090201_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: OTance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name: ` k7 cxccJ .';?r114 Owner Email:
Owner Name:tr-j/� W Phone:
Mailing Address:
Physical Address:
Facility Contact: r -_hez'4 S c ceJ Title: 9,—Ou ri'e- '� Phone:
Onsite Representative: ru .� integrator:
Certified Operator: 'jam Certification Number: W";�r
Back-up Operator: Certification Number:
1
Location of Farm:
Latitude:
Longitude:
Swine
Deng© Current
Capacity Pup.
Wet Poultry
Destgn Current
Capacity hPap.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
D . P,onit
La ers
l�. '
Design Current
CIa aci ` ;i Po
Dai Heifer
D Cow
Non-DaiEZ
Beef Stocker
_
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Qther
Pullets
I Beef Brood Cow
Turkeys
Turkey Poults
Other.:
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ N E
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection: ' ,3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
g�_No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z2
Observed Freeboard (in):_
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
❑ NA
❑ NE
waste management or closure plan?
'RNo
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 toNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes RNo ❑ 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 JZLNo ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EKjNo ❑ NA ❑ NE
❑ Excessive Ponding D 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): /IW"
13. Soil Type(s): 11,414
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [}.No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Jallo ❑ 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 RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? I f 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jjjj No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: T 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E[ No
► 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes EffNo
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 P3 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
❑C , No
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
1�1 No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
allo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
rNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
34. Does the facility require a follow-up visit by the same agency?
0 Yes
ELNo
iv YES answers ai
mmPndstfinnc nr 5
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
�✓ ' �Y%!i%fi�O� C[ f � w �� � /l a,S �� LfJ r Gt�Z'!/ W ��P J .
AGe Y�]r�r/ /� %
74 0'�I'
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: ft --OU — 0 ?
Date:
21412015

— q_'7_ q— I
Type of Visit: Q'Compl' nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -- /
Arrival Time:
Departure Time: ,' County: ` r1
Farm Name: _S; ��
5X41 Lcl J=a
4"k-
Owner Email:
Owner Name: aL
.
:Z�
Phone:
Mailing Address:
Physical Address:
Region: r�
Facility Contact: Title: QzU`j�� Phone: Onsite Representative: mow- Integrator: i 715 e�� _
Certified Operator: Certification Number: ���J�9,
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Design
Wet Poul#rye- Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
06)
-Layer
Dairy Calf
Feeder to Finish;
Farrow to Wean
Farrow to Feeder
Design
D P ult ;' Cal`aci
Current
to
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
.
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation`?
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 ®No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 ;n No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Eg-No ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: —LT— /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[S No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1127
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X 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
to 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
Co 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
fo 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 Ibs_ ❑ 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): �//l111�4 `,j Y21-1
13. Soil Type(s): /-U z-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 'gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Z] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2[ No
❑ NA
❑ NE
Re uired 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 ❑ Des ign ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U, No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®, No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

• Facili Number: - oP,51 I 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 [] 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
� omments.r ( tire er to uestioa # Eaplam,any�YES-answers and/or any additional recommendations or any other comments.
Use drawut�facdityhto"better eaplaiaisituattons (use additional pages as necessary).-
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone: 3 L5­1
Date: !7
21412015

/,�Z-/ /6
Type of Visit: (UCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: aatine O Complaint p Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit:l/�! yt Arrival Time: Departure Time: F�,�3� County: �r�- Region:
Farm Name: Qr'/y'4- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: JIL-i 7_ �fj�trC/ Title: ~ef-y' Phone:
Onsite Representative: s.� _ Integrator:
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current DesignCurif: en#
Desigu Current
tQ
Swine Capacity Pap. Wet Poultry Capacity =Pop
Cattle Capacity Pop.
��,..
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
A&v
Non -Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
_"
Design Current;.
Farrow to Wean
Dry Cow
*
17ry P,o�lt , Ca act Po
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
=
_-
3
Beef Stocker
Gilts
RN
on -La ers
-
Beef Feeder
Boars
ullets
Beef Brood Cow
Turkeys
Other -F7Turkey
Poults
Other 101
10ther
Discharges and Stream Impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
[] Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes R-No
❑ Yes O No
❑ NA ❑ NE
❑NA []NE
[] NA ❑ NE
Page 1 of 3 21412015 Continued

Facility ,Number: - p / Date of Inspection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 370
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jg 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
EgNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
[—]Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�g No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s):�
13. Soil Type(s):_--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
D NE
Rcauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
...Yes
014No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Z� Yes
❑ No
0 NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps J�jLeaseAgreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JR No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [D No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CZNo
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?
any YES auswers`and/o
�uJ pwn�/
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes ta No ❑ NA ❑ NE
❑ Yes J.No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
// vim— ��� GUT 1�v,��y.-�
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

1 I4-9
1 4)ec- /s A)
!Type of Visit: {3 Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: G46utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p Departure Time: County:
Farm Name: Ali c k G~A!un &ifex Owner Email:
I
Region f- 0
Owner Name: « Phone:
Mailing Address: .So l604 SA
Physical Address:
Facility Contact: • f' !T__ C j Title: Phone:
Onsite Representative: ` ( Integrator: _ A`,
Certified Operator: &t.6 6Go A-N Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Eli!Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
r
Feeder to Finish
Farrow to Wean
D P.o_u1
Design
Ga a
P.
Cei
Pop. _
Heifer
—Dairy
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
La ers
Beef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other i
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[514o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
&NA+
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�7No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: -_j Date of Inspection: 16
Waste Collection & Treatment
4. ;s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �"" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ 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
[2 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
B<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�JlNo
❑ 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
[210
❑ 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 rl"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
Q. Crop Type(s): 0
13. Soil Type(s): W OeL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�j.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[JJ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a'ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[?rNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E� 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
O 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
Ca'*No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
'
25.Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [❑ 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 To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D<o ❑ NA .[—] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�No ❑ NA ❑ NE
[:]Yes [2'�o ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
0 Yes
To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: umppliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 040utine O Complaint O Follow-ut Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Timer Departure Time: I >7 O County: Region: T
Farm Name: � oo �nn Owner Email:
Owner Name: 1�_�.f( o ocY v� Phone:
Mailing Address:
Physical Address:
Facility Contact: �(
Title: Phone:
Onsite Representative:
Kg
Integrator: M'[
Certified Operator: _
Certification Number:
Back-up Operator:
Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
Design Current
Capacity Pop.
Dairy Cow
Wean to Feeder Non -Layer
Feeder to Finish
Dairy Calf
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean Design Current
Farrow to Feeder Ca aci P,o
Farrow to Finish Layers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
as
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes <o ❑ NA ❑ NE
❑ Yes
[] No
[ "NA
❑ NE
[:]Yes
[—]No
[! NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes [ I+Fo
❑ Yes [9111NO
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [4o ❑ 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 ED 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
To
❑ 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
[R o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
to
❑ 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
Lsi"<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[R o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ to ❑ 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): a C�
13. Soil Type(s): 6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EErNo [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
t5xo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
io
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
u `Vo
❑ 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
[fNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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
do
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3'/No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

