090166_INSPECTIONS_20171231

�Vn
NUH I H UAHULINA
Department of Environmental Qual

M,5
Division of Wager Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090166 Facility Status: Active
Permit: AWS090166
Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine County:
Bladen Region:
Fayetteville
Date of Visit:
11/21/2017 Entry Time: 03:00 pm Exit Time: 3:30
pm Incident 0
Farm Name:
Crooked Branch Nursery
Owner Emall:
[e-mail]
Owner:
Crooked Branch Nursery Inc
Phone:
910-645-1380
Mailing Address:
a 1 a S Poplar St
Elizabethtown NC 28337
Physlcal Address:
1750burney Rd
Bladenboro NC 28320
Facility Status:
Compliant ❑ Not Compliant Integrator.
Prestage Farms Inc
Location of Farm:
Latitude;
34° 32' 52" Longitude:
78° 43' 12"
From Clarkton, take hwy 211 West to Wright Road, turn right, go to slopsign, turn right and farm on left one mile.
Question Areas:
Dischrge & Stream Impacts Waste Cal, Stor, a Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Charles M Hardee Operator Certification Number: 16284
Secondary OIC(s):
On -site Represontative(s): Name Title Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Calibration Sept 2015 Sludge Survey 10-24-2017 Sludge 2.8, trealmetn 4.0
page: 1

Permit: AWS090166 Owner - Facility : Crooked Branch Nurse Facility Number: 090166
Inspection Date: 11/21/17 1npsection Type: Compliance Inspection . Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 6,080 5,400
Total Design Capacity: 6,080
Total SSLW: 182,400
Waste Structures
Dislgnated Observed
Type Identifier Closed Date Start Data Freeboard Freeboard
Lagoon
09-166-01
19.00
Lagoon
1
19.00
41,00
page: 2

Permit: AWS090166 Owner - Facility : Crooked Branch Nurse Facility Number, 090166
Inspection Date: 11/21/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
heroes & Stream tmna
1. Is any discharge observed from any part of the operation?
❑
■ ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?_
Waste Collection. Storage & Treatment
X21 No No No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
� ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
■ ❑
❑
8, Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
aste Annllcatlo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

9j
Permit: AWS090166 Owner - Facility : Crooked Branch Nurse Facility Number. 090166
Inspection Date: 11/21/17 Inssection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No No No
Crop Type 1 Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2 Coastal Bermuda Gress wl
Rye Qverseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1 Wagram
Soil Type 2 Goldsboro
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
.1101313
Records and Doguments
Yes No Me 82
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0; ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
[]
Lease Agreements?
[]
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
■ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

.J
Permit: AWS090166 Owner - Facility : Crooked Branch Nurse Facility Number:
090166
Inspection Date:. 11/21/17 Inpsection Type: Compliance Inspection Reason for Visit!
Routine
Records and Documents
Yes
No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fall to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑0
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below: '
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
Cl
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yja
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑0
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately:
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(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 ❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ 0 ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ M ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

on of Wateol r Resources
Facility Number C_y ISoil and Water ConservaYian 01��'j
u Other Age,cy
Type of Visit: 7Routine
fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint _ 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' qp Departure Time: County: &aAn. Region: F45_1)
Farm Name: - 001VA—V 151'4-1-14 to "P*f Owner Email:
T
Owner Name: it S� Wmne:
Mailing Address:
Physical Address:
Facility Contact: Ku,y iyoe4t�'L_ Title:
Onsite Representative:
Certified Operator: 004t,.G C�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
4 4 Integrator: l r-t
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity P .
Wean to Finish
Design C**urrent
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design
Capacity
Current
D.
"
Wean to Feeder os
Q
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design C**urrent
ltr, C•.a Welt P.o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts4
s
Beef Feeder
Boars
jNon-Layer
Beef Brood Cow
er
oults
Dischareesand Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E3_NV--❑ 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
[f—NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
f] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

