet: h2o.enr.state.nc us Customer Service. 1-877-623-6748
An Equal OpportunitylAMrmnve Action Employer - 50% Recycledl10% Post Consumer Paper

license number and exam date, if you can't find the certificate of training. It is not unusual for
operators to lapse and have to retake the exam to regain certification. It would probably be a
good idea to study your manual and check out the rules on the TACU website at
htt J/h2o.enr.state.nc.us/tacu/index.html. Newer manuals are available from your county
extension office for $25.
Assuming that your certification did run out by Dec 31, and you end up having to take (and
pass) the first exam, you would still need a legal OIC to sign off on any spray events conducted
between now and then. Please talk to some of your OIC neighbors and see if one would be
willing to help out temporarily. At this time of the year, you may need to spray on short notice. In
fact, with your lagoon levels, you will need to spray in the near future.
In his inspection of 05/21/2007, Steve Guyton mentioned that you needed to start
keeping transfer records. Unfortunately, I did not notice that previously but I now agree. I
redesigned the transfer form so that it will work for your farm and enclosed two copies. For
surface area, just multiply length and width of each lagoon. If you cannot locate the construction
information, use 91,476 for Lagoon 1 from our computer and 35,800 sq ft for Lagoon 2,
estimated from an aerial photo. I could not find construction data at Fayetteville.
New permits will be coming out in the fall. You will be mailed renewal forms in February
or March and these should be back in Raleigh by April 1, 2009.
1 apologize for any confusion caused by me or other past inspectors. If you have any
questions concerning this matter, please do not hesitate to contact me at [phone].
Sincerely,
*?V�- *-A�
Man Schneier
Environmental Specialist
Division of Water Quality
Fayetteville Regional Office
Attachments: Inspection Revised page 3
Sludge Survey Extension form
2 Applications for Animal Waste Exam
Instructions for above
Revised Transfer Record form

61�S CrV_j 1s-1r,f0
Type of Visit -0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Q` Departure Time: J County: Region: 1
RIO
Date of Visit: la !�� 09 Arrival Time: � p � (}� ty gi
Farm Name: l M Owner Email:
Owner Name: H-rr 1d_ 11GS Phone:
Mailing Address: L10 4 7 ! - a-sh PJ— D lad 41 her p
Physical Address:
1 e ,,�,' Chonyedl�It�rluj54��S�S—iL�
Facility Contact: Title: Le, Phone No:
Onsite Representative: Integrator:
Certified Operator: Iw (d f t lien n aA D1 KC Operator Certification Number: A'A.169a•_
�OchlBack-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o u Longitude: u
Design 0 Current
Swine Capacity Population Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
kq Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Farrow to Finish
❑ Gilts
El Layers
❑ Non-LayBetsers
❑Beef Brood Cowl
Number of Structures:
❑ Boars
El Pullets
LiTurke s
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CE�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes W No
❑ Yes Callo
12128104
❑ NA ❑ NE
El NA El NE
Continued

J
Facility Number: D q — yS Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stricture 1 Structure 2 Structure 3 Structure 4 Structure: Structure; 6
Identifier:
Spillway?:
iib
Designed Freeboard (in): I 1
Observed Freeboard (in): a [ a
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Ckgo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed ❑ Yes
j�kNo ❑ 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
El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5JNo ❑ 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
C'No ❑ NA ❑ NE
maintenance or improvement?
Waste duplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
NrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Crop Window Evi�`d+ence oIf Wind Drift ❑ Application Outside of Area
/c�creptabb/lee
xI ,❑
12. Crop ty*ss)7+�R4 1 jRJ A 1 I t.C�l `1- #&e f V �I 6(UfA OYB(YPP,i RnrG`P_ PLIA,P
13. Soil type(s) �—I) Ll '. LV
14. Do the receiving crops differ firm those designated in the CAWMP?
❑ Yes
I'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D 'Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
15JNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JKNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: O 433
Reviewer/Inspector Signature: Date: j ap 0
IZ'28/04 Continued

Facility Number:jo 2— Date of Inspection I9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RrNo ❑ 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
5JNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
t@ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
09NE
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
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
R NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[l Yes
RNo
❑ 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
Wo
❑ 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
'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�, oleo e, mow 0A'Tde- biA ks on I oon jTwood7 weed . PIe#e, +f;
r S b�yl S,Gt�Q
I���S q�� iT
Is, .3eve-alWelds 91t 01�-Sefa 'ed_ 6,- Oni mowed- Dim Q. 0�,
W� Ar y
a �
dre rnowP� ar, 9c � ��y�fa(
3 y . Ca I i b(a� 01 w ¢r m � s f e . P l-e� �Q� f+ w0411 oln,a- re r a'cJ;
CIS s h otis rn arm g S - � Intact +elf bey
o?S�.S"r��e Survl
PQ �9h �O
Px �►� .
r Sly Is urve141MY�C 1
Q��I 0
ao�t
al, Solt Surge ry w J' 5�+� Dot
r
C000� ` awe( rY�Qr}dl�► meco^cU.
We((
h bet o� aL MS `&- y rnac�h� a�"h o If boo k�-� ha�.�
PIC410cer cha led- cell o e-
com►� - ,r, ,e`er; air a,�,, h a e- e I bit,
Page 3 of 3 12128104

liver✓
Facility No. Oq Farm Name
Permit ✓ COC
049, 1 epee- Date
Ltg
OIC AA
- 'NPDES(Rainbreaker
(o'i8-6(q3 (11)
PLAT Annual Cert )
FB Drops
( wit
Design freeboard
Observed freeboard (in)
'--Sludge Survey Date
Liquo Trt. Zone-----
7dii6raitio—n Date
Design Flow
Actual Flow
Design Width
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu Zn
Needs P
c1yA swk.*rht - `ai I f
© Crop Yield �1
Wettable Acres
WUP
_ Weekly Freeboard ✓
Rainfall >1" —�✓
1 in Inspections
120 min inspections
Weather Codes
Transfer Sheets
R UGE
(nfd b or incinerator ✓
0-fa tP
' • 111 _
J ,i
�• 1 1
.'i
..
..
•I
�ii".�
1 Il��
.i
Hof0s="r
verity PHONE NUMBERS and a /iliations
Date last WUP FRO Sala I op Date last WUP at farm
4,ec.glgjo�ca-ep!'a`ztll�v
FRO or Farm Records
Lagoon # �Jp 'S 'F UO3
Top Dike 1, d l/ffrom*f
Stop Pump��� f /
Start Pump c ap
d 04
App. Hardware
Iq S5>D

Type of Visit IR 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
10
Date of Visit: �� Arrival Time: Q; Departure Time: �Or.3 County: B Region: �R{!
Farm Name: Qd-eA flfsk/' Owner Email:
Owner Name: 601ow_ TT� ��Pli Phone: Cho &649_ 4D Y
Mailing Address: .5ti iadP harp 1UC- a s3aa
Physical Address: Facility Contact: 16yf Alkon Title: �� Phone No: g `QT7
Onsite Representative:
Certified Operator: ffizQ
Back-up Operator:
Integrator:
Operator Certification Number: j �f
Back-up Certification Number:
Location of Farm: Latitude: = c = 10" Longitude: = ° = I = "
ifsIII,
>R:
Design Current D gCurrent
nacity
ON
)ON ign Current
Swine Capacity Population Wet Poultry CapPopulation
Cattle
Capacity PopWation
❑ Wean to Finish ❑ La er
❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er
❑ Dairy Calf
Feeder to Finish Z 0
El Dairy Heifer
❑ Farrow to Wean Dry PoWtry
El Dry Cow
£._.
❑ Farrow to Feeder `a
❑Non -Dairy
❑ Layers
❑ Farrow to Finish
El Beef Stocker
El Gilts Non -Layers
❑ Beef Feeder
❑ Pullets
Boars
El Beef Brood Cow
El Turkeys
Other'
❑ Turkey Points
,..�.
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CRNo
❑ 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
�tNo
❑ 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 1 of 3
12128104
Continued

Facility Number: —09 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W 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): ft I ct
Observed Freeboard (in): 0 4 �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IR 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
JRNo ❑ 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?
RYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®'No ❑ NA ❑ NE
maintenance/improvement?
t 1. 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/Inspector Name S ' Phone: qIQ _433 3308X'&P_3
Reviewer/Inspector Signature: jk&U&Date: 3 o700
n ..e 7 _r 3 1 7/JRNIll IC on inned