[Facility Number: A jDate of Ins ection:
14. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [1114o [] 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 0 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.
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes [Rfo NA ONE
0 Yes ®,To ❑ NA ❑ NE
0 Yes IS 1V q ❑ NA ❑ NE
❑ Yes E3'go [ NA [] NE
[:]Yes [r -& ❑ NA [] NE
❑ Yes [] No NA 0 NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z—No
❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
[Z"No
0 NA 0 NE
34. Does the facility require a follow-up visit by the same agency?
Yes
rXNo
❑ NA 0 NE
Comments (refer -to question #1): Explain any YES answers and/or an additional recommendations or any other comments.
y
Use drawings,of facilityto better explaWtituations (use additional pages as necessary}
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:33' 33
Date:
21412014

i ype of visit: ql Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: @4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time&('44
Departure Time: County: Region:
Farm Name: NJ( co0� _ Owner Email:
Owner Name: (� p�9(it- Phone:
Mailing Address:
Physical Address:
Facility Contact: LC � t �t%� _ Title: Phone:
Onsite Representative: Integrator: roD
Certified Operator: '1C{y�,l t _ Certification Number: 0 ✓ `'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current =Design Current
Design Current
Swine Capacity Pop. WetiPoult .�..' Capacity Pop.
ry
Cattle
Capacity Pop.
Wean to Finish I 11-ayer I
Dairy Cow
Dairy Calf
Wean to Feeder
on -Layer
Dairy Heifer
Feeder to Finish
' "
Farrow to Wean__
Design Current
Dry Cow
Farrow to Feeder
D .Paul .' Ca aci. P,o .
on -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
Turkey Poults
LLJ01her
Other
Discharges and Stream Impact
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes R! No ❑ NA ❑ NE
❑ Yes fNo DNA ❑ NE
[]Yes [—]No UTNA ❑ NE
[:]Yes ❑ No
[:]Yes ®No
❑ Yes [f]"No
EJNA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J>i6' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:)Yes [11,Xo' [DNA ❑ 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 [f]N ❑ 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 [25>o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z Xo 0 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 [nNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes krNo ❑ NA ❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 4o ❑ NA ❑ 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
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?
Required Records & Documents
❑ Yes
UP4o
❑ Yes
lam'•"
❑ Yes
[&No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes MIFo ❑ NA ❑ NE
❑ Yes [81�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
[:]Yes
LIB, o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Wo
❑ 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
UXo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 L_ o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

w
IFacWty Number: - Date of inspection:
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 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:
Z�J-No ❑ NA ❑ NE
L.f Ko ❑ NA ❑ NE
❑ Yes
®fiTo
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
NKo
[,] NA
❑ NE
❑ Yes No [] NA ❑ NE
[:]Yes eal�o 0 NA ❑ NE
[:]Yes [�< ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
�No
❑ NA
❑ NE
ED-No
❑ NA
❑ NE
ONo
❑ NA
❑ NE
Comments (refer -to -question #): Explain any YES answers and/or any additional recommendations or any other cotnments `
Use drawings of facility to better. explain situations (use additional pages as -necessary). °e:: , rr ,
pG7 12
�
� 9 E,:,r gib
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho& 0 4 33 `3 33
Date:
21412011

Type of Visit: U Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ► Arrivall Time: p `, oL-D Departure Time: , a County: jqjrr
Farm Name: TJGL` G-D urrL5 a Owner Email:
Owner Name: C 61 as G—n C> d a yL Phone:
Mailing Address:
Physical Address:
Region:(
Facility Contact: 0-� Lf �54t/ it r.r Title: _ Phone:
Onsite Representative: Integrator: 1;14,e ly
Certified Operator:Certification Number: 9LIZ,31
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desi Dgn Current - = Design Current
esi Current
gn ,� i
Swore i Ca aci ,ty Po Wetoultry Capacity Pup Cattle- Capacity Pop.
P P P
Wean to Finish y Layer law Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
"` "
Dairy Heifer
Farrow to Wean
= Design Current
Dry Cow
Farrow to Feeder
DryPoui Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Ocher
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ Yes
VNo
❑ Yes
rzn -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Contdnited

[Facility Number: - Date of inspection:
�--/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CE�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
[23 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 allo ❑ NA ❑ NE
❑ Excessive Ponding 0 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): &WZ CrM J4d 4L
13. Soil Type(s): W -z-- /ri a �3 / !Z D / 6- b A—,__
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes (3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F;A 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 M,/ No ❑ NA ❑ NE
❑ Yes EZ_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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge`? [:]Yes ® No
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: L7 - aLo ( I Date of Inspection: 8
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CANo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes " No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes �No ❑ NA [] NE
❑ Yes
Ga No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
Comments (refer to question#.} Explain.any YES answers and/or any additidiiiF ecom_mendations.or any otf►er comineats:_
Use drawings of facility to better'exRlain situations (use additional aaees:as necessaFv
1 k 25`�— 3�ri�urs��c 57s-ems,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /1p
Date: f�
214/20II

2
Date of Visit: Arrival Time: t'� Departure Time: County: w Region:
Farm Name: -0, &t�&IezL Owner Email:
Owner Name: All c k w d' Phone:
Mailing Address:
Physical Address:
Facility Contact: zrn CA Title: ,
Onsite Representative: A&;,
Certified Operator: f C r 'CL'
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: u
Certification Number: Mi-2 I
Certification Number:
Longitude:
Design
C►urrent k Design
Current
J
Deslgn Current
Swine
Capacity
Pop. ��WetPo�u�ryC=apacity
Pop.
Caitle
Capacity Pop.
Wean. to Finish
iatLayer
Dairy Cow
Wean to Feeder Non -La er I
Dairy Calf
Feeder to Finish
dg nca
s,z ' "
Dairy Heifer
Farrow to Wean
S
�„ k Design
Current
Dry Cow
Farrow to Feeder , _ Dry Point sCa aci
Non-Dairy
Farrow to Finish
La ers
Beef Stacker
Gilts
Non -Layers
Beef Feeder
Boars
-
Pullets
Turkeys
Beef Brood Cow
O#he
urkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
[:]Yes [—]No
❑ Yes RL No
❑ Yes [a No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection: 3 !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [& No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in):y2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X 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
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C, No
❑ NA
❑ NE
maintenance or improvement?
Waste 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): pv�
r�
f5 13. Soil Type(s): / _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes S No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
54,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DNo
❑ 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:
2). 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 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: 6 — — I /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EINo ❑ NA ❑ NE
=t
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes �R 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No [DNA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes RI No ❑ NA ❑ NE
❑ Yes JR] No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes No
[:]Yes No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any. additional recommendations or any other com inents , 0
Use drawings.af facilityto betterexplain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: `�/p-�33�33LtD
Date: 6 --43 2z_Da
21412011
Page 3 of 3

