090209_INSPECTIONS_20171231

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090209 Facility Status:
Active Permit: AWS090209
❑ Denied Access
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County, Bladen Region:
Fayetteville
Data of Visit:
1012612017 Entry Time: 10:30 am
Exit Time: 11:30 am Incident 0
Farm Name:
Billups Nursery
Owner Email:
Owner:
Barry D Billups
Phone:
910-862-4502
Mailing Address:
928 Culbreth Smith Rd
Elizabethtown NC 28337
Physical Address:
12395 NC Hwy 242 N
Elizabethtown NC 28337
Facility Status:
Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Fane:
Latitude: 34° 47'29" Longitude:
78° 3634'
1 mile S. of Amon on Hwy. 242 in Bladen Co.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col, Stor, & Treat Waste Application
Otherlssues
Certified Operator: Barry D Billups Operator Certification Number: 17943
Secondary OIC(s):
On -Site Representative(s), Name Title Phone
24 hour contact name Kathy Barker Phone:
On-site representative Kathy Barker Phone:
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspectoris):
Inspection Summary:
Calibration Sept 15 Sludge Survey 8-23-2017 0-3.5, P-2.1 47%
page: 1

P.
i
Permit: AWS090209. Owner- Facility : BarryD Billups Facility Number. 090209
Inspection Date: 10/26/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & StLqaM Impacts
Yes No Nil No
No_Ne�
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
Structure
❑
❑
0 ❑
Application Field
❑
❑
PAN?
Other
❑
❑
M ❑
a. Was conveyance man-made?
❑
0 [11:1
Outside of acceptable crop window?
b. Did discharge reach Waters of the State? (if yes, notify,DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 Cl
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No_Ne�
1101111
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
❑
PAN?
❑
6. Are there structures on-site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
❑
Outside of acceptable crop window?
❑
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 Cl
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Ap IIGp atlon
Yes No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
1101111
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

It
Permit: AWS090209 Owner - Facility : BarryD Billups Facility Number: 090209
Inspection Date: 10/28/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Stocking?
Crop' yields?
120 Minute inspections?
Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
appropriate box(es) below:
Failure to complete annual sludge survey
Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
otgrIssues '
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWO of emergency situations as required by 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
If Other, please specify
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 on-site representative?
34. Does the facility require a follow-up visit by same agency?
Yes No Na No
❑■1111
❑0013
0011❑
❑ ME] ❑
1100❑
❑0❑❑
Yes
❑0❑❑
No Na No
❑
E ❑
❑
❑0❑❑
❑0❑❑
❑ E ❑ ❑
❑ ME] ❑
❑ ME] ❑
I
page: 5

g I lA • (61S D
Structure Evaluation Inspection
Facility Number: -- -D Date: 2-6 RC 1'6 _
Time in: 81. Zo A- ' Time out: $!3911
Farm Name: i(Les il'avrel Farm 911 address:
Owner-Name: ''1 jet `y 6k L or Phone
Facility Contact: a .( � �, J
Qnsite Representative: tc Integrator: (V\ g
Certified Operator: a-df : a.l IL r Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard,? Yes No
Was non-compliant level reported to DWR re.5 • POA received tr-S
Structure: 1 2 3 4 5 6
Identifier:
Spillway?'
,
Designed Freeboard (in.): •
Observed Freeboard'(in.): 'lam - _
Are there any immediate threats t the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes No i7
Does any part of the waste management system need repair-Yes No
Condition of field's*
Condition of receiving crop }—ct-bN .
Comments:

1 AV (4 IP -o.-46 80
r ivision of Water Quality
Facility Number ®- Z O Division of Soli and Water Conservation
O Other Agency
Type of Visit: EMompliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (2KRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: rim Iff County:
Farm Name: C. yL1.2/fs' ��.!'+� { '" Owner Email:
Owner Name: ec{ J`t/ t Phone:
Mailing Address:
Physical Address:
Facility Contact: n om► 54'AAC111-- Title:
Onsite Representative: t� r
Certified Operator:J'rj
Back-up Operator:
Location of Farm:
W
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
C 0 ()Latitude:
Region
Phone:
Integrator: N0 jr
rs
Certification Number: L7T1f 3
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
C.q 00lUV Non -Layer EHJ
tory t,ouitr
Layers
Non -Layers
Pullets
Turkeys__
Turkey Pou
Other
Design Current
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)?
Longitude:
G"P., 0
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ®'Ko- ❑ NA ❑ NE
❑ Yes
[:]No
[2 -NA
❑ NE
❑ Yes
❑ No
[:NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes [2'&o
❑ Yes [rNo
❑�<A ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r7No ❑ 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 Windowjjjj�� ❑ ��Errvidence of Wind Drift ❑ Application Outside of Approved Area
Z7
12. Crop Type(s): GV'��";[ K" S 6 o
t3. Soil Type(s): rl eAa! l&6 [fit I (G — ----- - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [+10 ❑ NA ❑ NE
15. Does the receiving crop,and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [;?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?
Reauired Records & Documents
❑ Yes [DoNo ❑ NA ❑ NE
❑ Yes [�eIQo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [R`�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Month'ty, and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
l;j"'"'
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[,_�AA
❑ 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 too the integrity of any of the structures observed?
❑ Yes
�
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[.i'db
❑ 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
�10
❑ 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
[ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
qNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r7No ❑ 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 Windowjjjj�� ❑ ��Errvidence of Wind Drift ❑ Application Outside of Approved Area
Z7
12. Crop Type(s): GV'��";[ K" S 6 o
t3. Soil Type(s): rl eAa! l&6 [fit I (G — ----- - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [+10 ❑ NA ❑ NE
15. Does the receiving crop,and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [;?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?
Reauired Records & Documents
❑ Yes [DoNo ❑ NA ❑ NE
❑ Yes [�eIQo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [R`�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Month'ty, and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

AA rf
;"
Facili Number: 7 - JDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
L
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:
D-Ro ❑ NA ❑ NE
r9l�o ❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;?f -4o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes [D/No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[["No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[2'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E�1(io
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[eNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33
Date:
2/4/2 YY

alms :17 .b -p- C, 1,; C U
r. lvislon of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
type of visit: gTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! 3 r.L Arrival Time: 4 oa Departure Time: County: Region:
Farm Name: .i t! S Atvc e -y -Aywov{. Owner Email:
Owner Name: 3C �i [l Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
[C
Onsite Representative: Q
Certified Operator:Vzl�f
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator: 443
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
47 S G7 Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dr Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkev Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes UjKo ❑ NA E]NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes R No
B-TgA [:]NE
C3 -9A- [7N E
DVA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/412014 Continued

a-el i Number: - Date of Ins ection:
❑ Yes
D -No
❑ NA
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'15o�❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No D-N-N
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Identifier:
�o
❑ NA
❑ NE
Spillway?:
❑ Yes
Q -<o
❑ NA
Designed Freeboard (in):
the appropriate box.
Observed Freeboard (in):
❑WUP ❑Checklists E] Design ❑Maps ❑ Lease Agreements
[]Other:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S-N-o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
F&_Tl�o
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ol . ❑ NA
❑ NE
waste management or closure plan?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
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
®.Ko ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
21<o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2.1 o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes<
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
Q 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): (j -W49L y �S V V
13. Soil Type(s): r(e nu...rw ; [ (e
14. Do the receiving crops differ from those designated in the CAWMP?] Yes ['r No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q'1 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2,1113 ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
Q -<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
F&_Tl�o
❑ 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
EEI-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment7 ❑ Yes E!j No ❑ NA [] NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [GttS ❑ 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 l�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ] Yes [2 -Ko ❑ 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 �o DNA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
[:]Yes [3 -N -o ❑ NA ❑ NE
❑ Yes F�_90
[—]Yes [301�0
[—]Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments.
Use drawines of facility to better explain situations fuse additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PC' �_o( �
�Vj-�5 D . �,,7
P 3,7
Phone:` 3 c7 3c
Date: 'cS iC.JtI�(,3
2/4/2014