Facility Number:Qa — Date of Inspection
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 &No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
2I . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR 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
RNo
❑ NA
❑ NE''
❑ Yes
❑ No
CRNA
❑ NE
❑ Yes
[a -No
❑ NA
❑ NE
❑ Yes
15JNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
❑ No
tRNA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ®'No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
99*No
❑ NA
❑ NE
❑ Yes
JgNo
❑ NA
❑ NE
Additional Cohnments anW..oi Drawings: �g,
-7 e6e- MO.190o1 hay ks 4 siread rrn vlcA b* on ba e srvf betel 1ojwaf, ,
at, VV Gib j000t � &0 days.
ZN w � I [ rJ�Pc�C'�br og 21c�:0'1�
aft, crop 43-6aA Al[ t C �r'
` �'Ek n B 1MS
fin, . � en�iFl2d 41 Cs 1-no-I-14�0(. © ,
I2f�}--Form -�0 tc aut bars
01
Ha
Fa►rmp,�+os . hart heFM
cl� ham goat Sch@�v���
`9
n'e�j pale
Page 3 of 3 12128104

Facility Number: �evt,�cL ©I loa boo9
—� Date of inspection 3) t�Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5;No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes & No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 1pvvw_y 6'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis O Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit? �l
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?
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
(2:No
❑ NA
❑ NE
ETYes
❑ No
❑ NA
❑ NE
❑ Yes tg`No ❑ NA ❑ NE
❑ Yes ❑ No t9NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes NNo
❑ Yes ffNo
El NA ❑NE
El NA El NE
❑ Yes 1f No ❑ NA ❑ NE
❑ Yes tg'No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes KNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
>mow, la�oo, bayki and,r� , 0Yilch al b;0-s is -a1d �c� bd�+'>° n la�0U,
� I rid- �' 17"a,%acre whfne. n��d,
Is. uM-was arr W- a�3oj—dy
Plea �p �s Ireurds R��+`led- M mai 1�ea{ TC" a� a o 0 9
as,s�l✓ r,/.t S d oie. z&n,-vm6v&o1" zi. 3-f4,
w h�-had a.n fexfmrt* �Pb- avor b&+-hIs war no+ tfl>e cote ,
�lea,� C�nd�t s ��d s✓(ve or s oor► ar ems' to or a y a elqovcf�iL��
� M ins. Form fa- Mftfon �,e% rwf w �n a� aooq
4 -oal A14h wte.both e*fi"ed, 01cs' aooe b,+ nc �r�; -hhir im
I lei ©IC 4 bacle -Pooh, lbeco"& s haws +hdr o IC exeA oc OAof- a008,b u'I--
r Is s OVA 'l a lie an
M4. n o�'be. ii+f � �►�-. T d >i�s�Pd: -j'� � 1
a licu� -(ojmsgn`ca� -'l1 1 ha.Ae 46 y6a ke- -hl e- psi-) �n a� ooQ
&ftv, bq% haVIA4 h(?41S ISsvef r►hllch hal p d_ 1 hsped� sched v lip
gxcPlta r n vied abavP -t' rpw r odd 1212Vo4

Facility No/O�'�Farm Name E& Date
Permit J COC �� OIC— r-h,, fq, NPDES (Rainbreaker
FB Drops
.a
PLAT Annual Cert )
Freeboard
1
2
3
4
5
6
7
Design
BIMS
Observed in
'j
Sludge Survey Date Perm Liquid ft
5
$ Sludge Depth ft
J'sf
YS r/
IrVII.;, 4V :)ADT
Calibration to
1
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
,roil Test 41allo t Wettable Acres Rainfall >1"
pH Fields pH Lagoon_ Crop Yield 1 in Inspections .�
Lime Needed 5 "2 Cain Gauge ✓ 120 min Inspections
Cu �Zo tkly Freeboard Transfer Sheets
• 1 � _
�.[L7i��
�1
EM
p��,pan�oo� o.`�76't.S/71b) .f -7713
Pull/Field
Soil
Crop
Pan
Window
wx—QC
s — 5D f S
S -H
Opig. A" f
A-hpole a 4- o. 6r AK}
K,e-sI0- &ael+-

0 Division of Water Quality
Facility Number 7 O Division of Soil and Water Conservation
O Other Agency
Type of Visit
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
�om�pliance
routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: �,�� Arrival Time: `,3 D Departure Time: ; 3 [) Count}': it Region:
Farm Name: �1�P5��'% //-D4 Farms- Owner Email:61
Owner Name: „f�-oLd d�e et- Phone:
Mailing Address:
Physical Address:
Facility Contact: 41aw fie[ 1 �ey - Title: Phone No: 9-/O//e-,?
Onsite Representative: Integrator: AV u 4,0AL
Certified Operator:y��-..e _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ n = g =64 Longitude: = ° = 1 = u
K
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
�❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non- Dairy
❑ Beef Stockei
❑ 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?
at
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
12129104 Continued

Facility Number: r5 _ dr.le-4teq Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes tKNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
E4 No
❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
R 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 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ElEvidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Zr.Cry%"L
13. Soil type(s) f::�v /r.� -gr �'.1 ���� /L y.�& '� Z1& /% u 14 i t_
14. Do the receiving crops differ from those designate/din the CAWW? ❑ Yes
(Z No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? EZ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
(LNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[9 No
❑ NA ❑ NE
IComments (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):
ec#-N L
Reviewer/Inspector Name ur— Phone: %"j a- y.33 _jTZ>0
Reviewer/Inspector Signature: Date: Z
1 b/Ld/U4 uonunuea

Facility Number: — 5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 54 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes 151 No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists
❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 50 Yes ❑ No ❑ NA ❑ NE
I&Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CH No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2Ko
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ERNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[KNo
❑ NA
❑ NE
and report the moitality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-77
To
�ylr �l u1,tl (�
12128104

a
i
sion of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: D County: p''L Region: Jfgp
Farm Name: car_ Owner Email:
Owner Name: y Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ 4j J z�YL
Certified Operator: wr_5_1�_o!7
Back-up Operator:
Location of Farm:
Phone No:
Integrator:�'r�i
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 o [� t = Longitude: = ° = ' =
Design;, Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish 614,0
0 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-
Other
❑ Other _.. _...._
❑ Layer
❑ Non -Layer
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?
Desig© Cu
Cattle Capacity .Pope
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 ANo ❑ NA 4 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[]No
❑ NA
CWNE
❑ Yes
❑ No
❑ NA
2�NE
12128104 Continued

t Facility Number: Date of Inspection W97
y Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA RrNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA JR 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 JRNE
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 P�NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ,®,NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA (271 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)
11 Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
PQ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
4 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
0 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
.9 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
RNE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
1)11, A"j A 11,-rt i7WA..'4' 5 �a ✓ w�-� � ve�; in �[ e " /
�r✓r°�3�-rye- CA TO A)PA.:�
ReviewerAnspector Name d-y` Phon !7
Reviewer/Inspector Signature:
1L/LO/VY I..VI.1i/...

t
Z
.9L Date of inspection
Facility Number7
4 RecLuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0-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 ONE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. j+Yes JM No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis QL 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
ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
VSNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
9NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
J,NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
&M
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
KNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[ 1 Yes
❑ No
❑ NA
;4 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
�3 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
M NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments and/or Drawings:
Tf-0 3fe-r
WI ' ✓l% i� P} Tim 5 �r��`' �5 rr� �I l i rylC ev
ct� jit en d e h TA0146 fer- 1P W+ q� &-kt Ct WAAC- Try ► 5 Frr'tvr
WaAe jrT z f:� �� lT K� if
12128104

Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason'for Visit L)r�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: i Departure Time: ' fl County: Region:Q.
Farm Name: a~� .'pe%--o" Owner Email:
Owner Name: _ r� �f
r� , Phone: / D— y&: z2!5-y
it�
Mailing Address: y0 7� rs� n d r ��rrc,6 0 -rb •N C, _ 4g�L�17
Physical Address:
Facility Contact: �T�:/'� Cit Title: Phone No: 2LP=
Onsite Representative: ��-•c� Integrator: IW&k
Certified Operator: _ s�"''c� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o =1 [=Is Longitude: = o =' =
Design
Current
Design Current
Design Current
Capacity
P pulation
WetPoultry
Capacity Population
Cattle Capacity Populationn
❑Dai Calf
❑ Dai Heifer
to Finish
❑ La ern
to Feeder
rr-1
❑Non -La er
er to Finish 0
ow to Wean
yry❑
D Cow
ow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La ers
El Stocker
El Gilts
❑ Non -Ls ers
ElBeef Feeder
El
El Boars
El Pullets
El Brood Co
El Turkeys
Other;
r,=,t
El Turkey Poults
Number of Structures•
❑ Other 0Other
Discharses & 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
[0 No
❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[A 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
KNo
tic
❑ NA P NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CqNo
❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ bi ❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection �o
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(fNo
❑ NA
❑ NE
f
a. If yes, is waste level into the structural freeboard?
❑ Yes
CR No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier.-
Spillway? -
Designed Freeboard (in):
Observed Freeboard (in): �fl
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Pj Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J9 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 (o ❑ 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 yRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) �0 r~ '�pn l-Xnrl f Men
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? KYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? 0 Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
Comments (referto question #): Explain any YES;answers:and/or any recommendations or any other comments � ,q
Use drawings of facility tobetter explain situ atioits: (use additional. pages. as necessary): $ ; 'r � .
,Swr
7
Reviewer/Inspector Name I I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 19 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ErYes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CZ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eg No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5d 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
ONo
❑ 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
�KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[K 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
IN No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JQ No
❑ NA
❑ NE
Additional Comments and/or Drawings: 11
��� . DD� Q u rr �Rrrt_. ; n f �-u� D ��DD.S� _�sr.�%�� �•�/l a['r� �i.
V Fur� e5 i rt. ®� � On- � f�,rcB�`dj� /JKC.S �r
rrtur a
Yli '/'�f !�O✓C/1%r�%IGrY��/I� S D>�p(tllrrr �7
t� r d/''� �d� to vdr �/!/ C'r►' v=� /v� - .%/./��/`
Page 3 of 3 12128104

i
e
D1V151Un-0fµWatery
DsQudtlty 5 �htii 6Sv�i i di7 y yr r i._ i a Yi r /n7
titi y� Y IVLSIon'Of Sad and�WateC.COnservatlon
(Type of Visit �k Compliance inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Q, Routine O Complaint O Follow up Q Emergency Notification O Other
Date of Visit:
Facility Number
0 Permitted 0 Certified [] Conditionally Certified © Registered
Farm Name: Ag7:s .ram
Owner Name: F���
Bailing Address:
Facility Contact: ..... { .... 25 .............................. Title: .........................
Onsite Representative:._F.U..e.n .. t cr--- j......
Certified Operator: ............F.lden
....................... .... jH'.c4tr....................................
......
Location of Farm:
❑ Denied Access
Time. �v Printed on: 5/30/2001
O Nat O erational O Relow Threshold
Date Last Operated or Above Threshold: .........................
County: r Q.d
..................................... ..............
Phone No: -..
&gs-1/3,3 ............
«�.. '.......................
PhoneNo:... ................................................
Integrator: .......... C A5........................
Operator Certification Number:_....l( .2!V..,T................
[ISwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• C�' Longitude �•
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ] Layer MID airy
til Feeder to Finish 41&6 FE] Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps 0 ❑ No Liquid Waste Management System
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ElLagoon ElSpray Field ElOther
a. If discharge is observed; was the conveyance matt -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 galhnin'?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes R 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 [)3 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................
Freeboard (inches): 30 t31
05103101 Continued

Facility Number: 9 — 415
Date of Inspection as Printed on: 5/30/2001
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 19 No
❑ Yes 1XNo
❑ Yes No
❑ Yes [ No
❑ Yes 9No
Waste Apulication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[YNo
11.
Is there evidence of over application? ❑ Excessive Ponding PANT ❑ Hydraulic Overload
[Yes
❑ No
12.
//
Crop type , Zcsmud.r f!Eia Btrmud�t �Clu c a �� Gmr ,, 651, Ee_SEue &_rhzel
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
j Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
LV No
Required
Records & Documents
17.
Fait to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N] No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(le/ WUP, (ec lists esign, maps, etc.}
t4v
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
WNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ No
13
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or"anm y other coments.
Use drawings of facility to betty explatn`Sit uatians. (use additional "pages as necessary)A � [JField Copy ❑ Final Notes
��— OUtra(��11ca .do or, �n+ 'sak) — ,q 16 %01 &,mi., 1 I _ a v 1h 'al- ba .5-6
t�.v
.# �
1 16 `o t - `0Q SG 4 9 - ao Jt `ot - bW SG
)
(`+tJc-rTt co wee &-*Arrjk � Ars proves S >tan� '�^1f SPj2)ti+, a�/Is ,f�
11be�
J
IT- A#A 4, � Capy n� Trs�c�� tOcJer� � ���� r^inecGLisL J1 Z,,,, MnCr/6Jor�r
1~tcr05 `fXGc]G e� cFcrc5 Z!�(vL ar ,net cif
CU (%1 p 1t_,Xn1e 6, Sll� wclyr�0,11_ ,
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: q a
05103101 Continued

Fa`Iity Number: - 45 Date. of Inspection Zj /&'0,1 Printed on.. 5/30/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes N No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes N No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and or ra,vvingS
w
05103101

Type of Visit ® Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /O-7lj-ps Arrival Time: OS`. OO Departure Time: County: gKI4ale'J Region: /Oi-11110
Farm Name: ��a1rN 1��sY Owner Email:
Owner Name: urolj Alloy Phone: eh-K 0 9/0 --CV5-G/4V3
Mailing Address: 190%'Z lk,-519 44!ad
Physical Address: /
Facility Contact: A Y � 4lleAj Title: NC' OWyey Die[i Phone No: �Qi'e_ �9J0-��g-�5y
Onsite Representative: #at -
,old Alle/✓ Integrator: 8dv ce!
Certified Operator: U Ili A% Operator Certification Number: 2 6? F2 S __
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I 0 Longitude: = o ❑ I = u
Design Current
wvtne Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts 4
El -Boars
Other
❑ Other
Design Current
Wet Poultry. Capacity Population Cattle
❑ Layer
❑ Non -Laver
Dry Poultry
❑ Lavers
ElNon-Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharp_es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dai Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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)
Z. 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?
et
❑ Yes C9 No ❑ NA ❑ NE
El Yes
❑No
10NA
❑NE
❑ Yes
❑ No
® NA
❑ NE
KNA
El NE
El Yes
❑No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
5QNA
❑ NE
12128104 Continued

Facility Number: 0 -
Date of Inspection /D-2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): -.%9- -
Observed Freeboard (in): Z-G]
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 A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes % No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) &rA4 %4 lam, ?a 4.- / lP� e_ (G vers,!Ld -,e_S6q G
13. Soil type(s) / ees k y �G r IJS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CK No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Cotnments (refer�to gn ho #};= Ei}�fa��any YES answers"and/ora�any recommentt ill 11! or any other comments.
Use drawuags ofsfaciltty tolbetter explatnksituafions:: (use!add!Uow`1 .8ges as necessary):. w
Reviewer/Inspector Name
Reviewer/Inspector Signature:
`', a Phone: 9/O G
Date: D -Z --'LOLLS
12128104 Continued

Facility Number: Q g— s Date of Inspection /O-z&-p
_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 54No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[)I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
244
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IN 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
(9 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
99 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
{4 No
❑ NA
❑ NE
.Irl gY �; 4 WWs[ +tF A' _ J y.s G:' EF'dx �+ i B 4
Addthonal C - en and/or' Drawtn * ;3 k '
12128104

ANIMAL WASTE MANAGEMENT SYSTEM
OPERATOR IN CHARGE
DESIGNATION FORM
ANIMAL WASTE MANAGEMENT SYSTEM:
Facility ID Number. _ 01 County: 13LAO -
OPERATOR IN CHARGE- ]UgLOLO
Home Mailing Address '� '
City Fs.�►1 State + Zip Z a
Certifcate # 1=57 Social Security # Z&e --
Work P'hon iD.• -[as Hume Phone -i-�- Ags4
Signature Date QS
Mailing Address._`-- City MAU4,18090
State Zip Telephone# - w 0
Signature Date'% - - -,%, 04 ��-
' 4
Please Mail to: WPCSOCC
Division of Water Quality
1618 Mail Service Center
Raleigh, N.C. 27699-16I8

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Of Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 147 301W Tune: 1 !S
Facility Number �
O Not Operational Q Below Threshold
F1 Permitted C9Certified 0 Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
Farm Name: County:
Owner Name: ��dey. ,�5{tr p f _ .. ' Phone No:
MWling Address:..__
IL I It
Facility Contact: Title:.. ____. .... Phone No:.
Onsite Representative: G- �LL v `L` A It P/`r- Integrator: 'C
t"I
Certified Operator: _ _ �tc if+Jl_ _ - • - Operator Certification Number:
Location of Farm: Fi i0��+ti u' l & g Y
%Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • « Longitude `
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
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'?
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 J,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PR No
Waste Collection & Treatment
4. Is storage rapacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Mj No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ___ 1 _ 2 — - __ ---- .......
Freeboard (inches): ;,-4" 40
12112103 L. u, KH ec.� _1 Continued

FacilityNumber: — K5 Date of Inspection I Z .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes I;gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 9No
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? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Analication
10. Are there any buffers that need maintenancerimprovement? ❑ Yes ;9 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;.No
❑ Excessive Ponding ❑ PAN ❑ a Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
(Z�1
12. Crop type ov+eirt
. V_1 r W%. %) C*- AWSA-rxe, . feu Sc p_ Dnr5tu re-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Wo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9LNo
b) Does the facility need a wettable acre determination? ❑ Yes UNo
c) This facility is pended for a wettable acre determination? ❑ Yes RNo
15. Does the receiving crop need improvement? ❑ Yes 0 No
16. Is there a lack of adequate waste application equipment? ❑ Yes Kj�o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &o
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 ❑ Yes $No
Air Quality representative immediately.