44
Facili Number: - Date of Ins Inspection: ' OV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-+ro— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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
[RI�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
D<o
❑ 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
❑-1 _o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[c]-K
❑ 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 C2 1o_ ❑ 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 J '[� 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 [2Io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!rNo 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [J"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNj ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes Zr�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes EfNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C!No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CTNo ❑ 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 Cn No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �lo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E!rN o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the Yes EErN0 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [l"No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EJ�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [no ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes C20'go ❑ NA ❑ NE
Comments (refer fogaestion�E_fi): lainfaiiy YE,5answers an`d/ar any'adltional'"recuinmeridation"s nr anyoilier comUserawoffacillt to ber ex _lain situatiops(nse addltional ages as,tiecessa
C1,
Reviewer/Inspector Name: - Phone: 3 3 -33 3
C C��[
Reviewer/Inspector Signature: Date: /'go, !p
Page 3 of 3 21412015

IY4s 23 ol✓7-t5610
Type of Visit: 4EYCom Hance Inspection O 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: Arrival Time: Departure Time: t7D County: IN Region:
Farm Name: ��—�,rxw� �e r Owner Email:
Owner Name: �� Phone:
Mailing Address: r'
Physical Address:
14
Facility Contact: 'fC a Title:
Onsite Representative:
Certified Operator: S��y� ok,gd dl
Back-up Operator:
Location of Farm:
Phone:
Integrator: Pet G4z
Certification Number: �[_qv _
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capactty Rop.
Dai Cow
Wean to Feeder
Non -La er
I
alf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
C*urgent
Dry Cow
Farrow to Feeder 1)WRnuItr, -a HE ,INon-Dairy
Farrow to Finish ILavers
113eef Stocker
Gifts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Caw
Other
NJ Other
I IOther
Turke s
Turke Poults
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?
[:]Yes 10 ❑ NA ❑ NE
❑ Yes ❑ No [rNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes []No MNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes UD No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDateof Inspection: OG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []-NT'_'❑ NAB ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [j'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 ET il�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 E31Vo
❑ 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 Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2<0
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [!rlNo ❑ NA ❑ NE
❑ Yes 64o ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes 2 No
❑ Yes If<
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
po ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA E] 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 eNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2"No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - ILL jDate of Inspection: bC l
24,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EEI-Pb ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-4cr ❑ 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 EINu- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ED-No'
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3-W
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
B-PGo`
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0"�Po
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0-9°
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ 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).
5TPsje 'q'^l- 7-f-is
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
M
•
Phone: LB - M
Date: w 6 cr I�
21412014

.1, :R, I M 3 ;Lo cl 14 6b
Type of Visit: ompllance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: CrRoutine ()Complaint O Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: �� Arrival Time: ' U� / Departure Time:County:
Farm Name: Owner Email:
Owner Name: I PI& l`'C Phone:
Mailing Address:
Physical Address:
Facility Contact: & I � i- - Title: Phone:
Onsite Representative: �� Integrator: -.-�
Certified Operator: Ckn6c "KgPk
Back-up Operator:
Location of Farm:
Region:�
Certification plumber: I J'4 " 6
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder
D
S
Non -La er
Dai Calf
o Finish
Dai Heifer
o Wean
Design
Current
D Cow
o Feeder
E
Dr P,oultr,
Ca act
Pto .
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
Turk Poults
EFI-0ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes G-1Qo ❑ NA ❑ NE
❑ Yes [:]No �A ❑ NE
[—]Yes [-]No [ A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [3 No []-IAA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes [ go- ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

1
Facili Number: - Date of Inspection:
W t C 11 t' &T t nt
as e o ec ion rea me
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[3Yes
[3No
[J"NSA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
ww
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-M
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E-1go
❑ 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
[]?110
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q.PdS
❑ 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
°
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. 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 �!o ❑ 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): �CdwGi `S G
13. Soil Type(s): �j O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [] o ❑ NA ❑ NE
❑ Yes [:JNo ❑ NA ❑ NE
❑ Yes
[:(No
❑ NA
❑ NE
❑ Yes
[ "&o
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
[:]Yes
[no
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [!JlNo ❑ 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 El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [r Nc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

l
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g3'go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes G<O ❑ 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 E3 o [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [R'I<o DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑.?db ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes C3 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ 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?
r
C��.t A _�- I //' - P - f 7-r
.7-- e- I q D - 2t T
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P. V
❑ Yes [31�o ❑ NA ❑ NE
❑ Yes [;[No
❑ Yes [io
❑ Yes [�Io
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: 3 3
Date: XIL Loki
21412014