Type of Visit Orfompl'tance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit (2 Routine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /� /rf Arrival Time: Departure Time: County: Region:
Farm Name: % A%un-nn,, Owner Email:
Owner Name- _ n 1�YI _ Phone:
Mailing Address:
Physical Address:
Facility Contact: J�h cWL Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
U1J
Location of Farm: Latitude: = O = I = u Longitude: = ° =' = 11
Design
ty
C•nrrent
Population
Design C*urrent
etultry Capacity Population
Design Current
C*attle C+apacity Population
inish
❑ La er
❑ Dai Cow
eeder
rrE]Farrow
❑Non -La er
❑ Da Calf
Finish
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
❑ Da Heifer
❑ D Cow
Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Strueiures:
Wean
Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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 o ❑ NA ❑ NE
❑ Yes
❑ No
[BONA
❑ NE
❑ Yes
❑ No
�? A
❑ NE
LEA
ElNE
❑ Yes
No
El Yes
�❑
L" I No
❑ NA
❑ NE
❑ Yes
520N" o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Q9 — Qo?D Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E]1 o
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
E No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: 400
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
r
L'I No
❑ NA
❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElE3 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
E3<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,,,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L`� No ❑ NA ❑ NE
maintenance/improvement? 1. .�Is there evidence of incorrect application? If yes, check the appropriate box below. ElE Yes A ❑ 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 Win ow ❑ Evidence of Wind Drift ❑ Application Outside of Area
� �
12. Croptype(s) i'-J+►4c V��.S`c� $1►�r��� Nr
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0"NNo
ElNA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
D'1v!o
❑ NA
❑ NE
e drawmgs,of'fai'ility to better explain situation§ {use additional page
k l/lr s�G Aw,SS N tcd fi- IG �C�x� /►t vrG
!-c r / /n Vr
� 9i�'�•-�` cY4.�t4.G�/„�.. • S ol� �- Zara .
41 ter' 4-0 '&7
U)a n,•ee- o� l a bgxv% .
Reviewer/Inspector Ka f " '.`x Phone: /O ^X-333�
Reviewer/inspector 6 92 Date: /% ?_0/d
Page 2 of 3
12/281/14 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
DR<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 to
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ef(No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3 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
EI(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
�/
ETNo
❑ 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
B No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
B N' o
❑ NA
❑ NE
Page 3 of 3 12128104

~ ivision of Water Quality
T Fadli Number. Gf -�i '' JJ 0 Division of Soil and Water Conservation 3 vg
Y 0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit- 1 5-7-7-0*Arrival Time: a 95Departure Time: .� ; O e7 County: !-�' �"'� Region:
Farm Name: k-yn N u'�S � Owner Email:
Owner Name: V O k R,07 X Phone:
Mailing Address:
Physical Address: '
Facility Contact: �B _ /7�y - 4—zi-1 Title: Phone No:
Onsite Representative: S'�r.4..L� Integrator: car,
Certified Operator: 5���--�� _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: E] o
Back-up Certification Number:
0 Longitude: = 0 =' = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
Wean to Feeder D S a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design 'Current'
Cattle Capacity Population,;
❑ Daia Cow
❑ Dai Calf
❑ Dai Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EEJ�
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 U .No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M-No
❑ NA
❑ NE
❑ Yes
J&No
❑ NA
❑ NE
12128104 Continued

Facility Number: O 1
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / 1j
Observed freeboard (in):' a7
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 Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes IffNo ❑ 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? E-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fa No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P1No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s) Z
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ayes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [:]Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
01-rF1,t' 1�V'j-
�S �r�l�r ha���Y��UY✓ �cr�i�a-� �,�-f_�• ,jj�r��� w! it b� ���
B Ll^4q �L r %s Titer
al ne k e-- eJ o•t 1�_ J%
Reviewer/Ins ector Name l
p L��� � � �"� Phone: /O" .T0(D
Reviewer/Inspector Signature: Date: 5,�— 7—�
L/L6/U4 l.Unanuea

Facility Number: g — Date of Inspection 7-5
r
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If 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 ❑ No ❑ NA ❑ NE
JO Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
B Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 19No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[51 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[:g 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
R 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
[;kNo
❑ NA ❑ NE
Page 3 of 3 12128104

� inW;'2O;Facili7UmmerF
Q pQ O Dig Esf Soil d V4'ater Conservation
-- Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ,i County: en Region:
Farm Name: row /i� ,^y _ Owner Email:
Owner Name: —A)
Owner if 14-6rA Phone: (q/e2
Mailing Address: 6101) 577—�0�b�
Physical Address:
Facility Contact: �t tam niom Title: Phone No:
Onsite Representative: tl Integrator: 1 " Pk _
Certified Operator: H. 14a oAoM - Operator Certification Number: 99s//a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = d [ i Longitude: 0 ° 0 t =
V
Swine
Design Current Design Current
Capacity Population �N'et Poul#ry *Capacity Population
Design Curren#
Cattle Capacity Population
Wean to Finish
_
❑ Laver
❑ Dai Cow
Wean to Feeder
_
33-0 + ❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
_ W.,
❑Dai Heifer
❑ Farrow to Wean
Drj Poultry{
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
Beef Feeder
ElEl
PE]Boars
Pullers
❑ Beef Brood Cow
❑ Turkeys
---
Other
❑ Turkev Points
:..
❑ Other
❑Other
_ .
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
ElNE
Discharge originated at: ❑ Structure ElApplication Field ElOther
a. Was the conveyance man-made'?
❑ Yes
❑ No
P9NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
tgNo
I
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
tj)4o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