Facilit3'Number: — +( Date of Inspection 30 a
Rewired Records & Documents
21. Fail to have Certificate of CoveragdIrGeneral Permit or other Permit readily available? .Yes ❑ No
22. Does the facility fail to have all compp�onents of the Certified Animal Waste Management Plan readily available?
{ieJ checklistesigmap5!etc_) ❑ Yes To
23. Does record keeping need improvement? If yes, check the a ropriate box below.
❑ Yes
KNo
❑ Waste Applicaticpl [IFreeboa�] Waste Analysi7❑ Soil SamplinK
24, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�3 No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
CKNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
5ENo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E(No
28. Does facility require a follow-up visit by same agency?
❑ Yes
K(No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
WO
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
Wo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EZ.No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
MNo
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 Forme).Crop Yield Form ❑ Rainfall/❑ Inspection After I" Rain/
❑ I20 Minute inspections ❑ Annual Certification Forte
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Z�. -n cr-e. ogre. svrw.e- Aac .�s ,µ: ssr o,►c c _ oL cs�� p +�,
it-Q- w;it be. uPa1a#�e .
T ' 7 7 ? 3. _:� E-- Cam- crw -�; �.s +"�' SS `'" �...�a �• s S
10/1 g lv K !. 4
-tt-0- -0 [� PC-e )u 4; yr .
12112103

t
Type of Visit 0 Compliance Inspection
O Operation Review O Lagoon Evaluation
Reason for Visit l Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: - t� Time: 3�d
Facility Number
Not Operational 0 Below Threshold
Permitted Od Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: E`14�v.� /�e�f{ - _ _ _ County:
Owner Name: ` IGPc wa . s 4"c r— Phone No:
Mailing Address: KIN- a do � a. _ 6L C. �? F 3.z o01
Facility Contact:
Title:
Onsite Representative: CCF1'1eu -Icn
Certified Operator: Aj la. He,r
Location of Farm: H4.aM 41feti
Phone No:
Integrator: 'r r.b
Operator Certification Number:
A-d a4S.1 r
%swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' 4 . - Longitude ` •
Design Current
Swine rnnarity Pnnnigtinn
❑ Wean to Feeder
Feeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle capacity Population
❑ Laver ❑ Da�
❑ Non -Laver I I JE1 Non -Dairy
Other
Total Design Capacity
Total SSLW
jNumber of Lagoons ® ❑ Subsurface Drains Present ❑ Lis oon Area S `ray Field ores
-Holding Ponds I Solid Traps �..-;.No Liquid Waste Manaaement'Svstem
Discharges g Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharee originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach Vk'ater of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed. what is the estimated flow in galimin? M/Lj
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ NoT
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 EM No
Wayte Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a
Freeboard (inches):
05103101 3 8'' Conturued

Facility Number: Qq — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lad*oon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. N ere anv major maintenance problems with the ventilation fan(s) noted? (i_c. broken fan belts, missing or
or broken fan biade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
22. Do the flush tanks lack a submerged fill pipe or a permanentilemporary cover?
❑ Yes ❑ No
❑ Yes ( No
❑ Yes ® No
❑ Yes Cj No
❑ Yes No
❑ Yes ( No
❑ Yes ❑ No
0510310I

Facility Number: A y — iVS7- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
o] No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
(Z No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
14 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
j] No
Waste Application
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
[� No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
QdNo
12. Crop type�77ttc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1� No
b) Does the facility need a wettable acre determination?
❑ Yes
[ No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
W No
R2auired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
1P No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ YesAl
No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
q0 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[f] No
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
0 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VQ No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
V] No
25.
Were any additional problems noted which cause noncompliance of the Certified A WMP?
❑ Yes
[P No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer ta',questian TOP
4) Explain anyi ES answers%atidlor any,r'° ecommendahons or any outer comments-' day°A
Use°drawings of fai iltty to better explain situattonsr (use�additiorialwpages astiecessary) t Field Copy ❑Final Notes
%)aSfe 44:-p%j t✓e,+ bac_L 4Lor-4 A1CDA /c,6 1-- y5em+ e-V J"ay FG/Oc � 0" l
Ci + n e GcQtaC• r
02re— S A M =,06-^4 , %o cv SPa-h� i u
Reviewer/inspector Name
Reviewer/inspector Signature: Date: (g — &
05103101 / Continued

3
._.. � _�... .r.;� xe_�. �-.—../�.r`��=_ _s.cr-� ■ _�i:.: r ._�,n__---�� .d._r r � ..-�c� _�_-. �"z'__. r.,"�sar��.;
Type of Visit B Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit * Routine O Complaint. O Follow up O Emergency Notification O Other I ❑ Denied Access
Date of Visit: �� Tune-
Facility Number U
Q Not Operational Q Below Threshold
Permitted a Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ���� ,!.%tr.��.��....�'.r��!'.:`:' County: �.....�. ��...._..............---,.�.�.�_......_...
Owner Name: ............ ......1..... ?�1............................................. Phone No: ». ( d ...4rA
Facility Contact: ...- `J...... Title: ....... . . . ...... . .................................. . I . ..... Phone No: ............. ..._ .. �.. ..
Mailing Address: �2�..��...15 a .............. ............... . __.
;,
Onsite Representative:...... , iJ ... Integrator: _--��q/I«,!f A�_ �
Certified Operator:, ,,,,,,,�.. Operator Certification Number•
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Harse Latitude 0 Longitude 44
E
y
.: Desigiu Current
...=:.Swine •• . Csnaetily Pnni�liafinri
n to Feeder
erto Finishw
to Wean
r
w to Feeder
w to Finish
Gilts
Boars
} Number -of I[.agootss
Holding Ponds I Solid Traps
L
:
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area r
No Liquid Waste Management System
r t
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JUNo
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 ;R No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes No
2. is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6z
r, , --
2r
Identifier: .............. ........................................................................................................................................... -..........
...... I ................... ..........
Freeboard (inches):
5100
Continued on buck

y Facility Number: a — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes f No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ETNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ;—<) Yes ❑ No
8_ Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RJNa
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,® No
Waste Application
10. Are there any buffers that need main tenance/improvement? ❑ Yes NO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes J$No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes &No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes 0jNo
b) Does the facility need a wettable acre determination?
❑ Yes )allo
c) This facility is pended for a wettable acre determination?
❑ Yes RNo
15.
Does the receiving crop need improvement?
KYes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes J[No
Required Records & Documents,.,
I7.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W✓cP, checkh ' , design, mans,Eii .) ✓ f ✓
❑ Yes No
19.
Does record kee✓✓ping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20.
Is facility not in compliance with any applicable setback criteria in effect at the. time of design?
❑ Yes No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ATNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes ANo
(ie/ problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes [&,No
24.
Does facility require a follow-up visit by same agency?
❑ Yes [R No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
violations Q..... n... rvgre nofed• ditriftig this.visit; Yoi� wiil i-e. . . do t'ui .... .
Correspondence about this visit. .
Comments {refer to question ft) : Eacplain any YES answers and/or atiy recommendations or any other comments =,
Use drawutgs'of facility to bettei= explairi situations (use adrLbarial pages as-necessary):7.
-._
.ski Ile '�2f'r'�e oY12 ✓ � s.��l/w Q rft
vr� Vw
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

-� `l
Facility Number: — Date of Inspection / G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes �rNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Wo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �INo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes PTNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes WO
-AdditionW' ts an or Drawin
5100