'R c I No
Facility Number ® - 12,0 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit:om liance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
� w w
Date of Visit: 6 a0 Arrival Time: Departure Time: County: +�
Farm Name: b l Owner Email:
Owner Name: 71 Phone:
Mailing Address:
Physical Address:
Facility Contact: G [ Title:
Onsite Representative: !`
Certified Operator: �l LILA t
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Region:
PW—
Integrator: 1/ C
Certification Number: 17 1 q
U
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
rou
Non -L
Pullets
Pou Its
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No CTNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [`�]A ❑ 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 [3<jo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes Ff No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
w
2/4/2014 Continued

C' a
Facili Number: - Date of Ins ection: o
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l R40
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0 N ❑NE
[3'NA ❑ NE
Structure 5 Structure 6
❑ Yes Z j_Wcr [! NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0'N—o
[:�<A
❑ NE
waste management or closure plan?
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
Z4 -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2,Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ 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
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rZj-l�o
❑ NA
❑ NE
maintenance or improvement?
No ❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EFNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [moo ❑ 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): ` 9 eivo A44 S a 0 -- 4omxvy fl),,,
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D -N -o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Zio ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []kNo ❑ NA ❑ NE
acres determination?
r
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑oKo ❑ NA ❑ NE
❑ Yes E3 "'o ❑ 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
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 ❑ 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 2/4/2014 Continuer!

Faci it Number: - Date of Inspection:
A"24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ey, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [INo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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? ❑ Yes 1 ] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes [ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [7� No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments::
Use drawings of facility to better explain situations (use additional pages as necessary).
❑ Yes d No ❑ NA ❑ NE
❑ Yes []�No ❑ NA ❑ NE
❑ Yes IZJ No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
ck6,.Ar., — U ) 0 u,
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
1
Phone: 43-933
Date: 10-M-61)
2/4/2014

U Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit:®Routine
Bance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: t?d Departure Time: County 044001\ RegionFP_D
Farm Name: S v Owner Email:
Owner Name: ,� _a 0`�? Phone: F7b ` Orb q j
Mailing Address:
Physical Address:
Facility Contact:y i�]'4 r'r Title: S�,.�_ Phone:
Onsite Representative: �- � �� � T Integrator: .�
Certified Operator: fly t(war Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I ::::]
(atfGb IT 1 INon-Layer
Non -L,
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 01<_
i"" ❑ NA ❑ NE
❑ Yes ❑ No
Yes [] No
D,KA ❑ NE
2'1GA ❑ NE
❑ Yes
❑ No
[-NA
❑ NE
[:]Yes
To
❑ NA
❑ NE
❑ Yes
[2<o
❑ NA
❑ NE
Page 1 of 3 2/412011 Continued

aeili umber: Date of Inspection:
P
Q<o
❑ NA
❑ NE
❑ Yes
V_
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[;]-No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[-[ oo'
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
CEJ o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[!3'1�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑-<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Zp? o'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EE[_blo
❑ 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
Q4115-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ESN
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [g -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground 0 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 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): sG V
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes e3IG ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
Q<o
❑ NA
❑ NE
❑ Yes
®'i\To
❑ NA
❑ NE
❑ Yes
[;]-No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [DAo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F714 -o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [lo. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

log A OF
acility umber: Date of Inspection: law
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E'1To ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes M-ITo- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M"Ro ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [j'I'o ❑ NA ❑ NE
[]Yes [D No ❑ NA ❑ NE
[]Yes [o [:]NA E] NE
❑ Yes [ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [6 -fro ❑ NA ❑ NE
33. Did the Reviewcr/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [B'<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes to ❑ NA ❑ NE
Fus
omments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
e drawings of facility to better explain situations (use additional pates as necessary).
��ALLON -2,AO' (�
945y J:= �ASj�K
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-►'Drc " �/It(/ TR .--- I
t
Pho�j0 - ` 331 4
Date:1 1 POO )"'';
21417011