1•
Facility Number: — 0?0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 11EE❑�'''No JWNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 QNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes `M No
[I NA [3 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 X1 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes y� No
❑ NA ❑ NE
maintenance/improvement? / _
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or t0 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) k_t -jam,( bVmuAa (Brass
13. Soil type(s) WqQ r-&X4 —Lja
V'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ef No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
119 No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other comments jj�,,_-,�
Use drawings of facility to better'explain'situations. (use additional pages ass necessary): t
Reviewer/Inspector NameAr
e Phone:
Reviewer/Inspector SignatuDate: �6
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1�fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F3 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
*No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
k3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r7h4,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
191 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
J9 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
91No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
91 No
❑ NA
❑ NE
Additional Comments and/or Drawings: oazM
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - - O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
V
Date of Visit: s 0 Arrival Time: Departure'l'ime: County: Region: FAD
Farm Name: Vd om c
a�[ s,,P,�tI Owner Email:
IL
Owner Name: William doM Phone: G%10 5'B d "l
Mailing Address: 3114 Tack L ?a"`F' dh,.sjc aJ931
Physical Address:
Facility Contact: W f [am 060 Title: Phone No. /0&�
Onsite Representative: Integrator: A4
uxp"
Certified Operator: -a! I- 4 T, lJ�m Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = U = 0 Longitude: = o = , ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i7peb St70 ❑ Non -La er
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I 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..
El Dairy Cow
El Dairy Calf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: FF
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
PNA
❑NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
PNo
ElNA
[INE
❑ Yes
p No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection 5 '1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard'?
❑ Yes
❑ No 1A NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):y2y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Wes
❑ 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
QsNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
I0. 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
0No ❑ 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 o��f^^Acceptable Evidence of Wind Application Outside
Wiindow�+
of Area
�Crop -Drriift I❑
�❑
12. Crop type(s) la� bdu ! UACL, G7 _Os5 _W/ &e_ VLQI�
13. Soil type(s) We 00A LeA t K0, G�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EpNo
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JpNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
we-rk�+j an bzre areas aybu.,J lasoon .
w
Reviewer/Inspector Name phone: 33(b
Reviewer/Inspector Signature: Date:
12128104 Continued

2
Facility Number: q —,2bl Date of Inspection S 07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 6No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )4No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
al Comments and/or Drawings:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
[4�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
El NE
El Yes
o
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
lNo
❑ NA
❑ NE
12128104

Facility. Number, /
vision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit C�Com Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral ()Emergency 0 Other ❑ Denied Access
Bate of Visit: % Arrival Time: (r%; D t7 Departure Time: f i Q (� County: //�� Region:
Farm Name: Om N!e/Sty _Z Owner Email:
Owner Name: _-_/% �l%�a.,-yta�.•.- �� - Phone:
Mailing Address:
Physical Address:
Facility Contact: '�� "'' 494IV Title: Phone No:
Onsite Representative: � Integrator: IWIV494_
Certified Operator: Operator Certification Number: — ��a•
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ 1 ❑ a Longitude: 0 o 0,E—_1 w
Design -urrentz
Design Current
Destgnr Current.
Swine
Capacity Population
Wet Poultry
Capacity= Population: `Cattle
Capaclt�ylpulation
❑ Wean to Finish
Wean to Feeder
�
I
❑ Feeder to Finish �
El Farrow to Wean
❑ Gilts
�- -- - - - --
Boars �
Discharges &Stream Facts
❑
❑ Non -Layers
El Pullets
El Turkeys
❑ Turkey Poults
❑ Other
] . is any discharge observed from any part of the operation'? El Yes � No ❑ NA ❑ N E
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [I Yes El 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) [I Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation`? ❑Yes No ❑ NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than from a discharge?
Page ! of 3 I2/28/04 Continued
Discharges &Stream Facts
❑
❑ Non -Layers
El Pullets
El Turkeys
❑ Turkey Poults
❑ Other
] . is any discharge observed from any part of the operation'? El Yes � No ❑ NA ❑ N E
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [I Yes El 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) [I Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation`? ❑Yes No ❑ NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than from a discharge?
Page ! of 3 I2/28/04 Continued
] . is any discharge observed from any part of the operation'? El Yes � No ❑ NA ❑ N E
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [I Yes El 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) [I Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation`? ❑Yes No ❑ NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes � No El NA El NE
other than from a discharge?
Page ! of 3 I2/28/04 Continued

Facility Number: Date of Inspection
y Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
4
Designed Freeboard (in):
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P§No ❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
10 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? 9Yes
❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
JA No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
10 No ❑ NA
❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
14 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Znl'O'c*G. l /nnrY'r�►�
13. Soii type(s) f(%BA;& L/1sc
---
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? 9LYes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
21 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
91 No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
91 No ❑ NA
❑ NE
w.
:Comments (refer to question #): Explain -any YES answers and/or any recommendations or£ any?other comments x-
Lase drawing& of facility to better explain situations. (use additional pages as necessary
/ �TK� Wnrl�y�.-�. ,ZSrr,•„�r� l ivas�ra�Ih�s ,�1; �-��► •� ��� 6vrw+C �exc.
Reviewer/Inspector Name Phone: 9/D- 33-33t7 0
Reviewer/Inspector Signature: Date: -0 L
Page 2 of 3 12128104 Continued

Facility Number: -- U 1 Date of Inspectiion
Re uu ired 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 JR-No ❑ NA ❑ NE
the appropriate box.
❑ WLTP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ed No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
56 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?
El Yes
No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Additional,Comments and/or Drawings '"�
A'X7v-ate ,V010.s
Page 3 of 3 12128104

- r
-= Division of Water Quality
ZFaci;ht Number p Division of Soiland Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: County:!�%��n
'-� Arrival Time: Dy Departure Time: f (� Region:
Farm Name: OdBrn Ag i'� z•/- Owner Email:
Owner Name: iO4s� �� �• Phone: ����
Mailing Address: L� "i--� t �Q+�[J�`" i �.eYl /�K//'i .Lve
Physical Address:
Facility Contact: 'C _ _ -Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: r 4
Ww
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = 0 Longitude: 0 ° = f 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
5 [Layer �
CoOU Vivo Non -La et
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
ElBoars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El 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
El Dairy Cow
El Dairy Calf
El Dairy Heifer
ElD Cow
ElNon-Dai
El Beef Stocket
❑ Beef Feeder
El Beef Brood Cowl
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 N No ❑ NA ❑ NE
❑ Yes
[ONo
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes
,kNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