Division of Water Quality -
O Division of Soil and Water Conservation
O Other Agency - _
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tirne: i. .3a Pr-inled on: 7/21/2000
O Not Operational O Below Threshold
Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Abo7,
a Threshold: •...............
Farm Name:.---...�C�sP'......�s/.....1...4.+rc!�L..................................... County:......, ��G�n..........----.............................
Owner Name:...... C&C..r................ ....
............................................. Phone No:........���lit.. j��.�.�.�..................................
Facility Contact: ........ QLG A& .................................... Title. Phone No:...................................................
Mailing Address:..........
� S adrs ..1✓ ........ A3.3
Onsite Representative:..........P.l..................4........................................ Intef;rator:...............Dr.f..f.... ....................................
Y5��Certified Operator: G Lt'�(a • Operator Certification Number :..........................................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' 4 i Longitude ' 4 "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer 1 10 Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean'
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagonn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact4
1. Is any discharge observed from any part of the operation?
Dischartc originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance plan -made?
b. If dischar,,e is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. II'dischar2e is obsorved. what is the estimated flow in gal/min?
(1, Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I SL'ucturc 2 Structure Structure 4 Structure 5
Identifier: ..-... )........................ ........
.........................................-................ ..................
Freeboard (inches): h Z �t
5100
❑ Yes No
❑ Yes X No
❑ YesNo
❑ Yes No
❑ Yes PrNo
❑ Yes ONO
❑ Yes -g O
Structure 6 -
Continued on back

Facility Number:o9 —1++�jr I bate of Inspection 2T Printed on• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Cl Yes j No
seepage, etc.) v `
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(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? 9—Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes K
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes fi� No
11. Is there evidence of over application? ❑'Excessive Pondin� ❑ PAN ❑ Hydraulic Overload ElYes M,4o
j It
12. Crop type /7c°rhlUda Acz,4 / . Div. /110rW4,da qrqz(°
13. Do the receiving crops differ with thie .-c designated in the greertified Animal Vir4ste Management PI/an (CAWMP)? ❑ Yes No
14- a) Does the facility lack adequate acreage for land application'?
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
o
0This facility is pended for a wettable acre determination'?
❑ Yeso
r
15- Does the receiving crop need improvement?
9Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
FIfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
allo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ALNo
(ie/ discharge, freeboard problems, over application)
23- Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
fg-No
vi9latigns:oi- deficiencies *v re noted-dirring �bis:visit:• Y06 will•reeeive Rio further
•
:: corres• correspondence. about: this visit.:::: :: :::: ::::::::::::::: ::: :
: :
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):
/LQ. L� �je
!
`�;} � e
�
�d reSr eJ .
r I
. 7-t1s;�e S�aPes f- la hS h�l µow�_s .
�elw�cct�a (�s 1,4 9 cad.
G/�
ong rec.o ro[ f .
Reviewer/Inspector Name G
Reviewer/Inspector Signature: __ Date: 5100

Ir ,
Facility Number, — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Y171 No
liquid level of lagoon or storage pond with no agitation? 7�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes fi;4No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ` fl-1
tiona omments an or rawtm
A,
3/23/99

-`
.. [3 Division of Soil and' Water Gonservahon Operation Review 5
:+ _� Division of Soil and Water Conservaban Compliance Inspecon +EF j yi Q' r �Lt
x 0 Division of Water Quality Compliance Inspecaon u A '!
f— Other A enc - eratlan Review - r
_ g... Y.. .O-P L
19 Routine Q Complaint Q Follow-u of DW ins ection Q Follow-up or DSWC review O Other
Facility Number Ej Date of InspectionZ-19-9,21
.,_-_- Time of Inspection : 50 24 hr. (hh:mm)
Permitted Certified [3 Conditionally Certified - Registered 0 Not O erational Date bast Operated:
Farm Name: ................ fldw..... G1'`.S�tT.................--............................................ County: .--- .----- .. .... .'.�t'�.. ........................
Owner Name: .......Llt d-- I G57 .........................................................Phone No...... ......
1.....................
j 1'. ' J [� .....................
Facility Contact: ........ jFl�. ....---1 T�'''....................... Title:.................................. ...... Phone No: ...................................................
.......... ..............
Mailing Address:.. .............. 134R6....... Cenlrl........ .FI.l� ........................ ...........8
..a� /....VC. ..D^�..d'o .....7................................ .......................
Onsite Representative: ��1Li�....... .......
rFkllG,r..........
Certified Operator: ............... EUW....... 6?.... .1 Operator Certification Number: 164q
.................................
Location of Farm:
A6
.............. ....................................................................................................... ....................................................................................................................................................
. •
Latitude
0
�' ���
Longitude
Design Current :
' .° .. --<>Design:, Current - Design Ceirrent .`
:.Swine Capacity Population Poultry. Capacity Population Cattle Capacity Population-°-
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish J❑ Non -Layer I I= ❑Non -Dairy
Farrow to Wean_-
❑ ❑ Other Farrow to Feeder
❑ Farrow to Finish r
❑ Gilts
r Total Design Capacity da
❑ Boars " " : •- - - -Total 5SL, W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®No
777777������
Discharge originated at: ❑ Lagoon [I Spray Field El Other
`t 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
3 t c. If discharge is observed, what is the estimated flow in gal/min?
d. Dogs 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: IV I ��` -
li
3�f
...........�I
. Freeboard (inches): ..........................................................................................................................................
................
................................
...
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0No
seepage, etc.)
3/23/99
Continued on back

Facility [Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �Vo
(if any of questions 4-6 was answered yes, and the situation poses an //��
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level //11
elevation markings? ❑ Yes ® No
Waste Application t��
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
I I . Is there evidence of over application? J❑ Excessive Ponding El PAN ❑ Yes F No
12. Crop type _ f = �'Y1n1.u�tr[ ( &.'t �i s ' S IC_ 0
13. Do the receiving crops differ with those designated in he Certified An mal 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(le/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively cenified'operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �V dM61ati6iis or di fcie'ncies were poled• dpring this'visit.' Y64 :will-i•eb6*0 dd fui-tpipr
correspondence_ about. this visit". • .. _ ....
❑ Yes VNo
❑ Yes 00
❑ Yes ❑ No
A, Yes ❑ No
9(Yes ❑ No
❑ Yes VNo
❑ Yes [)(No
❑ Yes 9No
❑ Yes 0 No
❑ Yes o
❑ Yes No
❑ Yes allo
❑ Yes 19No
❑ Yes �No
❑ Yes IkNo
; 5 -1hrVi4,P -Ue 4 .sW
4Z) -r - O)l a 5- Cara 0--.1 —17
f -�
Reviewer/Inspector Name 1 �. T.
e=
Reviewer/Inspector Signature: Date: 6 — --
3/23199

Facility Number: — hate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes eNo
o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) El Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes60,
70
32.. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Cl No
13r. 5�wc I -a, �z (x'-eJ -V-r' a�u� W
/`� •O'J
5f
I��-, S v„ -ld�,e �•� Jam- � .
wig, LO
po�
3/23/99

Division of Soil and Water Conservation y
���❑ � Other Agenc
Division of Water Quality
140 Routine O Complaint O Follow-up of DWO inspection O Follow-uD of DSWC review O Other 1
Date of Inspection
Facility Number 6
Time of Inspection ;Z 24 hr. (hh:mm)
0 Registered 9 Certified 13 Applied for Permit © Permitted 10 Not Operational Date Last Operated
FarniName• .�.+� County • ..................................-------�1�.,€�...,�Q----......................................... .......�......
Owner Name: .......... �f�.e ......ek` ............ Phone No: ld ��0.....r. ` ..........
Facility Contact • . Title: Phone No: ................
MailingAddress:.........A..s .r .... .:Zo! W........ — ................................... ......................................... _ ........... ...................
Onsite Representative:....,,. Integrator:..,,C�,tlf�ol./-Z.
"..0
Certified Operator;......... ,���.........--•.................................. Operator Certification Number s..... ......... ...........................
Location of Farm:
LatitudeLongitude �• �' �"
Design.a Current 4 .,
;Design `Current ro _ Destgn Curs ent.r
„~
�o5v�ne
T;
`Capacity„Popuiatton .;.<Poultry Capacity Population Gatttey `4 Capacity; Population �-
a. _
❑Wean to Feeder
12,10 ❑ Daii
«;
❑ Non-Dairy
n Capacity
otalSSLW T
... w... r . ,.a .r . F
T
Number tef Lagoons /QHoldtng Ponds ; ❑ Subsurface Drains Present ©Lagoon Area ❑ Spray Field Area
» V ❑ No Liquid Waste Management Systemxe
- `
.
Layer
Feeder to Finish-«
❑Non -Layer
❑ Farrow to Wean
fr ❑ Farroui to Feeder
❑Other `
❑Farrow Finish
�
to
T Total Des>Ig
�
—Gilts
Boar$
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? ([f yes, notify DWQ)
c. 1f discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (]f yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons holding ponds) require
maintenance/improvement?
6. Is faciiity not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes J9 No
❑ Yes ,KNo
[--]Yes
P(No
❑ Yes JgNo
❑ Yes KNo
❑ Yes KNo
❑ Yes ®No
❑ Yes P9 No
❑ Yes � No
1
❑ Yes � No
Continued on back