'f
s
Facility Number .1 7 -
UDivision of Water Quality L�-
O Division of Soil and Water Conservation y
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit; outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — f Arrival Time: ; / Departure Time: , tJ County: elwe
Farm Name: l— Owner Email:
Owner Name: 73/c t r`7 3, u { Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ljQ�l
Integrator: W&,rPk
Certification Number: �7 Qi'
Phone:
Region:
Onsite Representative:
Certified Operator:( 7 i ^
7
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Other
Poults
Design Current
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
Won -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes g No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

V
` Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CS -N0
❑ 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): L
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
[a 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
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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
?S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [SNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidJence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ 9"YNt. a� I@_cry/j�nl
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FX] 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 ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [N No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 0,No
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
E] NA ONE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facittty Number: jDate of Inspection:a--
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
M No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
qNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2SNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZkNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®.No
❑ NA ❑ NE
Comments (refer to question #): Explain any'YES answers and/or any -additional recommendations or'any other comments;
ilse�drawin�s of facility,to.better-explain situations (use' additionai�� a es as,necessar } x_. � � �;
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Date of Visit: — / Arrival Time: W., 10 1 Departure Time: ® County: Region: '/ R—
Farm Name: ,� r i uI )Jet r.5 e— Sr
Owner Name:
T�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: — Title: / rpGG• Phone:
Onsite Representative: LA y _ rlJQr�'Cr*✓✓ Integrator:
Certified Operator: �rrj�` y � i /I uP,j CertilicationNumber:
s.
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: /
Longitude:
Desi
Current
[&No
Design
Current
Design Current
Swmc a�pacty
' Pop.
Wet Poultry
C*apacity
Yop.
Cattle Capacity Pop.
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
o
La er
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dai Cow
❑ No
Wean to Feeder OO
-__O
Non -Layer
❑ Yes
[Z No
Dai Calf
❑ NE
1 Feeder to Finish
❑ Yes
54 No
❑ NA
❑ NE
Dai Heifer
Farrow to Wean
Design
Current
Dg Cow
Farrow to Feeder D , , P,aultr Ca acit 1'0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
1
Other
TurkeyPoults
Other
sau�xs�urs�-ae��s
Other
aa�nrx as rta.xar��-: sxaRa.asa:�.ss��m�a¢s.er�x
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Z No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
54 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

' Facility Number: Date of Inspection:
❑ Yes
[ No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
NA
❑ NE
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
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,7L
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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 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
R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [K 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
r
12. Crop Type(s): .41fthl
13. Soil Type(s): Gal
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 ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2[ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Cg No
0 N ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facilit Number: IDate of Ins ectiow,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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
❑ Yes
0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[.1 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or an other comments.," u<
Use drawings :offacility to better explain situations (use additional'pages as necessary).
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: ljg j ^3,3p 0
Date: cL
21412011

Facility Number
04,vision of Water Quality
© Division of Soil and Water Conservation
0 Other Agency
(Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Timed Ar
Departure Time: %�% County: �
4 1115 /u r S-ery Owner Email:
Owner Name: &Y`f U 811/ii _ Phone:
Mailing Address:
Physical Address: 2
Facility Contact: ��r-rq C3l1%/0_T _Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
AA PPhoneNo•
MIntegrator: —6
Operator Certification Number:
Back-up Certification Number:
Region: 740
Latitude: = o =I = 11 Longitude: =0=6
°=6 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Laver
00 d ❑ Non -La er
Other
❑ Other- --- --- - _J
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
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 P<o ❑ NA ❑ NE
❑ Yes
❑ No
2<A
❑ NE
❑ Yes
❑ No
[B1A
❑ NE
[;1<A
❑ NE
❑ Yes
❑ No
❑ Yes
0�<o
❑ NA
[INE
ElYes
2 o
❑ NA
❑ NE
Page 1 of 3 12/28104 Continued