?-a,t'-1' t3l-)
(vision of Water Quality
Facility Number - ! 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01foutine 0 Complaint 0 Follow-up 0 Referral 0 Emerzency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �� Departurc Time: County: l ch Region:
Farm Name: l� iroo Gd Qs�✓11 Owner Email:
Owner Name: Q�� Phone:
Mailing Address:
Physical Address:
Facility Contact: 6844 fed` tw Title: S Phone:
Onsite Representative: 1.1
Integrator:
Certified Operator: #144f
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: l6 a r
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F
ern -La er
Pou
Pullets
Pouets
Design Current
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 DWQ)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
[f NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [DNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [E'No [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [D o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

14,
Facili Number: -of ot Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ES -NI""_❑ 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?: e
Designed Freeboard (in): ("[ „--
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑.Ko ❑ 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 g<o ❑ 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?
es &'K
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
C] Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[E�5_o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V2,lTo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[g.No
❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):GJ
13. Soil Type(s):
IA2pPA-A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[D,-b6
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'TKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
g-5oo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C4-Nw
❑ NA
[] NE
Required Records & Documents
''
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I ENO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
.o
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design [] Maps [] Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [LX9 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �' o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

It ,ti
Facili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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?
I;,w ❑ NA ❑ NE
to ❑ NA ❑ NE
❑ Yes
[Zpl'o
❑ NA
❑ NE
❑ Yes
[;j o
❑ NA
❑ NE
❑ Yes [ P10
❑ Yes L.4 o
❑ Yes Ce o
❑ Yes L.K 1 o
I
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
02r�o
❑ NA
❑ NE
❑ Yes
[!rNo
❑ NA
❑ NE
❑ Yes
[�fNo
❑ 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).
k-T
�,� e2Io�
(07n�
Reviewer/Inspector Name: h Phone 0 3 3-
Reviewer/]nspector Signature: Date: 0"U(3
Page 3 of 3 21412011

P-__ cl?_—G -0-
.1
Wivision of Water Quality
Facility Number - © 0 Division of Soil and Water Conservation
��
0 Other Agency bpi
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outlne 0 Complaint 0 Follow-up 0 Referral 0 Emeraenev 0 Other 0 Denied Access
Date of Visit: �' 3 Arrival Time: Q' p m Departure Time: County: - — Region:
Farm Name: OY VOA, —j 'D /'p KP %JU /,4r t:r e Owner Email:
Owner Name: n�a�Q/"�e� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: G Phone:
Onsite Representative: . f'.c.�t Integrator: //r4zi�A'
Certified Operator: ,%? Lrvr.� Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F�Non-Layer
a er
0
Non-L
Pullets
Other
Poults
Design Current
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 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [& No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
[:]Yes [:]No
❑ Yes ® No
❑ Yes No
❑ NA [] NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: V.—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rNo ❑ NA ❑ NE
1
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): 191
Observed Freeboard (in): _ '_r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
Ea No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r" No [3 NA [3 NE
[ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
U. Crop TYpe(s): z'r7'MfUjA
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ULNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ZLYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [XNo ❑ 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 Z. 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 rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
• 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 E�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 M 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 the 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 Eig.No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ['$g No ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
allo
❑ 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 ages as necessa ).
fur foray Fi` �4Is TO t?-a11ve e_y'a,ar-P FF TyJ:1c 47'Ass -
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: CL-1-
Date:.3'}—a-�l ice_
21412011

ivision of Water Quality
Facility Number ®- ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (!Koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ] ', 00 1 Departure Time: ' County: �rd,� Region:/
Farm Name: C%Diq it end a.r?ek Owner Email:
Owner Name: ,1,CIr i� �1?-e Y C _.,,.._ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: / ,-� G 4
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder^
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: nGjz':'O:�
Certification Number:
Certification Number;
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
I I Ed
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes EINo ❑ NA ❑ NE
[] Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [3,No
❑ Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