Facility Number: p — S
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes O(No
❑ Yes XNo
Structure 5 Structure 6
Identifier:
Freeboard(ft):..............IZ...................l..i............. ................................... .................................... ............................ ....... ................... ................
10. Is seepage observed from any of the structures? ❑ Yes KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Od No
12, Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
'Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes XNo
(If in excess ofLWMP, or runoff entering waters of the State, notify DWQ)
15. Crop type i7, rSyln ,'7�.. !- . r-c-m-'c/..�d►� ,(l yet#�c.?........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18. Does the receiving crop need improvement? Ayes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes KNo
20. Does facility require a follow-up visit by same agency? ❑ Yes )H�No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
22.
Does record keeping need improvement?
,Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWIvIP?
❑ Yes
;allo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
PNo
1 No'violations-or. deficiencies.were'ittited-during' this.visit.:You:will i.6ceive no' -further-:
: correspi?n 06l abioijt this: visit:: _
01
7Xx --7
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of D% O inspection O Follow-up of DSWC review O Other
Date of Inspection 11 7
Facility Number
Time of Inspection :� 24 hr. (hh:mm)
0 Registered 0 Certified IJ Applied for Permit [3 Permitted 10 Not Opera Date Last Operated: ......................
_-
FarmName:......r..................................... County:...............,��.................................
Owner Name.......... 7 r Phone No: 4*0.....�il r i/,37 �7... .....,
Facility Contact:......... . Title: ......./_ �/ ......... Phone No: .......
Mailing Address:....... .12ir�........��,�....��........�!�`�7d.,trfG�t.�l2p �s�Zd..... ..........................
1'
Onsite Representative:...... %e '!"'.................................................... Integrator:...�,r.41
Certified Operator:.........,. i, -......................................................................... Operator Certification Number,.... !;!5- 7........
Location of Farm: Zl/ _tr.,.,._,0900'
Latitude Longitudes �• �� �"
y K
wSvame
;; ❑ Wean to Feeder
�a
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
eA ri
k ❑ Boars
Currents _ f
. P4tilatioiV- •Poultry: a {
u Layer
❑ Non -Layer
❑ Other f
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
' Designs - Xxfn
wCapacity`°_Popul
' ]U Non-Dairyl _
at�
tea.-. ... _ ..
Subsurface Drains Present 110 Lagoon Area
No Liquid Waste
Discharae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3_ Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
pray Field Area ;
Y%Q+k ski
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
Continued on back

..
Facility Number: O9-
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaEoons.Holding fonds, blush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
Identifier:
Freeboard (ft.):..,.............)...... 3......•..• ��
10. Is seepage observed from any of the structures?
11. Is erasion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Aeulication
Cl Yes ANo
❑ Yes m No
Structure 5 Structure 6
❑ Yes IN No
❑ Yes 5KNo
Yes ❑ No
❑ Yes OqNo
14. Is there physical evidence of over application? ❑ Yes KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......... ........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes X) No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Pernvt?
[� No.vitifationsor. deficiencies.we're'-iiki d-during this.visiC-You'wil recei�e•no•ftirther,:
: corresp6ridei3cO aihout this: visit.' .
❑ Yes JKNo
JqYes ❑ No
❑ Yes A[ No
❑ Yes ffi No
❑ Yes I No
❑ Yes t'No
❑ Yes RNo
❑ Yes Ia No
❑ Yes P(No
Or
CALoe
7/25/97
Retidewer/Inspector dame ,��;e*� A
Reviewer/Inspector Signature: Date: �� Z7

Site Requires Immediate Attention:
Facility No. _ o at - 4 5
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S ,Xz5 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator: Cj�,, iz -5 FAiz f� Phone: q ko - Sqz- - o t ti
On Site Representative: -. 1 Phone: q- o - 4 334
Physical Address/Location: 5 R 1 p o 1 j .k � ero, N� 11 If�tZ
• J
Type of Operation: Swine _X_ Poultry Cattle
Design Capacity: -3-Z� z ej Number of Animals on Site: -5 z
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) , or No Actual Freeboard:-i-t_Ft. G Inches
Was any seepage observed from the
Is adequate land available for spray`
Crop(s) being utilized:
0 Yes or No Was any erosion ob ed? Yes or No
No Is the cover crop adequate? es r No
Does the facility meet SCS minimum setback criteria? `200 Feet from Dwellin ? 1'es
100 Feet from Wells? Ye or r
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o>c
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue�L``i
Is animal waste discharged into water o tate by man-made ditch, flushing system,
similar man-made devices? Yes o No If Yes, Please Explain.
No
E
ie: Yes o No
or other
,Does the facility maintain adequate was agement r volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?(YesA No
Additional Comments:
M, C -,�' .a. \ W «K V_ r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

f.
KORTa CAROLMM DLA�Me=_ OF EZA= & KA?ir_I. RZZ-0 R S
DIViST_CL4 0? M;h_"UU__7 _
rayettav4ille Reg,_mal O fice
Aniaal Operation Cocpliar-=e Inspec-_.= Po
-- =�8.4i-14�.�'I.Di�' =-�.��•
.33,TS�F�ION��DB�"'S' _:
..:P?.r'�L,�DiL*��"� -=4
X��.�as '[WF%2�.,�.5� r�7�t:� `n•--'..�
� - +Y �e��.1�� 30TI3
All questicros answered negatively wi11 be discussed in sufficient de___1 in
the Coe..-te-its Section to enable the deeced Pe=it=ee to perfc= the a_ 4rop_late
corract_ons:
SECTION I
nfinal Operation Tvme:
E0_se5, cattle, aim cult_=y, or Sheep
52CTION 11
I. Does the n=_Iber and tyre of sal meet or exceed
the (.0217) criteria? (Cattle (100 head),
hcrses (75), swine (250), sheep (1,000), and
Poultry (30,000 bi_ids with liquid waste
system)]
2. Does this facility meet c=iteria fez
Animal Operation REGISTRATION?
3. A -re animals confined fed or mafntaiaed
in t'zis facility fcr a 12-maath period? -
4. Does this facility have a ANIMAL
S. Does this facility maintain waste management
records (Vol¢ses of manure, lard applied,
sway irrigated on sperif4c ac aage With
specific cove= crop)?
6. Does this facility meet the SCS
set3ack criteria for neig:_bcr4_-g he-ISeS,
Wells, et-?
Y I N I CO.U- S

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ry Y�
1
t! rt
a rr
ao .�
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isa Id
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+ • 11• I I . ! �U N + U► I > t1+ N t! .+ r
to ci l) in 1, . + u I. U t} w � tl v �t1 r[! G 11 Ut 1; 41
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rr
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dnOJ6 PaZ!UefllO jai peso ' Air
)IJed OMS aMel AjolplBusS -----------

" :Sa
mston of Water Quality] f'
Fie liity-Number Q O Division of Sail snd WWater Conservahots ��}� 1.fl �tJ. 0 io�
0
Other Agency`
C
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Vish: %d Arrival Time: ; 30 Departure lrime: County: a"t- Region:
Farm Name: Owner (honer Email:
Owner Name: Phone:
Mailing address:
Phvsical Address:
Facility Contact: 1 Title• 4r-3'� PhoneNo:
Clnsitc Fiepresentatire: �p fL f �dL- _ Integrator:
(:ertilied Operator: '.t1W 1 74 Operator Certificate n Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: =U =1 ❑" Longitude: =o =1 ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
❑ Non -La er
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure $Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col
1
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any 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
XYes
❑ No
❑ NA
❑ NE
ayes
❑ No
❑ NA
❑ NE
ayes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
5kNE
❑ Yes
❑ No
❑ NA
V NE
12/2"4 Continued

Facility Number: T — 4
In 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 I Struct re 2 Structure 3 Structure 4
Identifier: i r
F
Spillway?: 61
Designed Freeboard (in): 19,
Observed Freeboard (in): _ /�__
Yes ❑ No ❑ NA ❑ NE
.Yes ❑ No ❑ NA ❑ NE
StructurL i Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Z,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
2� 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
;R No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
No El 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
JZ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA
V NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below. JKYes
❑ No ❑ NA
LINE
.Excessive Ponding [-Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 Ibs ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
❑ No
❑ NA
XNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
XNE
18. Is there a lack of properly operating waste application equipment?
[XYes
❑ 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):
� ✓7t r%� �t3'1 I p Ewa
Reviewer/inspector Name Phon : C}'/0,3�`~✓Z✓'�"
Reviewer/Inspector Signature: Date:
1212&W Continuea