Faciltty Number: 4q —Ao Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,.,.,�
20<o ElNA F-1NE
a. If yes, is waste level into the structural freeboard?
El2 Yes
o ❑ NA ❑ NE
Struc pre I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:y
E _
Reviewerllns ector Name
Designed Freeboard (in): c l
aReviewer/inspector Sigture:
Observed Freeboard (in): 331
Date: �}
Page 2 of 3
5. Are there any immediate threats to the integrity of any of the structures observed`?
❑ Yes
,,..,,__,,//'�
[9 o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[R<o [INA ❑ 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?
20'�es
❑❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
LI�'i�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
[9<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,�
l_Wivo ❑ 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
13. Soil type(s) &o4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 20"No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [Wo [3 NA ElNE
18. Is there a lack of properly operating waste application equipment? ElYes alto ❑ NA ❑ NE
Coments (refer to question#).;;Explain any.;YES and/or any(r commc datipns4or any othe
mr comments. A
Use drawings oC facility -to better explain situatfons:.(use add�donal pagestas necessary)•,
, iris a --
T
E _
Reviewerllns ector Name
Phone: �3
aReviewer/inspector Sigture:
Date: �}
Page 2 of 3
1248104 Continued

Facility Number: — Date of Inspection U
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20.'Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 04o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D X'o ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
[INA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,P
I�N
[:1 NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
2//o o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Elo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EK
❑ 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?
El Yes
CI No
EY'
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2"NOo
❑ 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
L2No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[; to
❑ NA
❑ NE
Additional Comments and/or Drawings:
7�_t� P.,� ley O
w
Page 3 of 3 11/28104

,QI`i1js 7 - ©'9 - z00 7
rvision of Water, Quality
Facility'Number O ZQ 7 Q Division of Sail,and Water Conservation
0 Other Agency. a
Type of Visit G-, mmp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Gy
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time::I�%fir Departure Time: %; Jai -County: ����'� Region: �/Za
Farm Name: 1, ;rcD _S /I/4f rse_� Owner Email:
Owner Name: ,8rthl� �3;fhA Phone:
Mailing Address:
Physical Address: 1
Facility Contact: 1_l Ct4 y Nt 4A% &.L4✓Title: � � ,��L Phone No:
Onsite Representative: to �'��t.1/ _ Integrator:/�I ga" gr& JN
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = 11
Longitude: = o =' = "
Design Current Design . Current
Swine Capacity Population Wet Poultry Capacity. Population Cattle
❑ Wean to Finish
21vean to Feeder 64/60
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:,
Design Current .. ,
Capacity. Population`A
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ "No ❑ NA ❑ NE
❑ Yes ❑ No L,S NA ❑ NE
12/28/04 Continued
N
❑ Yes
❑ No
C1
EINE
LINA
❑ NE
❑ Yes
❑ No
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
L54o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 0 Date of Inspection -aY-D
-71
❑foo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Waste Collection & Treatment
❑ NA
,�/
17. Does the facility lack adequate acreage for land application? ❑ Yes
OoKo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
Yes
El=
1,��1,. Ngo
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[D No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32-
Z5.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
El Yes
,,��,,//
IQNo
❑ 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
_. thereat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes _W - ;o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [�No F-1 NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes [T/N
9. Does any part of the waste management system other than the waste structures require El Yes D o ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I_1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FrNo ❑ NA ❑ NE
❑ Excessive Ponding [:1 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 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) 3 e ire u aFw (P-07
13. Soil type(s) ee-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑foo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
20'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
OoKo
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment? ❑ Yes
[ /No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
+r
Reviewerlinspector Name �j �ey�.L� phone: 4i�01933..3-?3
Reviewer/inspector Signature: - Date: 6
12128/04 Continued

Facility Number: Date of Inspection 6 -0T6 4
Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LT No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L 7<0 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I maps El 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2�,<�o
El NA
[INE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
l� 'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes LTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑'l i�o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ 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
MIhio
❑ 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
El Yes
//
D o
❑ 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
l3No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ell
❑ NA
❑ NE
Additional Comments and/or Drawings:
1,2128104