Facility Number: at— oi Date of Inspection ` "0
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):?
❑ 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 JK 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 KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X1 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 Z[No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes [KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) f %%%ll/r�/��*�1 ��/JfiJl� rG
13. Soil type(s) !i Y Z�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[:] Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
ie`tter eplainrsi
Reviewer/Inspector Name - N Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
,® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WrNa
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
r", 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
El 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
i�d 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
]Q 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
RA No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P} No
❑ NA
❑ NE
Additional Cotnmei t&, 4od/or Drawings."° dr�1
AVr ePAy W. - �X��,�r:K�✓ TT /�� Y��- Air a 7��`v
kfr- �>! �r� ..z��d� �r.�� ..� hrr a 3-,••tc o �i�$u/ T�,s iS
440 eXPha % n 7—h • .S i s T;V12A,- c , ;/1 i
S�rG7 ; P
12128104

[Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: �a % rime:•'x a
Facility Number a a 1
r(TN70perational Q Below Threshold
10 Permitted 10 Certified 13 Condiitiionn�aliy Certified 13 Registered Date -Last Operated/for Above Threshold:
Farm Name: _,,,,_ &J1 ;1i c► M _ Llxa c rs� /i/!« s c P. _ County-
-4
' �. , . 'Phone No: r7 S - Owner Name: �� ��� Q,�........ / $� `/r? 7 7----.----
Mailing Address:
Facility Contact: Title: ' / Phone No: —
Onsite Representative: 2d �grn�� d yQ
_�,L�� Integrator: ,,,, 11,0 &t��'� �'rU
Certified Operator. ,r�a- _u_ Operator Certification Number:
Location of Farm:
]swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation? [IYes 9 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 galimin? A/4
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 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2
Identifier:
f f►
Freeboard (inches); 13
Structure 3 Structure 4 Structure 5
❑ Yes P0 No
Structure 6
l2/l2/(13
Continued

Faeiiity Number: g — ,.D/ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ( 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 maintenance/improvement? ❑ 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 maintenancerunprovement? ❑ Yes No
11 _ Is there evidence of over applicatioWydraulic
es, check the appropriate box below. �'es ❑ No
❑ Excessive Ponding �AN Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop dJ� rc c% 1Y s m sa ! l� tar i u 0 S t' Grp u ! &tAr.tG&_q ^�
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
IL-1 No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
® Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar 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
❑ No
roads, building structffe, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
%- vGr�i Wd ,tic Icok_.� i-�.d� V,,4
no*, - Co � �cx►�CC. S � f .r.
"S
tO k & c A_ hen-s r ec�,.0 ��'
Qu- // ci c, r erg C`.i Czti o2
//
lc� 0?7 I �f3 �j /Qc-rG, Srr- e. jpwf
e� �.� oar g I t_
Reviewerfty ctor Name
Reviewer/Inspeetor Signature:
Date:
12112103 i/ " Corgi

Facility Number: - ap f Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ET§oil 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 W No
26_ Fail to notify regional DWQ of emergency situations as required by General Permit?
Oct discharge, fi=board problems, over application) ❑ Yes IQ No
27. Did ReviewevInspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
28. Does facility require a follow-up visit by same agency? ❑ Yes ® No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [9 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 0 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 wired 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

Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Faciliri lumber Date of \visit: I � Time:
Tot O erationa! 0 Below Threshold
® Permitted ® Certified ©Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: Count-:
Owner Name: �. 1 �� C�vh ill M Phone No:�L 1 a 4 ,;)a a-
.T.
Mailing Address: _�. 314.4 .IarL K�cAc,-rAS, LlzcAia�466t- 2 K.CL 2833-7-
Facility Contact. . KC ALLA I I,+ G z, n_ _ Title: Phone No:
Onsite Representative: ti� lAALVIt.. to S G vt Integrator:_'l�t _
Certified Operator: F i c ti d�� _ . `�] r� u rn Operator Certification Number:a-
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �'—�� �� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry capacity Population Cattle Ca acitV Population
® Wean to Feeder 10 Laver I I JE3 Dairy
❑ Feeder to Finish 10 Non -Laver I I Non -Dais
❑ Farrow- to u`ean
❑ Farrow to Feeder ❑ Other
❑ Farrow- to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I ! I JLJ Subsurface Drains Present IILI Lagoon area iLJ Spray Field Area ]
.Holding Ponds / Solid Traps ❑ No Liquid Waste Management System = -
Discharges & Stream Impacts
1- Is anv discharge observed from any part of the operation?
Discharge orizinated at., ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischame is obsen ed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if ves, notiffi, D WQ)
c. If discharge is observed. what is the estimated flow in saUmin?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 34
05IV3101
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[4 No
❑ Yes
91 No
❑ Yes W No
Structure 6
Continued

7 ,
Facility Number: 9 — 940 1 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes EA No
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes N No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes R9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9+ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [� No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type (3ef'{Y,U M._ q-('Git O.S
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 ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes E4 No
16. Is there a lack of adequate waste application equipment? ❑ Yes f�j No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W13P, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
El No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/inspector fail to discuss reviewhnspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conutnents;(refer tq'questton #) Explain any, YPS answers and/or any rec" it me dations,or any:other counment
-��� #�
rise drawings of facility to better ei Wit situations. (use addtttoi al pagesras necessary)
r-= i ❑ Field Copy ❑Final Notes
Reviewer/ltispector Name ,;,,, _f,
Reviewer/inspector Signature: J Date:
05103101 Continued

Faciiit)' \umber: C- —2 Date of inspecti„ i ! �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
3 I . Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes R No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ❑ No
ry
-Xdditeonal. ouiineets:apd/or;Dr2wiaos:,=
05103101

IType of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 09 20i Date of Visit: 4-12-2002 Tie; 8:30
O Not Operational O Below Threshold
0 Permitted 0 Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _ -- -- --
Farm Name: MumNumy ... County: Bin- ----------------------------------- M-----.--.
Owner Name: WilliamAituua�[t..-_._._...._.__•------• Phone No:27_.---------------------------
Mailing Address: J144.jwk RlckaAson.Ruad ...... ........................................ E1ict cWmmXC...._....................... ..... MUM .............
Facility Contact: mmav .............................................. Title: Phone No .
OnsiteRepresentative: owcrl.SonuBnchert-CA DugW.TAURowe_- Integrator.
Certified Operator. .............................. Operator Certification Number:..-
Location of Farm:
rrom caution light in Garland, take SR 1528 West west toward Bladen County line (SR 1200 changes to SR 1528 in'laden
County) continue to stop sign at NC 210, then right on NC 210 for 0.1 miles, then lets on SR 1002 for 7 miles to farm entrance w
® Swine ❑ Poultry [] Cattle © Horse Latitude 1 34f-- 47 ' SZ " Longitude 1 78 ' 31 t' �"
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes ONO
Discharge originated at: 0 Lagoon ❑ Spray Field 0 Other
a. If discharge is observed., was the conveyance man-made? ❑ Yes C9 No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) 0 Yes 9 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes M. 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 C& No
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway 0 Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........................... .......................... ................................................................................ ...........................
Freeboard (inches): ........... 2j............ ...........................