Facility Number: — Date of Inspection [ D
" 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 NNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA E&NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
❑ NA
[2aNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
R[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
[XNE
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
ENNo
❑ 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
ayes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
®,Yes
❑ No
❑ NA
❑ NE
e';C�nj� GL�� C�d�7'L v�rjL r O_{L� T�L ct�fJ%©vim Tel— A�
(.Z ✓�,��l-r'ti- 9 �LIJ�`� � W �S/� G[IGES ®tr/ c/'i r• 1 �iuc ¢` ; tom" �-� /'t/2�`Y h rd`�
x4 C-� sue,
'�52'glzz ztx& 7o
r m • I�GUQ T�1c� ��� � i �_ ��c �'� r .
7.
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eo-ilu--,L--�
l4el'49tv 7 a X;� /Vt­
qV
r 7/7R/fill

EMW
�o

Facility Number Q
6 ll ision of Water Qa
Division of Sod and'VI
Q Other Agency
ter Conservation L `
Type of Visit (compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine C_Omplaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Gil: /!� Arrival Time: ! 3ir? Departure'Firne: r County: Region: r>�
- r'L
Darin Name: _�tr�'���'- r�" _ L __ Owner Email:
Owner yatne: y Te' ' r'i� f i!` Phone. -
Mailing Address:
Physical Address:
Facilit-s-C:oillact: -�ai�n���f �L='✓l Title: PhimeNo:
Onsite Represent a rive: �ild� !> L ��e'L Integrator:
(.'ertiiied Operator: Prt! ��f �I kj. _ Operator Certification Number:
Back-up Operator. Baek-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: = o = 1 ❑ " Longitude.: =o ❑ , ❑ a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�� ❑ Layer
I ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Tu6ey Poults
❑ Other
Discharges & Stream Impacts
I . 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
❑
DadCow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
h. 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, notiN DNVQ)
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?
Wares ❑ No ❑ NA ❑ NE
[XYes
❑ No
❑ NA
❑ NE
19yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑. Yes
❑ No
❑ NA
5kNE
❑ Yes
❑ No
❑ NA
V NE
12128104 Continued

Facility Number:
Bate of Inspection
Wnste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[XYes
0 No [.l NA El NE
a. if yes, is waste level into the structural freeboard?
,Yes
El No ❑ NA D NE
Structure l Slruclyrc 2 Structure 3 smicture .l
Structure
Structurz 6
Identifier: Ei�
DesiLzned Freeboard (in):
Observed Freeboard (in): •a
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
N 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
R No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
(� Yes
5_�- No 0 NA 0 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
'F0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No 0 NA V NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
tKYes
❑ No ❑ NA [?fNE
,Excessive Ponding [Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside.of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
� NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
M Yes
❑ No
❑ NA
XNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
IXNE
18. Is there a lack of properly operating waste application equipment?
XYes
❑ No
❑ NA
❑ NE
Comments (refer to question #E): 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):
it 4 U_ .tt/" �5 �tz
�
�-�--" c/2J.s�r�
�r-�
%�.�u!
G7 f��c r>�o: v� C ct
h+1 4 ✓ ( f `
t(fx'f
Reviewer/inspector Name Phone
Reviewer/inspector Signature: Date:
r
0
121.ZSI!4 Continued

lMacilitV Number: j�y,_) 13afe of Inspeetiosa
,- —
Waste C:'olleciion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
0 No
DNA
El NE
a. if ves. is waste level into the stnictural freeboarV
,Yes
( No
❑ NA
NE
structure I struct�lc 2 Structure .s Structure •1
Siructure
Structure 6
[mott Idelitiflc:l':•!.'1
I)esiv,nedFr-eebuard(in):
r
_
Ohserved f'recba.ard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
U yes
&No
❑ NA
EJJ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
n Yes
�S No
❑ NA
❑ N-E
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? D Yes FX No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Ej_ Yes 1 _' No Ej' NA [l 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 El Yes J0 No ❑ NA 0 NE
maintenance or improvement?
'Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need ?0 Yes Ej No ❑ NA M NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below. Yes ❑ No ❑ NA Ef 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)
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?
M Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%€
,i Yes
❑ No
❑ NA
[XNE
17. floes the facility lack adequate acreage for land application?
F� Yes
L! No
❑ NA
XNE
18. Is there a lack of properly operating waste application equipment?
Ayes
Cl 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):
.ram 1..1-^4.``�". l' ='�i`_ �.- t G• �i, j�� `t r ��_ 5 `.^�^-r,i•_ `<~. ,(�. L C�=�--,1-- ...: ,
'7—
-n
t�
J
l->{ ' '��t''!T !`` rr; t,•// %�� .�r1 t�,�. !< .. 10,C77`'icI4`-;o-.1( ' `�L ✓ti C"i?. i'-'t:_. r .
('�,�:>✓ .:Yr6' .� - L -j
Iteviewer4nspeclor Name r 1 �� c`C %`rr�L F� - Phone:` '` t`� z _f_'• L�
Reviewer/Inspector Signature: yam., Date:
t
IL'125174 (.Onrtnuea

e
Facility Number: `
�� — L�:.) Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &: Permit readily available? ❑ Yes ❑ No ❑ NA ® NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ❑ No ❑ NA C9NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
IN NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
®.NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
aNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
12�NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
® NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
UNE
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
[3No
❑ 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
EKYes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[&Yes
❑ No
❑ NA
❑ NE
G 7 +
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hkh..

4

Facility Number: �-i — i�,:`� Date of 111sp:eetiolz
XVastc Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`' [Yes Ct No ❑ NA h NE
a. If yes, is waste level into the structural freeboard`? No ❑ NA L i NE
_ Structures i Struciure 2 Structure ; Structure •1 Siructur Structure 6
f� Identifier: 7�ts.r.,�-(�'i:=''
rf W :
Designed Freeboard (in): ! 6,L
1
Ohserved Frecboard (in); 2 E f -�-
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes
&No
[INA Li NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ll Yes
[ S_ No
❑ NA El 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
M_..No
F1 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 Anylicarion
10. Are there any required buffers, setbacks, or compliance alternatives that need �� Yes
❑ No
NA TNE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. tKYes
❑ No
El NA C�NE
,Excessive Ponding [Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAIN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
❑ No
❑ NA
X NE
15. Does the receiving crop and/or land application site need improvement?
� Yes
❑ No
[] NA
GI NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
Q Yes
❑ No
❑ NA
PR NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
[l NA
XNE
18. Is there a lack of properly operating waste application equipment?
,Yes
0 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):
1.,J_ ^"~~(� F C / IJ r [C � �! f�•x ' e
i i ["1 �,1 �,•�.�. f ev l�r/� J
G%x"/: � t 4 o 'Lic '! l� %i
hc?ej
F,Reviewer4nspector
Name Phony i
Reviewer/Inspector Signature:
Date:
12/L161W t.onanuea

Type of Visit Q<5ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — 1 t? Arrival Time: ' Departure Time: ! C7 County: ��A �'^� Region: Z'-o
Farm Name: ry7—ram _ a✓r►'��_ _ Owner Email:
Owner Name: a✓o4, „ d rr r—/.1406f— _ Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone No:
Onsite Representative: SrOW11--la-- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: = O = d = Longitude: = ° = , ET,
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑Non-Dai
❑ Beef Stocker
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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?
Z Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
10 NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? RYes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No ❑ NA ❑ NE
Structure l 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
tKNo ❑ NA ❑ NE
(ief 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? ZYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? yes
�SN� ❑ 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 [J Yes
2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA SNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ONE
❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No ❑ NA R NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No ❑ NA ERNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
❑ No ❑ NA ® NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No ❑ NA NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA ® NE
Comments refer to uest�on ## Ex lath am YES answe' ( q ) p r y rs and/or any recommendations,or any other�comments
Use drawings of facili ' to better ex lam siivations. use additional a es as
la t?' p t p g ecessa„ryF)= t =�`
._ Till
MW
FD e-
�1r. ! Irr� Wus Gzi7 e-1., `v �'�/�lYIJ l h iS Cyr , P-/Cd 0&r2�b1_5 L; cl�'.
rM(
Ai�,,,_ 0 �C
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: �O
12128104 Continued

Facility Number: —. L j 1 Date of Inspection
Required Records & Documents
r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA aNE
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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 91 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA qNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ® NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26. Did the facility fail to have an actively certified operator in charge?
-Yes
❑ No
❑ NA
® NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[aNE
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
[4 NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
® NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
® NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(0 No
NA
33. Does facility require a follow-up visit by same agency?
[yes
❑ No
❑ NA
❑ NE
g �- W�3 Su��� 6 �wG? ��� d--,Sa.L �-G�k��--ST•rF �,��
Moe'�` g�� L�� 0�4-�_ .�e�elS I D u_.i--G SL,.-.-7
r ! ' ,� �, rrl-D,+r� 7v IV VV . 56w,- _rorvt-
M�rk�r 'W Inark
1-
r �ie57r U�oS b c F f C- ovyf � �tv"^ -rAY_ r-r r
122&04