4
O Division of Water Quality? /
Facility Number Q O Division of Soil and Water Conservation �-
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J�^� Arrival Time: . D O Departure Time: I f j 1D I County:
Farm Name: O �t� 1Ju r 5e ry Owner Email:
Owner Name: 21 I U aS Phone: _
Mailing Address:
Physical Address:
Facility Contact: , sn 't -y- % �Q! Title:
Onsite Representative:
Certified Operator: /' i f u10.j
tl
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
R.Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feede:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude:
F7°
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Papulation
FoLNon-Layer
Layer
"Otto
'Q
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Longitude: F] ° r
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEX Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Dumber of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®.No ❑ NA ❑ NE
El Yes
0 N
0 N
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn 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): 17Q z
Observed Freeboard (in): -3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan'?
❑ Yes �TNo ❑ NA EINE
❑ Yes �KNo ' ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [-No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes aiVo ❑ 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)
ReviewerllnspectorName
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[A No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
IgNo
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s)'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E.No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Imo. No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Sa No
❑ NA ❑ NE
Comments (refer to question #) Explain airy �YESYanswers and/ rr`any recogmmendations or apy other comments.,:g
,. , ' r. g B th, L At
Use drawmga'of facilii y to better explain situations {trse _additional pages asine`cessary ? r � , , -� �;_
i
ReviewerllnspectorName
"g �-. ' II`, "µ� Phone:=
j917.dr
ReviewerAnspector Signature:
rp Date:
Page 2 of 3 12/28/04 Continued

:r
Facility Number; Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IN No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [B -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
(9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ESNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CKNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
AdditionaWomments and/or Drawings: r �'
Page 3 of 3 12/28/04

ivision of Water Quality
Facility Number O Division of Soil and Water Conservation t y
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
O Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: ; O a Departure Time: �f�a County: Region:
Farm Name: Owner Email:
Owner Name: 'Fa' / ac. xf Phone:
Mailing Address:
Physical Address:
Facility Contact: rr 1 �i�l��� Title:
Onsite Representative: 0 �*r
Certified Operator: 4
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = d Q Longitude: =0=1
°=1 = 1{
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I JEI Layer
Wean to Feeder J IO q t c) I b DOD ❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ 1 urke s
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population;;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ELI
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 X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�RLNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12/28/04 Continued

s
Facility Number: —
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 4�
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 [9 No
❑ Yes 21 No
Structure 5
El NA [I NE
❑ NA ❑ NE
Structure 6
❑ Yes (4 No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RNo ❑ NA [I NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E] 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 [K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12- Crop types)Xf►rm r��o, ZiLL
13. Soil type(s) _ l 1 e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V[No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ro No
❑ NA
[:1NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 9/ri—!/, ER -33Dv
Reviewer/Inspector Signature: Date: & — ( —,700Z
12/28/04 Continued

Facility Number: — D Date of Inspection l D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ 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 El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ •Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I& No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.4 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E 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
10 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JRNo
❑ NA
❑ NE
al Comments and/or Drawings:
12128/04

1vision of W,atcr.QuatitY
FaC�lfty'Number �� O Division of Soil and" Water Conservation'
,..
Other';Agency
Type of Visit 0-15—ompliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit a Routine 0 Complaint Q Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 3 0"flb Arrival Time: 0 i 3 0 1 Departure Time. �y� County: . " ✓�- Region: o
Farm Name: t_�_� P� 5 U 1-,-5er Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /0 1A n' Z .G i 11 u 21, Title: Phone No:
Onsite Representative:,�� 4����'�^� Integrator•
Certified Operator: ✓���/'` L�.,�,-��� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 [=4 ❑ 6{ Longitude: =0=6
e❑6 ❑ u
Swine
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
I -I
']LI Farrow to Finisl
❑ Gilts
❑ Boars
Other.
❑ Other
Design Current
Capacity Population
;Design Current" .
Wet Poultry "- Capacity," Population
❑ Layer
❑ Non -Layer Lj Dai Calf
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cc
Numbor of Sti
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
E. ❑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?
Page 1 of 3
❑ Yes IN No ❑ NA ❑ NE
❑ Yes
[KNo
❑ NA
EINE
❑ Yes
[[No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
JK No
❑ NA
❑ NE
❑ Yes
(4 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection a' y
} 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
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
IS, L8i1-`fid 0 i? t11�<�3 i vt �fl v �" i►!'I'►q U -0f G
Spillway?:
Designed Freeboard (in): (r
Reviewer/Inspector Name Phone:/!� y3_3 ~3340
Reviewer/Inspector Signature: Date: fj 3 O o6
Observed Freeboard (in): 3 Al
Soil type(s)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
R No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
X No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
19 No
❑ NA ❑ NE
through a waste management or closure plan?
® Yes
❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[R No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
5d No
❑ NA ❑ NE
maintenance or improvement?
Is there a lack of properly operating waste application equipment?
❑ Yes
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[SNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)—Der n_kr 'a 0" GY41 Z / ego,r r_s rrJ
IS, L8i1-`fid 0 i? t11�<�3 i vt �fl v �" i►!'I'►q U -0f G
Ge ti7r�
Reviewer/Inspector Name Phone:/!� y3_3 ~3340
Reviewer/Inspector Signature: Date: fj 3 O o6
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
10 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JZ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other%comments A
Use drawings of facility to better explain situations. (use additional pages as necessary):
IS, L8i1-`fid 0 i? t11�<�3 i vt �fl v �" i►!'I'►q U -0f G
Ge ti7r�
Reviewer/Inspector Name Phone:/!� y3_3 ~3340
Reviewer/Inspector Signature: Date: fj 3 O o6
Page 2 of 3 12/28/04 Continued