NCDENR
North Carolina Department of Environment and Natural Resources
Michael F. Easley, Governor William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D.
April 18, 2002 Acting Director
Division of Water Quality
Mrs. Sonya Barber
Harvest Net, Inc.
P. O. Box 32
Council, NC 28434
Dear Sonya,
Enclosed please find the first page for the Odum Nursery inspection form as promised. If you
have any questions please do not hesitate to call me.
Sin rely /
hn C. Hasty, Jr.
Environmental Specialist
Fayetteville Regional office
225 Green Street - Suite 714, Fayetteville, North Carolina 28301-5043
Phone: 91GA81-15411FAX: [phone]Internet: www_enr.state. nc.usIENR
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled l 10% Post Consumer Paper

.M ,r-.•
facility -Number: 0 cl - Z p Date of Inspection -6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[I Yes
� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancermprovement?
❑ Yes
ro
8- Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yeso
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
4NO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
J�No
11. Is there evidence of over application? ❑Excessive P nding ❑ PAN ❑ Hydraulic Over/load
[I Yes
jNo
12. Crop type e r 44 Glal� I Z P SMa
13. Do the receiving crops differ with those designated i the Certified Animal Waste Management an (CAWMP)?
❑ Yes"
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
b) Does the facility need a wettable acre determination?
❑ Yes
P No
c) This facility is pended for a wettable acre determination?
❑ Yes
[d No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
E9 No
Reauired Records & Documents
17" Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes [ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
CNO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
0-Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
dNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
I*No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
Rio yiQla it}njs:e� a f cep is>etli��:��:Ywi�i�v0outn0rhsvec�ed- ftw
comes deice: abtiti this visit "
w. ..,._.. ..�_ ", :._i .^._ _.: '—._•.-.. _. r. _�_;. _ -: -._. �. .".�-�� - --. --... ..-' .'-. _.,--.. >. _... as-n --_ _. . ::.Z_ .tea-. _...3x, _..=1 ..
.. x__.. b.w'^'i .—._�.- ..,...a_.
41 q, Ne�� `� keep tje fi 4a6oan/ /eue�s 4", A',-
ry ©au•n� ,f QG�nq �c°SceJOr/-tS�r�gl02rw.,c{� f+t° [� W�t��'7fteAclei jkckT�--
�Lj -0,-5 eed cr+ f 1�DkS Qood.
1 (r ,}
U o/t- le ve-f 2-1
Reviewer/Inspector Name olt n . _ �i ,S 1% _ r
Reviewer/Inspector Signature: Date: l - / Z - D Z 5/00

a ram.
F9cih'1y Number: Q —201Date of Inspection J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes tNoo31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
o _ ommen or rawrngs:= _
AL1
5100

D�visi on of Water Quality
O.DivWon of Soil and Water Conservatiion
g en e..::
s y
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit ®Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number O �
Date of visit:
d%/.7O/ Timv: : 4Ca Printed on: 10/26/2000
O Nat O erational O Below Threshold
® Permitted 0 Certified Conditionally Certified ❑ Registered
Date Last Operated or Above Threshold: .........................
_❑/
Farm Name: .................... uGir.(�"'.:..... .......................... I ........... ...
a��
County: .......elA......//.................................. .......................
/ -/
Owner Name:............. / etf�- ...... �ff,G�1�" ��C.
....... yc...............................I..........
O r p
Phone No: 4( ,.? �f� .` Z�Z.�.............
Facility Contact:........G�,!�.<...!.A^'—....... ��1��"......... Title:...............................................................
. Phone No: .............
`` /
............3�
Mailing Address:..........lyX"....f.4....ft ...
p...
...................................................rl./...'`.......... +.fJ.............�
Onsite Representative: ........ „/.>.,<.C7F,1.�......... odk,lt+.................................. Integrator: ..... �1�.,�..�.. ,,�f��`-........................
Certified Operator: ....... f��-�,.... ,7�-.... ..,JC!/, .........
Operator Certification Number :..................
Location of Farm: /
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 14 Longitude • 1 it
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder d J❑Layer I I❑ Dairy
❑ Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes KNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes §?[iVo
c. II' dischars e is observed. what is the estimated flow in gal/thin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes D?LNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes kNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Struc;turc I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............Z h....................................
Freeboard (inches):
5100 Continued on back

Facility Number: d — 26/ Date of Inspection 0 Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes NfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes PfNo
(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 CKNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? CWYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ApNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �WNo
u
12. Crop type bzzli.14/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP checklists, desi� maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste ands & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fait to notify regional DWQ of emergency situations as required by General Pen -nit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a foIlo)v-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
N4.Viblati0ris oi- d0fciencies were n�tea diWing this:visit: • :Y:oij will•reoeive tno i'ui`OO
coriespontYcnce about. this visit . . - .... ..
❑ Yes ANo
❑ Yes XTo
❑ Yes �No
❑ Yes XNo
jKYes ❑ No
❑ Yes ONo
❑ Yes 9No
❑ Yes .K No
❑ Yes KNo
[:]Yes ffNo
❑ Yes $[No
❑ Yes Wo
❑ Yes Mo
[]Yes (WNo
❑ Yes KNo
Comnfents:{refer to"guestio6 4 Explain any:YES aiiswers and/or any recommendations or any other com menu`=
Use drawings of:facility tobettei• explain situations •(use-at3ditional pages as necessary) ry
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ellflll/ 5100

Facility Number: Date of Inspection / oI
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes []No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes allo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes NrNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ($No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes .B No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes BrNo
JAddifioomments an or.' rawinp -
'-r
N
5/00
J

4 Q'D�tvrston of Water Qoalrty a o:D and
Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number D p / ©ate of Visit: / �Time: �� Printed on: 10/26/2000
Q "Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name : ............. �dlt.r-...... 1vl?.Zx k.�yCounty: �..............................................
..................................................... ..................
Owner Name: ............''!//�t%/�llrx-........C.��r..�...f.r. Phone No:...%G%lG...s8..��.�2.2 .7.................._..
!1A .......... �"' ... Title: Facility Contact: ......... ................................
Mailing Address: .......3� r� �Gi.•! lRee.0 V. T .YvI.Z!J ...: % G _..2 3 .....-•--
Onsite Representative N1A Integrator: .s
........................................................................................ I.,_ P-04 .... � ........................
Certified Operator: � � �ur Operator Certification Number �.............................
....... P ............. 7 6
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C 44 Longitude • 4 66
Design Current Design Current Design Current
Swine Capacitv Population Poultry Capacity Population Cattle Capacity Population
99 Wean to Feeder 26UD Epp ❑ Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish I I Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharacs & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JR 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
9No
c, lf' discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
R 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
ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
IgNo
Structure 1 Structure 2 Structure 3 Structure 1 Structure 5
y...........................................
Structure 6.......
Identifier. ............... .. . .
Freeboard (inches):
5100
Continued on back