• 1~ acili Number: - Date of Inspection:_3­�'1_-9e)4-11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural frceboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
&No
[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?
❑ Yes
(� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): &9r`I7?U�.[
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 andbr land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 5�No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [:]No
Waste Application ❑ Weekly Freeboard ❑Waste Analysis ❑Soil Analysis [] Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 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
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• Facili Number: - Date of 1ns ectlon:
,l
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 EINo ❑ NA ❑ NE
[] Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [a 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 or any other comments. .
Use drawinEs of facility to better explain situations (use additional pales as necessary).
u pda4r yt?-Vr-
Reviewer/Inspector Name: Phone: 1La� nn,,3 W
Reviewer/Inspector Signature: Date: _o_U O� O G %
Page 3 of 3 21412011

'he
Facility Number]
tvision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0-160'mpliance 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:41;p Arrival Time: ��(% (J Departure Time: /d % County:
�U-�/'TF`�/✓
Farm Name: 4 � I' n1 AkrTQ Owner Email:
Owner Name: 10411 /C�Jgr /44"'k' C.r �*i� / Phnnp:
Mailing Address:
Physical Address:
Facility Contact: /"/Alz2r -E— Title: Phone No:
Onsite Representative: r" a Integrator: r
Certified Operator:�� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ 13oars
Latitude: n c
Back-up Certification Number:
Region:
="
Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
� 8D ❑ Non -Layer I I Ej�
Other
❑ Other i i
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Puilets
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 2 Flo ❑ NA ❑ NE
[]Yes
❑ No
FNA
❑ NE
❑ Yes
❑ No
U IKA
❑ NE
[]Yes.
❑,NNoo
[B A
❑NE
❑ Yes
o
❑ NA
❑ NE
[]Yes
9"'No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection 114zel!!1
Waste Collection & Treatment ��/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElC! Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 92 A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O 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 EJ-IqA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ No �NA El 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 El No CI NA El NE
maintenance or improvement?
Waste Application ��----,,!!
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes P o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E*N�o ❑ 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)leOf0.. :5,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IT 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
Ol No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
G;�<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B<o
❑ NA
❑ NE
Comments (refer to question: #): Eiplain any YES answers.andlor any recommendations or a,ny other comments .'�'t
Use drawings of facility to better explain situations. use additional, pages as necessary)-
Reviewer/inspector Name
Reviewerllnspector ' gal
Phone:
Date: 0"9 r�
Page 2 of 3 1

,r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ` ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes P110 ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
5o
❑ 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
B o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
B<A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3'-No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes IJ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes B<o ❑ NA ❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Zwo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IJ 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
CrNo
❑ 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
2<0
❑ 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
01No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EIo
❑ NA
❑ NE
Additional'.Corriment9 and/or Drawings �
f, .F .
i
Page 3 of 3 12128104

31-MS /D -dg- 76011
ivision of Water Quality
[7 Facility. Number O Division of Soil and Water Conservation
Other Agency
Type of Visit
inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
6�ommpliance
(7Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 5 -OQ-011 ��A,rrlIival Time: ; Qq�ry� Departure Time: /O.;�o County: 91AN dpRegion:
Farm Name: C rOD keA PwQ tjQ�% ur5 e- ru Owner Email:
Owner Name:..&16� A Prile e_ Phone:
Mailing Address:
Physical Address:
Facility Contact: �4 AtZ 16 u u N '_Title: 7Ze,4. ��r c Phone No:
Onsite Representative: 4 C'' "I r�� Y _ _ Integrator: �%'�—► r` 'r�
Certified Operator: / Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 I = 6f Longitude: 0 ° 0 , 0 "
Swine
Wean to Finish
LJ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Pouits
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ICI No ❑ NA ❑ NE
❑ Yes
❑ No
[M NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
12128104 Continued