i
Facility Number: — Date of Inspection !7
ti
Required Records „& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ISNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �gNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA [INE
❑ 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
Z[No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Rj No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[K -Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to property 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
PSNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
CLt. a L.Mrj .I't vn r
Page 3 of 3 12/28/04

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other E3 Denied Access
Facility Number [tate of Visit: IaZ .23 ° Tune: / = aS
Q Not Operational Q Below Threshold
Pa Permitted Certified [3 Conditionally Certified 0 Registered Date Last Operated o/rr Above Threshold: ..................»..
Farm Name:...........1�,�.(..�l..Ysy....l.k.ctrr ..._....... Couunty:......»..»!C>/ct4r..................... �...
Owner Name:...»» a rr y ............... . ....................».............. 'Phone No: „ i 10 ) ...» 940— 14 S-0-? ..............
Mailing Address: 85 S o L 1,`e d 6c4,4 4,a cj.*j 0?8337
Facility Contact: .. »».»..» »... »...».... » ._ ._ .. . W__ ...w. Title:Phone No:
Onsite Representative:.._.. K. n ...,, �_ » » ._... ._ ._» _ .... Integrator -
Certified Operator:._ �, , »., � l Operator Certification
Location of Farm:
OSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 44
•^•••• -" -,a.cs awf ',
C:av usa�cays�
s-r,r.,_--tea-.
_ .:10i.. A.4w"�&Wy
JA
Wean to Feeder
❑ Layer
Feeder to Finish.
[:] Non -Layer
Farrow to Weani��''"
Farrow to Feeder
Other
Farrow to Finish
S
,
❑ GiltsEj
w
Boars
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon Q Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
rDestgn Currel
..;CaPaC1tY..�'pOD�18t1
b. If discharge is observed, did it 'each Water of the Stats? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
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): . 4 //
❑ Yes W No
❑ Yes ❑ No
❑ Yes ❑ No
H /*
❑ Yes ❑ No
❑ Yes ❑(No
❑ Yes m No
❑ Yes J� No
Structure 6
12112103 Continued

Facility Number: 9 -- a Date of Inspection
5. Arc 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 [] 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
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste APi ication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11, Is there evidence of over application?? if yes, check the appropriate box below. M-Ife's ❑ No
❑ Excessive Ponding ❑ PAN 21ydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type l3er. "t, (o _ / S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 13 No
b) Does the facility need a wettable acre determination? ❑ Yes 18 No
c) This facility is pended for a wettable acre determination? ❑ Yes E] No
15. Does the receiving crop need improvement? ❑ Yes ['Z No
I6. Is there a lack of adequate waste application equipment? ❑ Yes P No
Odor Usues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
6 iI iti.] " (ir1 _ .0 1 Cagy r
LL.�O p r
Reviewer4mpector Name i
Reviewer/Inspector Signature:
12112/03
tnanoaLAinNAM'nat>mypagcs!'asin ry,): ®Field Copy [I Final Notes
187�9rY7�I�mE - _
Date: /a2
Continued

