260059_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

i,
4
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QIK'o-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ,' County: C Region: �
Farm Name: ee- Flat,­r" P, e , Owner Email:
Owner Name: if-D12-tj 1 j A))-r CO f f t t.i'- Phone:
Mailing Address:
Physical Address:
Facility Contact:�J rr" Title: btu Y IIIPhone:
Onsite Representative: Integrator: u-c-A"e"t
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
I
�tlgi I I
Desi n Gurrent
,
�I Iit1E
best "n Current
Willuti�^ �
�taltlli gp!
Des[ n
3 �Vl�iliW�'
ululllullllltlill
Current
�mAll�lli�
Swine
Capacity Pop.
Wet Poultry
Capacity
Ppp.
Cattle
Capacity
LA
1�li,e�il�,
II�III,dki
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
p
Dai Heifer
Wean
l
Design
Current
D Cow
Feeder
D Poultr.
Ca aci
P,o .
Non -Dairy
Finish
La era
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turkex Poults
0
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes JJ-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
jgLNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: (o - Date of Inspection:
Waste Collection & Treatment
tj 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes O.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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
5D No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
SNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
l&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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): crm u��. �i�u�rsz-r„( -Zey i7�-r- 144 -#g ..
13. Soil Type(s):
14. Do the receiving crops ditT'er from those designated in the CAWMP? ❑ Yes to No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes O No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes M 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 5a No ❑ NA ❑ NE
❑ Yes X.No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RLNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ej�No
❑ NA ❑ NI-
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard EaWaste Analysis 071 AhL Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E, No
❑ NA [] NE
Page 2 of 3
21412015 Continued

[Facility Number: & - Date or Inspection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No 0 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
53 No
0 NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
K No
0 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
[RNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jallo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
ReviewerlInspector Name:
Reviewer/Inspector Signatui
Phone:
Date:
21412015
Page 3 of 3

-v
N
f Water Resources
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 %]-� Arrival Time: ; �Q'D Departure Time: �' County: .6 1 laegion: �
Farm Name: 1 ! j Yr GrY 3::7yt G Owner Email:
Owner Name: „- ' � r 0 U ,Z`f— Phone:
Mailing Address:
Physical Address:
Facility Contact: V,:: c ct Title: Phone:
Onsite Representative: �"�-,� Integrator: ✓V'
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Fceder to Finish T 3-Do
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Design Current
Dry Poultry Canaeity Pon.
Layers
Non -Layer
Pullets
Turkeys
Turkey Poults
Other
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Hleifer
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 M_No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
D No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
&No
DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[a No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
L� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FL No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
t
rent, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®, No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): m_ as/2.0 Vn1_1 r
13. Soil Type(s): Q O�— -- .•-.___.._-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ 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
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes UKNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes S No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes Eg No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412015 Continued

-y Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2�.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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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/inspeetion with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
[-]Yes LNo ❑ NA ❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
E�_No
❑ NA
[] NE
❑ Yes X❑ No
❑ Yes f2 No
❑ Yes O-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refe:r to qu`estlon #)Eiplain any,YES answers"and/or: any additionalxecommendations or'any other. eomments.
U"se drawingssof`,facility to bitter giplaln'sltuations& use'ndd.itiorial ' a es as necessar i } ( p g.
rrA
n!
Jf4j, C}`�Ge l7►'c�' I r�Di�iS 1 "� pur- J-�teo-eit
Reviewer/Inspector Name:
Phone: Pa~-303D (_5`!
Reviewer/Inspector Signature: ��f,�-- Date: % 1 ]— -9-0 1 7
Page 3 of 3 21412015

r
S f)-6--1 at_, -r(,
Type of Visit: &'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outine O Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 77 Arrival Time: ; Da Departure Time: 1 3 , V County: �A/--JR.'egion:
Farm Name: v ftee- i_-5[.l'►115 =n 4 Owner Email:
Owner Name: �DRy : r �C - �D'i_ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Z? aA,; J (fC) (/c -'— Title: jPec.A n -e r Phone:
Onsite Representative: �$-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: %-5�!
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
7D
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, l;ouitr,
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkey Pouets
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [allo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes [:]No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

L Facili Number: - Date of inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5,No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E[ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [n,,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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): Z r/-,m_fja /pv i Srr� / ,---
13."Soil Type(s): f q ! Z.a )�Jy h / J` a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ 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 ELNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: lG - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
1,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eallo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E:�No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
,�Nv
❑ NA
❑ NE
❑ Yes [RNo
[] Yes J�j No
❑ Yes P!.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
( .. q, t+recnrt fidutlonsgor�any�otherco`mments ;,,
Comments refer.to teest on #) ,Explain any YES iinswers and/or'any additlnna t E *'yG .-, �s� ._k f+xc �,, i`.„ZZ J.
Use drawings of,`facillty to bet er explaln,�sttuations (user additiagalspages-as,necessary)
Reviewerllnspector Name:
Phone
Reviewer/Inspector Signature: Date
Page 3 of 3
�tJ y3�33�'
21412014