Facility Number:QDate of Inspection T -O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,I No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1 denti f ter:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V1 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
(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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElYes
Vf No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[)I 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 Evidence of Wind Drift [IApplication Outside of Area
��Window
1❑
12. Crop type(s) - Se-y (k-r-71" C. � l J S at�1 r�"n�
LA
Ei - S
t
13. Soil type(s) N0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff 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
[2 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
IVOf,r_ 0 -TG
fii-n OeAj v rN /
ReviewerAnspector Name ./0!�'; C_ Re_1/ , e Phone: q
Reviewer/Inspector Signature: Date:
12a8/04 Continued

�u 9 zvuGt
Facility Number: t7 C/ — Date of Inspection 7-o 9 -0 9
_Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [6 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No El NA ❑ NE
the appropirate box. ElWUP El Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
17 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W 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
[] YesNo
❑ 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
[INA
ElNE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
12128104

�vislon of Water Quality -le-f
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 4erComplience Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vislt outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I=—U=J Departure Time: i3O 1 County: . Region: l
Farm Name: � � �7 13 r—a mck �U/� S �i` y / Owner Email:
Owner Name: ~��/J.� � /7/_ e'OlI e­r r!/ Phone:
Mailing Address:
Physical Address:
Facility Contact: a� Title:
Onsite Representative:
Certified Operator: dr Gfetf
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: ZI_
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = ❑ 4 Longitude: = ° = 6 = 1f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
0 p ❑ Non -Layer
Dry Poultry
Non-L
Pullets
Pau its
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
RNo
❑NA
❑NE
❑ Yes
�RNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility j Y Number: —Z Date of Inspection [�O�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo WNA ❑ 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): / j'
Observed Freeboard (in):
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. Arc there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M 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
WNo
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
6Z No
❑ NA
❑ NE
maintenance/i in prove men I?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IN No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l o 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) ,.�mj,0__,��Gti`Se
13. Soil type(s) A1pA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? C8 Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [2q 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 K No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
Comments (refer to question #): Explain any 'YES 'answers and/o`r any recominendations or any other` comments. "
Use drawings of facility to better explain situations. (use additional pages, as necessary):
i
Reviewer/Inspector Name
- ----- -- -__ __z _.
.' " Phone: 9/0 f.3.ja
Reviewer/inspector Signature:
Date: 7i&
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? ❑ 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. ❑ WDp ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J@ 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
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JQ No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C4No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J§ 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
XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
19 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additional Comments. andlor.EDrawings:
Page 3 of 3 12128104

i
ivision of Water Quality
Facility Number /(0 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 6-6—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QWoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'rimed ! ! -3 07 Departure Time: '3 {7 I County: •'L Region:
Farm Name: Owner Email:
Owner Name: /L[/�X r �'` ��Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.,
Certified Operator: t� y G. �h f jEr!2 -f
Back-up Operator:
Phone No:
Integrator: a1':6��„ _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = 6 = Longitude: = ° = ` 0 "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r Q ❑Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Imparts
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)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
DEY Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: IE
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [<No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
11/18104 Continued

Facility Number: -- Date of Inspection 2E�7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 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 L@ 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s) 04
W. 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? �R Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ZNo
❑ 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):
ReviewerllnspectorName
.rrt!-� Phone:
Reviewer inspector Signature:
Date:
12128104 Continued

f� Facility Number: — Date of Inspection _�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CZNo ❑ NA ❑ NE
❑ Waste Application ❑ Wcekly 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
;3 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
FM No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M 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
Z 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
54 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 0ompllance 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: I
/ 130 1, Departure Time: { M County: L Region: _ '�
Farm Name: ��fle�r� s 1 a±2j�' - �NUI:512n!'Z Owner Email:
Owner Name: /�f/,��t /t-�✓�b/ Phone:
Mailing Address:
Physical Address:
Facility Contact: �tY_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: T
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 t 0 11
Longitude: 0 ° = ` 0
16
ti rolmur,
'' :gnDesignCurrent��"t DesigT1111cf-U
wnecittioo:, Wet Pi O_y uMtry��,,'Capacity Popu[ahon£ 91.toi�e pulation
f +TrKiw h
❑ Wean to Finish ❑ La er ❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer ❑ DairyCalf
❑ Feeder to Finish ❑Dai Heifer
❑ Farrow to Wean ❑ D Cow
❑ Farrow to Feeder Non -Dairy
❑ Farrow to Finish ❑ Layers "
❑ Beef Stacker
❑ Gilts ❑Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cow
rt ❑ Turke srw h
Other "` ❑ TurkeyPoults;s is
❑ Other ❑Other Numberof Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
❑ 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?
to 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?
12128104
Continued

f Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 00
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 E,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes ,9No ❑ 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? 5 Yes ZM45: ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA RNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA aNE
❑ 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
JZNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
C'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA a NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
b NE
18. Is there a lack of properly operating waste application equipment?
N Yes
❑ No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
4y��r 5tl o 9 +mot. i5 cL�I low �
At� C�
ReviewerlInspector Name �� a� -� Phone: 9/
Reviewer/Inspector Signature: Date: —'s —9
Page 2 of 3 12128104 Continued

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �WNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA JZ NE
the appropirate box. [l WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 21 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
N 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
RNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ff NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ONE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
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
ERNE
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
EZ NE
33.
Does facility require a follow-up visit by same agency?
10 Yes
eNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
r 1
i� G��' U 1S LOfl�S L-s.-f'Csr.! /ticrei9 �P /iYei�'1
�Bwn -rD e
�Z AA D
j a4ol if, ®Ir- ro w ��rrni� - 1 �clli;'G
avid tA- � i qe-
O P� 20a'r
bd
12128104

t
f
1
vision of Water Quality
Facility Number ��M.3
Q Division of Soil and Water Conservation �
O Other Agency
Type of Visit ompnance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up 0 Referral O Emergency Cher ❑ Denied Access
Date of Visit: ,3" 5—O Arrival Time: %oD I Departure Time: ,,jib County: Region:
Farm Name: .ne A-!� d ar tr.� /VLr ✓_t;r_44 �l Owner Email:
Owner Name: /�1 �� sr - �� / -/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Latitude: =
0
Phone No:
Integrator: a2i �_�
.01
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
(rD8'D I I on -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure E9 Application Field ❑ Other
a. Was the conveyance man-made?
" Longitude: =
0
Design Current
Cattle Capacity Population.
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E j
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?
MYes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
❑ NA
❑ NE
9LYes
❑ No
❑ Yes
ELNo
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
12128104 Continuer!

i�
s
Facility Number: Date of Inspection
ti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �'—
❑ Yes �&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
O 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
E4 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
❑ 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.
aYes
❑ 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 29 Application Outside of Area
12. Crop type(s) 0 /� rstrf
13. Soil type(s) J(f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15""' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
TO NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
N 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?
t.Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any- ,other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Fier-�Daa/ r .,
Aot 4A�Dti�- eUcrt GlaS ; n � C a'D/Pry}} j,�v..tr
"s1�ifiD%,c�sr
QU,err Al0/ 7, IXOPe1 lrJcr �C �� ,'•�� ��rn.�cviT�
a 065e' i» W, C R ,-e- DOcfs .
.
Reviewer/Inspector Name �UC� r�-- 1 Phone: 9Ucr0o
Reviewer/Inspector Signature: Date: �5 3 022
Page 2 of 3 ' 12128104 Continued

Facility Number: Date of Inspection
Reuuired 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 S No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA JKNE
❑ 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 O NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA aNE
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
O-No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA NQ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
,9 NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
C 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
allo
❑ NA
P 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
EN 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
CE No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
hPpU e @ Y- ev srLf teas b/ /yjvG-nr l`fC dvaa 79a7u u.Eas
k✓rti _r_a W.-rr��5i7
l
J
L I-5r 7'- W � I b = JD -PLC f"pL TO f- D 07C
�r
12128104