Facility Number: 9 —coq Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 16 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 ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (a No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 1�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes [�No
28. Does facility require a follow-up visit by same agency? ❑ Yes PNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes M)No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes [%No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
♦� �n f �R Yr p �. .. . , i 3 r 9.e - rr y.lyN;T •MP!.�i's °{}� i '+, s [r a�� &k . .,'�5
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.��. �." it ss t �� �nL %�€a�,€, a��s"a iP�<� s ;. �:S v�u iy':
S <t v— yp �N a-3. L vti o to c c-r,� -�C+ kz� c t �-.
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7
J2112 03

. .. . .........
❑ Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
-_ u.r�r, runnm
Date of Inspection
Facility Number D Time of Inspection Z?.!- 24 hr. (hh:mm)
0 Registered ©3C)ertifflled © Applied for Permit 13Permitted IMNot O erational Date Last Operated: ... ..........
Farm Name:............................................
Owner Name: .... ,...... !%,..�..... ..... ........ Phone No(T.��yl.....t?..iCt...... .y:��. Z....
t......................
Facility Contact: .................. , .ffAoitl=... .... Phone No:...................................................
�Mail...�1./3-Ex-. Z..... 0... ..3.....
ing Address:�.......t .SXZ .......... ....... /..... 7... .....
Onsite Representative: ................... 1!:�........................................................................ Integrator:.......fftA1. ar./ r.... '� �r.00Y.../.%r
Certified Operator......... ef..?� ...
............................. ............. Operator Certification Number;..............,.; ...
Location of Farm: Z�,_ Zi L .L _Z101, j ri,4t adG � V7
............�.
Latitude Longitude �• �� 0°�
Design Current
", pesign Current
Design Current
.Swine Capacity. l'opu�ladon
Poultry k.....
Capacity Populattaa` Catfle
.,
Capac►ty .: Popufa0on :-
M No
Wean to Feeder
",
❑Layer
i-010 Dairy
❑ Yes
KNo
❑ Feeder to Finish
„❑
Non -Layer
11"110 Non -Dairy
!A
Farrow to Wean
❑ Yes
PR -No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
lgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Farrow to Feeder
❑ Other
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
FNo
maintenance/improvement?
❑ Farrow to Finish
Total Desgn,Capacity.
❑ Yes
liallo
❑ Gilts
❑ Yes
5� No
7/25/97
Continued
on back
❑ Boars
4f'
,TotaL.SSLW
Number of Lagoonss/ Hcilding Ponds.Z ❑ Subsurface Drains Present ❑ Lagoon Area 0 Spray Field Area
`
:. ... .. ...
❑ No Liquid Waste Management System
General,
1. Are there any buffers that need maintenance/improvement?
❑ Yes
M'No
2. Is any discharge observed from any part of the operation?
❑ Yes
M No
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 Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated now in gal/min?
!A
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
PR -No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
lgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
X No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
FNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
liallo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
5� No
7/25/97
Continued
on back

Facility Number; 0 — get
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLagoons, Ilolding Ponds, Flush -Pits, etc.!
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stn►cture I Structure 2 Structure 3 Structure 4
identifier: ...................................
I" �¢¢'
Freeboard (ft): ..........> .......•............•..• d..........•.........• ................
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)
15. Crop type .....!...+^d�1`
'Yes
❑ No
❑ Yes
❑ No
Structure 5 Structure
.............. ....... I .......... I •...............
6
.................•..................,............................
❑ Yes
IgNo
❑ Yes
1 No
Yes
❑ No
❑ Yes
® No
❑ Yes
& No
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[[nspector 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?,
❑ No.vitilations,or. de>cicieiicies.were,noted•du' ring this:visit. You:will rece'ive•no•ftirthei• :
OfrespOhdehce ah'out this. Visit.,',; :::. : . :.:..:.:.
❑ Yes (N No
❑ Yes No
Q Yes ❑ No
I'Yes ❑ No
❑ Yes R No
(;�D -&No
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
*/f
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