Type of Visit: O'1~ompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ( tnutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: a O County: Region:
Farm Name: zf u /k ef" �Gt .h"s Owner Email:
Owner Name: tea✓ i e rfj, C' ���"� Phone:
Mailing Address:
Physical Address:
Facility Contact: J_�>Oea_j L L71�`Yt Title: Phone:
Onsite Representative: `=«
s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: _dt✓ ZZ171,Va -Of,
Certification Number: [i�r p- ej/ l
Certification Number:
Longitude:
Design Current
INN
Design
E
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pnp.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I
INon-Layer
I
Calf
eeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
1DrvCow
Farrow to Feeder
Dr, P.©alit,
Ca aclt
F.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
10ther
IL
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

1~acili Number: - Date of Ins ection: j /
Waste Collection & Treatment
;1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
9—yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LCY No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�l/y1l�A•r f t/
13. Soil Type(s): jPit/ .51 J1192¢ 1 _liar
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ® No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ® No
❑ Yes CZ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: v20
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ER 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 allo ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
fZ 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
51 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
64 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
P 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
rV1 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Uak No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2,No
❑ NA
❑ NE
Comments (refer to question #): Explain -any YES answers :and/or any additional reedniinendations o:r any other comments.
Use drawings of facility to better explain•situations (use,,, dditidnal'pages'as nccess`ary)
Ci its Ld �'7 r"' • a"`-'�•
Reviewer/Inspector Name: fj yv-G
Reviewer/Inspector Signature:'
Page 3 of 3
Phone: 2�� /1J"3�t7a
Date:
21412014

p +Ms � rolrr�3
- Divi"lion ofWater Quality .. . ._
Facility Number A - Division of Soil and Water Conservation
Other Agency
Type of Visit: W Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Iteason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: d!3' S0 County: Region: FRO
Farm Name: CA j Rims G Owner Email:
Owner Name:1%ay1k_Co1.1j_&Phone:
Mailing Address:
Physical Address:
Facility Contact: �avi� Co11,& Title: 61volef Phone:
OnsiteRe Representative: � g Ic,'4Q}v0'd_
p �Q�I Integrator:
Certified Operator: W&t h CoM eL Certification Number: h q.rQ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop,
wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
can to Finish
airy Cow
can to Feeder
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P■oultr.
C•-a nci
P,o P.
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharzes and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [)_� No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Z No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
to No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

I~acili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Iq
Observed Freeboard (in): oa g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tg 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 (2 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 13 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 [5 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 M No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
t4. Do the receiving crops di
WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes ® No
❑ Yes No
[:]Yes No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ 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
Reauired 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 [3 Design [3 Maps ❑ Lease Agreements
[]Other-.
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[)7 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
[�t NA
❑ NE
Page 2 of 3
21412011 Continued

Dq
Facility Number: 01& Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C'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 [RNo ❑ 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 2 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
N 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
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
rU-No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FXr 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 necessa`ry).
as M�e port ctvet Yvoite PI a, in ]reoroll, vye have a - go F141 at oar oA'�fe I
b 1P kw Cvf'& Sanfl-e— Oft vse- `hat 1U ra vmb&, Sep &ahe, rpmm e
tv��'�� ,�T"II1
V'robab be a foal nvmher). W o4e saykof o►�eyrxd� 0odays .-
^ y 13.
_ate 1 o3+o,,e. ra/1 oaf On Aare 1
�, Its rva kl)i 01 1a OMbfre
t �r
0. O pd 5 ' �l ChCyeQ'�? `Pf'ted.. O0t d Vf Rq �� iti�i(-CQ 1I bO'fi"o1 ` 7'Oa/w ft
la, we:a6
RLTO " ca14 �eoL jn ao p
CD,`�a�tcu�ttst-cr a Cody
�e(otd rel giha� `k retwb f (a-dr -
�S 3 y��s,
No)4e a wkfej f w?fb rel0&f'' S�ur��s✓v�ec' t°i�
N&0) ProdVorCopy
Cerrla- at calf Wo� �r A),gava,orl��aa� trlql r3
Reviewer/Inspector Name: _ �_Qon Schn-e1-or
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 914J13
Date: I r ®- 433 330o [Vmt)e
116
21412011