Type of Visit ( 'Compliance Inspection 0 Operation Review 0 Structure Evaluations 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: P J Arrival Time: ! flD Departure Time: County: e�- Region:
Farm Name: i/�z' �'�" Aa�' � ry-L— Owner Emaif:
Owner Name: zh1k n— Phone:
Mailing Address:
Physical Address:
Facility Contact: l0 _ - /COL Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ,/i1/ rd/y
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o E] t ❑ " Longitude: = o = I [__1 u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity P RUGHon
❑ Wean to Finish
La er
El Cow
❑ Wean to Feeder
LIED Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Stocker
El Non-Layens
ElBeef Feeder
El
ElBeef Brood Co
t�umher of Structures:
El Pullets
Othwl
er
❑ Other
El Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J9 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?
5§ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VINo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection— (Q�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
RYes
❑ No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r)-0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[F] No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
[]No ❑ NA
®NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [)� NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA (D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA 9NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [R NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[!INE
15. Does the receiving crop and/or land application site need improvement`?
❑ Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
E5 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
ZJ
Him*k .:
C0 drawings of facility toibetter explain situ y YES9answers;aniilor anyPrecommendattons or�any other comments
( q ) p x
ations (use additional pages as necessary) �- a
� ftIkwu j �Avetq ids
T ��e•Lt� ��5� h�5 7iC�' 1���r ,�.�r�a`rr� �-�+f9� tA.1e�T,,r�/j'�P 1�!'t' ���Gl�, i 5 1��� )'L Pi!^V�
qjV
Reviewer/Inspector Name I v r Phone: .3 �33t7�
Reviewer/inspector Signature: Date: _ y ,XelD
12128104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes H(No ❑ NA aNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑-NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
;9LNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
]fain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
0 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
® NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA W NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
PINE
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
[LNE
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
GkNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�R No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
RYes
❑ No
❑ NA
❑ NE
12128104

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen Sullins, Director
Division of Water Quality
January 2, 2009
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Harold Allen
4047 Marsh Rd
Bladenboro NC 28320
Subject: Inspection Amendment and Clarification
Elden Hester Farm
Facility No. 09-0045
Bladen County
Permit No. AWS090045
Dear Mr. Allen,
This is clarification of several problem areas of my inspection of December 31, 2008.
Please file the enclosed inspection revision with the rest of the inspection.
checked with our Raleigh office and you do NOT have a sludge survey exemption form
on file. You can either file for an exemption for 2008 OR conduct one as soon as possible.
Basically that would be a late survey, and you should do another one in December 2009 (unless
you are granted a rare several year extension). You do not have to use this Sludge Survey
Extension form, but can send a plain language request for an extension. Either way, you MUST
send a COPY of all pages of the sludge survey for both lagoons (including a "map" of areas
sampled). Please keep the original on the farm.
Also our computer system shows both you and your wife as invalid Operators in Charge
(OICs) as of January 1, 2009, due to lack of continuing education credits. If this is the case (and
it may not be), you have until January 31 to obtain the necessary credits or you can retake the
OIC exam in March. One problem is that the computer list was posted on Oct 28,so will not
reflect changes since then. Another problem is that not all continuing education courses will give
you animal waste credits. If you check the invoice for the $10 fee to renew your animal waste
license, it should have on it the credits you need and when they are due. If you have any
questions you should contact the Technical Assistance and Certification Unit (TACU) in Raleigh
directly at [phone].
1 was unable to find any animal waste continuing education courses being offered in
January on the TACU website. However, due to the number of farms in this section of the state,
it is possible some could be offered. The other thing to watch is whether you could get enough
credits to be legal in only one month. Please check with your county extension agent.
The next exam is on March 12 and the application has to be in Raleigh by Feb 10, along
with the $25 fee. The two closest exam locations are Kenansville and Raleigh. An application is
enclosed and I filled out some of the top portion from our computer records, since you might
have trouble locating your earlier exam date. The Commission should accept your earlier N rJhCarolina
Naturally
North Carulina DWQ/Aqui ter Protection Scclion 225 Green St./ Suite 714 Fayetteville, NC 28301 Phone [phone]
FAX [phone] Internet: h2o.enr.stale.nc.us Customer Service 1-877-623-6748
An Equal OpportunitylAffirmative Action Employer — 50% Recycledl10% Post Consumer Paper

license number and exam date, if you can't find the certificate of training. It is not unusual for
operators to lapse and have to retake the exam to regain certification. It would probably be a
good idea to study your manual and check out the rules on the TACU website at
http:llh2o.enr.state.nc.us/tacu/index.htm1. Newer manuals are available from your county
extension office for $25.
Assuming that your certification did run out by Dec 31, and you end up having to take (and
pass) the first exam, you would still need a legal OIC to sign off on any spray events conducted
between now and then. Please talk to some of your OIC neighbors and see if one would be
willing to help out temporarily. At this time of the year, you may need to spray on short notice. In
fact, with your lagoon levels, you will need to spray in the near future.
In his inspection of 05/21/2007, Steve Guyton mentioned that you needed to start
keeping transfer records. Unfortunately, I did not notice that previously but I now agree.
redesigned the transfer form so that it will work for your farm and enclosed two copies. For
surface area, just multiply length and width of each lagoon. If you cannot locate the construction
information, use 91,476 for Lagoon 1 from our computer and 35,800 sq ft for Lagoon 2,
estimated from an aerial photo. I could not find construction data at Fayetteville.
New permits will be coming out in the fall. You will be mailed renewal forms in February
or March and these should be back in Raleigh by April 1, 2009.
1 apologize for any confusion caused by me or other past inspectors. If you have any
questions concerning this matter, please do not hesitate to contact me at [phone].
Sincerely,
Man Schneier
Environmental Specialist
Division of Water Quality
Fayetteville Regional Office
Attachments: Inspection Revised page 3
Sludge Survey Extension form
2 Applications for Animal Waste Exam
Instructions for above
Revised Transfer Record form

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of F,nvironment and Natural Resources
Coleen Sullins, Director
Division of Water Quality
January 2, 2009
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Harold Allen
4047 Marsh Rd
Bladenboro NC 28320
Subject: Inspection Amendment and Clarification
Elden Hester Farm
Facility No. 09-0045
Bladen County
Permit No. AWS090045
Dear Mr. Allen,
This is clarification of several problem areas of my inspection of December 31, 2008.
Please file the enclosed inspection revision with the rest of the inspection.
I checked with our Raleigh office and you do NOT have a sludge survey exemption form
on file. You can either file for an exemption for 2008 OR conduct one as soon as possible.
Basically that would be a late survey, and you should do another one in December 2009 (unless
you are granted a rare several year extension). You do not have to use this Sludge'Survey
Extension form, but can send a plain language request for an extension. Either way, you MUST
send a COPY of all pages of the sludge survey for both lagoons (including a "map" of areas
sampled). Please keep the original on the farm- 15
Also our computer system shows both you and your wife as invalid Operators in Charge 14-i
(OICs) as of January 1, 2009, due to lack of continuing education credits. If this is the case (and
it may not be), you have until January 31 to obtain the necessary credits or you can retake the
OIC exam in March. One problem is that the computer list was posted on Oct 28,so will not
reflect changes since then. Another problem is that not all continuing education courses will give
you animal waste credits. If you check the invoice for the $10 fee to renew your animal waste
license, it should have on it the credits you need and when they are due. If you have any
questions you should contact the Technical Assistance and Certification Unit (TACO) in Raleigh
directly at [phone].
1 was unable to find any animal waste continuing education courses being offered in
January on the TACU website. However, due to the number of farms in this section of the state,
it is possible some could be offered. The other thing to watch is whether you could get enough
credits to be legal in only one month. Please check with your county extension agent.
The next exam is on March 12 and the application has to be in Raleigh by Feb 10, along
with the $25 fee. The two closest exam locations are Kenansville and Raleigh. An application is
enclosed and I filled out some of the top portion from our computer records, since you might
have trouble locating your earlier exam date- The Commission should accept your earlier IV `�hCarohna
�valurally
North Carolina DWQIAquifer Protection Section 225 Green St./ Suite 714 Fayettevitic, NC 28301 Phone [phone]
FAX [phone] - Internet. h2o.enr.state.nc.us Customer Service 1-877-623-6748
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