t_
K
Type of Visit (9'Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 9-1 routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: %,: t7 C) I Departure Time: � County: rf�
Farm Name: Owner Email:
Owner Name: Zi-'-f2�(�c_ �(��x 01 Z Phone:
Mailing Address:
Physical Address:
Facility Contact: err Title:
Onsite Representative: / 44? _Drcn.--
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Region:
Phone No:
Integrator:'''�� /e�.�--
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o 0 4 ❑ `4 Longitude: = o = � = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
fpO*D S1.00 JLJ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Ulurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RN
❑ NA
❑ NE
❑ Yes
J9LNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection LL21�Y�
lti 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:
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): f 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5? 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? R Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IN 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 R No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J& No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) '��c+�f'vi,��i ,.t A1/Yy`•S��d
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? ❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
I,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
JRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA
❑ NE
ments(referto1�questio1�(n#jgE�xpla'l�nvy,,agYltYl�,S answers andior any recommendations or nny other comments.
1�. 63'�3'd.t ' 1 Fx'irl�YR
raw�irn+�gs a%Iaciiity�¢}}t,n bet44���er� explainrsituatippons. (use! ddpitionai pages as necessary):
ffse�1[i9�15' ✓ir'4�'e����i�.'�1;�1 siYS�I'.'�.�s+.Y$3'�+.} `;:a.Lkhd iJY.��wMx51,>.�'�g �'� � `
/y! Ou1 'rl, 6 c u,1 `% D L • ��S N���s 70— d one
ea i�-� /We, cool Ae t-ow W� t—n xr_:� i -5 d& n e. 3 D3- 0l5-1
�.17 /.k M i rL ..:rn�y
Reviewer/Inspector Name, _ ; y Phone:/Q--L���
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 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 �to ❑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?
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?
Additional Comments and/or. Drawings:
❑ Yes
ja No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
El Yes
J4No
El NA
El NE
❑ Yes
J0 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑Yes
®No
El NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit (T Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ',D 1,4 0 "Arrival Time- Departure Time: County: Region: _.M _
Farm Name: n,1 f` r-A,4_t �� ti r-2.c-�-� ^s _ Owner Email:
Owner Name: Mom#- i'"ic:.c-r�reg _fA�4L a Phone: r
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 4x-K'_d zx"exaA,.. Integrator:
Certified Operator: ��� .A. L M �f� 5Sa'k- Operator Certification Number: ��zS! Z
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
fZ Wean to Feeder
to Feeder Qr
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish +
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer j
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges
�& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design . Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: U;
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 Eko ❑ NA ❑ NE
❑ Yes
❑ No
Q NA
❑ NE
❑ Yes
❑ No
[A NA
❑ NE
Pq NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
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 l Structure 2 Structure 3 Structure 4
Identifier: 1
Spillway?: VLO
Designed Freeboard (in): I i I
Observed Freeboard (in): 7W
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 allo ❑ NA ❑ NE
❑ Yes ❑ No 21 NA ❑ NE
Structure 5 Structure 6
❑ Yes 5kNo ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
[![No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[!�No
❑ NA ❑ NE
maintenance/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 Drift [I Application Outside of Area
12. Crop type(s) '"ytitiV�— �3 J 15vKa�Vl ('v)
13. Soil type(s) pia
t4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
99.No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
FLNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
G!�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
tZ No
❑ NA ❑ NE
Reviewer/Inspector Name cy ' Phone:
'711- 7/5' 66Z3
Reviewer/Inspector Signature: Date:
12128104 Continued

. Facility Number: — f blv Date of Inspection D �
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes JgNo ❑ 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. ❑ WUil ❑ Checkliste' ❑ Desi gxr ❑ Map,' ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 5Ycs ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Cl 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 W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [KNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No ,
ElNA.
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
BNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[?No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
5 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
[�tNo
❑ 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
E� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ea No
❑ NA
❑ NE
12128104