X I
Facility Number: p 9 — Zp/ Date of Inspection 10/26/2000
_ P Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [J Yes $Z'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Rc No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
E 'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
JRNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
$rNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Pj'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ HydrauIic Overload
❑ Yes
JgNo
12. Crop type �iz++dd rnr••(� 4.Gfi�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
;RNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
U'No
b) Does the facility need a wettable acre determination?
❑ Yes
,® No
c) This facility is pended for a wettable acre determination?
❑ Yes
J9 No
15. Does the receiving crop need improvement'?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JgNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes RNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
J;�'No
19. Does record keeping need improvement? (ie/ irrigation reeboar aste anal sample repo
❑ Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
X'No
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
;R:N0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑YesNo
(ie/ discharge,. freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0No
24. Does facility require a follow-up visit by same agency?
❑ Yes
*No
25- Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
j[SNo
0:. �'�1Q • 0ioris or deficiencies -*C� re noted• ding t_his'visit, • Y64 wif2•feeeiye do futthetr • ..
corres ondeirce: about this visit' . . ...
Comments`{irefer to' uestion # :' Explain any YFS answers andlotr any iecoinmenilatiois§ or any`otlier comments _ : w
-_
Use°drawings of faciJhkto-6eiter explain situations (use additional pages as necessary).
01
11. %17�s� lrfiv .✓fair' ,�,�,rc/ l
�®�irre
� a �� or �o./.svy/��'�•/q�/ �,� /��.r-�,� yu�. zap
w
Reviewer/Inspector Name -
Reviewer/Inspector Signature: .0 Date: /Z Zoe 5100

1
Facility Number: py —7v1 Date of Inspection /x ,to Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 19 No
- troComments and/or -Drawings:
5100

Division of Soil and Water Conservation 'Operation Review
f—}
[r,Division of Soil andWatee Conservation "Compliance Irispeetion� i
,;
Division of Water Quality ComplifdCe'Inspectiou
r ,.'�
Other Agency Opeiratzon Revie[v ` __ - X
LO Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up or DSWC review 0 Other
Facility Number p $fit Date of Inspection /Z 1/
Time of Inspection 124 hr. (hh:mm)
E3 Permitted 0 Certified 0 Conditionally Certified [3 Registered Cj Not Operational I Date Last Operated:
Farm Name• tr ............ County ........... �/f^ - ".................... ......... I .............
Owner Name: ��4.� ��li f.✓. ................. ...................... Phone No:
.............�r} d, .. ✓r .r. ..ZZ 7...................
.........................
Facility Contact: ....................................Q�"'� ............................................................
....,.Title• Phone No:
Mailing Address: ...... / r��...ti.C.Ri...�.c/C'�eP . �.. .G.!.IQA��...+�G......... /..A...•3,�1
Onsite Representative:....14/4, F......... JiLf44!r................................................. Integrator:...'00��� ,� ........................
Certified Operator: .......... 04 r -�(-1......................... Operator Certification Number:
Location of Farm:
Latitude Longitude
" 13 i Current >- - 7 Desi
-.
gn gn Current Design Ciiirent
Swine >- :.Capacity Population' Pi; iltrq _Po ulatioii Cattle •Ca aci Population -
Capacity..
Wean to Feeder ap2,46 p ❑Layer ❑Dairy
v ❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy :j
-
❑ Farrow to Wean
❑Farrow to Feeder 10 Other -
❑ Farrow to Finish To" ial Desigtn'Capacity
❑ Gilts
❑ Boars - taI S.: o T SLW
Dumber of Lagoons / - ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
_ 0-
Holding Ponds /Solid Traps _ ❑ No Liquid Waste Management System
Discharges & Stream Im i; acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the State? (If yes, noti fy DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ..............................----.........................................:......................................... ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes KNo
❑ Yes JK No
❑ Yes ® No
❑ Yes ® No
❑ Yes B;No
❑ Yes �QNo
❑ Yes i@ No
Structure 6
❑ Yes ;R No
Continued on back

It `�
Facility Number: hate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 5No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IN No
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type �t,e f,.'_.ZKm z..S� �rx rrE
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? CR Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes FJ No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes K No
16. Is there a lack of adequate waste application equipment? ❑ Yes 19 No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes JRNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(e/ WUP, checklists, design, maps, etc_) ❑ Yes RNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes IVNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IN No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 29 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [�KNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes JK No
O:.NQ•vio t ris:or de#iciencies-*, re no€ea•d&iiig�his:visit;- You will- eeeiye fid further
corresponc eMe, Aotit this visit. ... . . . .. .. . . _
Use,drawings of facility to"better eiviai i situations {use additional pages as necessary} _ _
/3•' Nsc� C4FA1XV* P/� � � c4 ?'e �rSCws e✓ �•-lam-:a To,�r-cr�►' ,c/ -
ALr
.a,�. ��/.rKsr�%►/.J,� v-1�- yam' 1W
Reviewer/Inspector Name V
Reviewer/Inspector Signature: Vy _rnaxpo Date:- zz z11f_f
3/23/99

-y
1F7acility Number: date of Inspection / J/
Odor Issues -, ,/
26- Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ' ! IO No
liquid level of lagoon or storage pond with no agitation? '"' IIII
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OkNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29- Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 19 No
X Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? No
3/23/99