(Type of Visit ® Compliance Inspection p Operation Review O Lagoon Evaluation I
Reason for Visit • Routine O Complaint O Follow up p Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �/ar'' Time:
0 Not O erational O Below Threshold
® Permitted ® Certified G0 Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Nance: .._._ `�rnQ.F.�.. _rc Sur _._NSt r f. _.__.... »_ County:
Owner Name: _Ma t f,, (rc1 icr���i PhoneNo:
Mailing Address:..__;>' a ».» .._
FacilityContacts ........»._._._.._......._ ...»...» ..... »..»».»....» ...» . Tide: ......... ................. _..._..�. Phone No: _. _...._..._... _. _ ._.._. _ ......
Onsite Representative:...,......! ...... . Integrator -
Certified Operator:........ ?2 .f f ,............ »..... ».— /Va "d4*-..`. ............ . ....... Operator Certification Number:. ...... . ,».,,......., .»....
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude F-70 4 dd
Dischmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is 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? R Y+
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .._._ .. ..._._.. _._...___._ .. »..___ ....___ .._._.__...... __ _____....._ __._ _ _ ........... »..__ ... __....
Freeboard (inches): q3 +f
12112103 Condn;;d-

Facility Number: cf — ( Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 00 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [I Yes J� No
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
8. Does any part of the waste management system other than waste structures require maintenancelamprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop qT,? 8 G r b^M L. oQ.c_ (' r u I r,
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 5 No
b) Does the facility need a wettable acre determination? ❑ Yes [ No
c) This facility is pended for a wettable acre determination? ❑ Yes 1 No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes EA No
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 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes R.No
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 [W No
Air Quality representative immediately.
r

Facility Number: Date of Inspection
Required Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes W No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 10 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ®'No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes W No
28. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ;M No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Nambsr. O
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date 2 1 �-q.(( ...
Tune: 1 Z._._ S�
Generol InfQUMIOW
Farm Name• Cru0Ke.,4 Srat.0
Qwner Name: ►r 4orr T, G One No: %f�a�S88 4 2-To
On Site Representative:
MaWing Address: )' / & 7 (.o
NC- z4z337
•---r
Physical Address&ocad=--,
• Latitude• I J Longitude: l..
Operation escriot on: (based on design characteri:tfo)
Q Sow
�ovf Swine No. of Animals . Q yof�Poukry No. of Animals O � No. of Animals
ifq-U aery le off O O Non -Lam O Bad
❑ Feeder
OrheMEt of l ivestoek Nrunber of Animals:
Number of Lagoons: 1 (include in the Drawings and Observations the freeboard of each lagoon)
FMI11111mectim,
Lagoon .
Is Iagoon(s) freeboard less than I foot + 25 year 24 hoar storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
O Man-made Q Nor Manmade
Cover Chap
Does the facility nerd more acreage for spraying?:
Does the cover crop need improvement?:
(list the crops which rued bVmwtm W)
Crop".., +� e� c-m t4 SL... .L Ac=rage•
9 4'+-
Setback CrUerfa
Is a dwelling located within 200 feet of waste application? ;
Is a well located within I O0 feet of waste application? - =
Is animal waste stockpiled within 100 feet of USQS Blue Line Strwa?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — yank 170%
Yes O
Yes O
Yes O
Yes C]
Yes 0
Yes (3
No 0'
No C,
No a'
No M'
No C31'-'
No W'
Yes 0 No C�
Yes C) -,No C3�....:
Yes 0 No CY
Yes 0 No cr,

UdIntenance '
Does the facility maintenance need improvement? Yes O No 3"'
Is there evidence of past discharge from any part of the operation? Yes O NO C3'
Does record keeping need improvement? Yes O No 3�-'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes Q No Q"
- Ce.-�, NuOQ881
Explain any Yes
Signature: Date;
cc Faci iryAssessmew Unk ..
p.rL%Jt s - or Qbsewsgorw
0
Use All"A enu if Needed
- -t:l [!rf• .-f.J.t�'S Y. r .. — .,,. --- .•r • a.��,��einwr �Mwnata T`+++�fClfi�l� �'rf:Q Ar�.�ar�..�4..•aTw �@•s•-<•w�
i�1l.r• � .:: i ... � ;!tl:!iF:':�l••��`ii �����.'b y�Z•'n.�'f !!i'�ti'�.' JT�?•'1:i���"'•/,••':1... •.
•.� '. :%.. •ram -._ ,. - ..'. •...•.� 1 _ •r.... '