f j^l
1
[] Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Follow-uE of DSWC review O Other
Date of lnspection I�3
Time of Inspection /. J 24 hr. (hh:mm)
10 Not Operational Date Last Operated
Farm lame.4 /die County:..............._!13�
111.4
Owner Name:....... ....1.1 ................. A`' . P ..7.......'2......................................... ,,....,...I ................... p
d... ...... ................ Phone 'Vo:......: S.. 0...... 'Z.......
Facility Contact: ...... Title. Phone No:
01
Mailing Address: yY... �%1�lsw,I�.....11! `�!'s?.... ®�l .r� zv.. ... p .. ..............
y� .
Onsite Representative:...... °.. . s "" ...... Integrator: .......A.......L. '�'S................
Certified Operator:........!6`!IQ!!. J. ` ` � 4 w ........................................Operator Certification Number;- 0 g ?d
.......................
Location of Farm:
Routine
Follow-up of D
Facility Number O O
E3 Registered E Certified © Applied for Permit' [3 Permitted
Latitude �•:' �« . Longitude �• 0` �"
Destgn„k Current Design - Destgt5' Current
4 y F , Current
Swune Capacity Population ` Poultry dGapacity ;Population Cattle ' Capacktyr`Poptilation
Wean to Feeder .2i eV GOY% "' ❑ Layer ❑ Dairy
�, ❑ Feeder to Finish ❑ i\'on-Layer ❑ Non -Dairy
❑ Farrow to Wean`
❑ Farrow to Feeder ❑ Other
` ❑Farrow to Finish Tt1ta1' I?es�gnCapaClty
r'
V ❑ Gilts <,
❑ Boars Tofill., LW
E Number o cons 1 Holdin `Ponds ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Lag l fig.._
- ❑ No Liquid Waste Management System 4
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. 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 JR No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes ® No
c. If discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes , No
3. Is there evidence of past discharge from any part of the operation? ❑Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ,9 No
maintenancelimprovement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? Cl Yes No
7/25/97
Continued on buck

r
Facility Nuntber:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeomis,11olding Ponds Flush Pits etc:
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identi Fier:
Ar
Freeboard (ft): .....-' Z') ..................................
10. Is seepage observed from any of the structures'!
Structure 3 Structure 4 Structure 5
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12.. Do any of the structures need maintenance/improvement!
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
3
13. Do any of the structures lack adequate minimum or tnaximutn liquid level markers'!
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop hype r ell,... /.. ............................................................................................. ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency`'
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
13 No -violations or deficiencies were- noted during this. visit. :You *ill receive no further
correspondence about this:visit:..
❑ Yes ;KNo
❑ Yes X No
- Structure 6
❑ Yes A3,No
❑ Yes fiT`o
J Yes ❑ No
❑ Yes El No
❑ Yes KNO
t
❑ Yes ® No
❑ Yes M No
ZYes ❑ No
F j Yes ❑ No
❑ Yes 18 No
❑ Yes ® No
RrYes ❑ No
❑ Yes M No
❑ Yes M No
❑ Yes JXNo
Co imen#s"(ieffr to: question #): 'ex-
any'.YES answers and/or`any recorn uendattons ar any other coinmed s '
Use'drawmgs of facility- to bet#er explain situations, (use additional pagcs4s necesssarv) _ :, R " ;
r
7125/97
Reviewer/Inspector Name IF14A eat
Reviewer/inspector Signature: �,�.,� to Date: 141/1Z3

..�zk.ati���:.'..�Wr.:':'roc•&S�f��.�n'.4:'e,»o„�R.,.n,s,u.<;'.'�..,.x...,58E a�:€>;a�f .+'�°�-""�'�✓��-` sza ^:�eig{i �,�� ssa, '
Division of Soil and ater Conservation 0 Other Agenc27
y a'
Division of Water Quality
'•',�..,�ra:.-;'aaS:>::.:n.: ...:,-a�..; �:"«�r`..,�- �r.,,�...,.'°.�_:,>--;4..'2.::..6�?�"xd;*:a�.�`�v'..,ww:_.a�,,-"'.".3� .3';..."'e",'' t�:'�8dc�"'� x� .�. 3 '� -.. �: "�:. .,,.
t9 Routine 0 Com laint 0 Follow-up of DI4' inspection 0 Follow-up of DSWC review 0 Other
Facility lumber �o Date of Inspection
L -- Time of Inspection 2.4 hr. (hh:mm)
© Registered E Certified E3 Applied for Permit O Permitted 113 Not Operational I Date Last Operwat_edd.
Farm Nante: County:.......,.. �+`�'�.J...................
JJ�..'' ''.............. - / .... ---........-.------...I.......................
Owner Namc:.........11l1.?1.... .w- �/A�.........I..... Phone No:..............................>��.....................................
'/ /,�/ / r 9ia -�,zz7
Facility Contact: �TJ.Z .••-••....•••.... Title: .................... .............. .I.f.......(.lj...��!:`.:..... ............................ ............ Phone tio:
lf_^ p pl _/
Mailing Address:.......1.��7.. Y,f-± 1� �.Ca�..r�.t� 1� 4'.�1..�" ..................
G .2
....................... .........---
// ,�.......................
Onsite Representative......... �C,fry..........41...•+.`.�........................................... Integrator:...AMM�� ... � i"�- ............... _..
Certified Operator, ............................................... t,
...''//Operator Certification Numberr.�Z , ...........
Location of Farm: �o.,�� ���, i�A� �61� ��Z ,� Ay.,-..,. Az c)
Latitude •=1 « Longitude ' 6 44
ry..'Design ax ureent
De5lgnaa ttrientn `., c CSlgn RrreAt
h
Capacity Pol uiatton PoU..' Capacity :Population �Cattie Capacity .Pnptxlation
Wean to Feeder(
Q [y -. ❑ La er Dairy P
❑ Feeder to Finish
❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
.;,'El Farrow to Feeder
JEI Other
❑ Farrow to Finish
sToWA Design.Capacity.
❑ Gilts
k
❑ l3 oars
3
„
_;Tota1,SSLW
- umber bf Lagoons I Holding Ponds
� ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
1\'.
❑ o Liquid Waste Management System
,„ ,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes flR No
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance. man-made? ❑ Yes IRNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ;K No
c. If discharge is observed, what is the estimated flow in gal/min? /t%114
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ;'No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
mai ntenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �No
7/25/97 Continued on back

Facility Number: 0 2p/
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): .?Y.. 9...................................... ................. ................. ....................................
...... ....... .
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13_ Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
No
❑ Yes
No
Structure 5 Structure 6
...............................................................
................................................................
❑ Yes
K No
❑ Yes
No
Oyes
❑ No
15. Crop type ...av�'i�f..,rrt.........................................................................................................__............_....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vioilotions•ordeficiencies.we'renoted-during this:visit. Xoit:rviA receiveno•ftirther:
correspondence alioutthis:visit::::
Reviewer/Inspector Name
❑ Yes 19No
❑ Yes XNo
❑ Yes Wo
❑ Yes Pq No
❑ Yes XNo
]� Yes ❑ No
❑ Yes KNo
❑ Yes KNo
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
!J/.f/,si/,�.fa�'-�GOE l�lG7 ��j►.�-�v.�f..
7125197
Reviewer/Inspector Signature:
Date: JZ 5? — 97