Facility No. � I Farrm Name Co[I�el ��" Date
Permit ✓ COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge De th ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
If
Date out of compliance/ POA?
met
Soil Test Date �a
pH Fields
Lime Needed
Lime Applied
Cu-I __I_w,-Zn-I ✓
Crop Yield
Wettable Acre
WUP k(
Weekly Freeboard
1 in Inspections
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
ee
Soil Test Date �a
pH Fields
Lime Needed
Lime Applied
Cu-I __I_w,-Zn-I ✓
Crop Yield
Wettable Acre
WUP k(
Weekly Freeboard
1 in Inspections
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
ee
Gal)
•
�'ir7r�lr'7r�G1L•'������
07,
�
,�:
�� ��
ate.
; .,
�
- �l.
■r
■-
WE
F _l Ao. ftdI ►a Is (A) P.z-j )a/ 3C P y �'
Verify PHONE NUMBERS and affiliatio s
Date last WUP FRO ja jd 110p FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Tfivew Same 1e Stop Pump
a 0*?� Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac

124 ( 2e)l Z
' vision of Water Quality
--Facility Number � - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (yfloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: oun Region; Yr&
Farm Name: / Owner Email:
Owner Name: L/j/�h.J �� /�— Phone:
Mailing Address:
Physical Address:
Facility Contact: pr"' Title: �1J.t�iP�'- Phone:
Onsite Representative: Integrator:
Certified Operator: ��y�p _ Certification Number:��_
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
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Poults
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)?
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?
Page 1 of 3
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 205o ❑ NA ❑ NE
❑ Yes
❑ No
2' A_
❑ NE
❑ Yes
❑ No
[L,.X<
❑ NE
❑ Yes ❑ No Jf l`t' ❑ NE
❑ Yes IICI' o ❑ NA ❑ NE
[:]Yes 10 ❑ NA ❑ NE
21412011 Continued

Facilit Number: r Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? L 'es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E? A ❑ NE
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.)
Structure 5 Structure 6
❑ Yes IIQ<o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E;jrRo
❑ 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
U* o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&31<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
<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
a2-<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): Z' X? 1,4,4AI I -A,
14. Do the receiving crops differ rom those designated in the C WMP? F
❑ Yes
To
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E?5o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Eallo
❑ 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
4�""
❑ 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
2 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
L!d'""' ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Ins eetion:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Erlqo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a-41Tb ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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 MNo DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D No g3 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
P<0 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Vo ❑ 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
[g o ❑ 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
ff 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
[9 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ oo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eu� ❑ NA ❑ NE
Comments (refer to question #): Explain, any YES answers and/or any additional recommendations or any other comments::
Usedrawings of facility to betterexplaiit situatlorig (use additional pages .as necessary) -
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3of3
Phone:, ..
Date: %aZ
214 011

q
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Season for Visit: O<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /U . 0 D I Departure Time: ,'.Ta County: �w,Al Region: -Ro
Farm Name: Co l h er f-'a r►y"s _g:7 K G, Owner Email:
Owner Name: Datyj A ( vmr in= Q I Z 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Phone:
Onsite Representative: ���� Integrator: 3—G /&W'2"'
Certified Operator: S"a�-,e.r Certification Number:}`} /� f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
M
la ^j.a `C
.�, ,,, •.' .a
_.. f' �
'.
_nK ..i.�
,•, .?.�'�. ivhv�'
�
5z.
� i}�,�' k��:d
t -
x;,�.
zf
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FIRM
).p
S
-- i k T a
,ANY
■
--
5
ME
i k 1, --_
�� s
■
--._,ems,
ra
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-
Q'lf 1.,, t c
_!k
t
_..SF�
■
'
--
Y
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y y kiiSx1
y�+
d` Fi
f
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?
❑ Yes [R_No [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
allo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: id - = I Date of Inspection:
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
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.)
ZNo ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
[:]No
❑ NA
❑ NE
maintenance or improvement?
Waste A212lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ERNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):��tr9-•--
13. Soil Types):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
IT 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 [3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - bate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZI No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
JzN Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP7
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
RYes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes [2kNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or, any additional recommendations or any other.commetits
Use drawings of facility to better explain situations (use: additioual --ages as necessary).: .
0,2m7T;;M-e WD -,k-
Reviewer/Inspector Name:
Phone: Hzq _d0.3.--3_0o
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6� %! Q00�%
21412011

1
N.(
E7 Division of water Quality
Facility Dumber a2_�_]
O Division of Soil and Water Conservation �V-�v--__—.C1 Other Agency
F
f Visit ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Arrival Time: 19 ; D 0 1 Departure Time: : O C7 County:
Farm Name: �� �� r� 6541mL6 _T7,-1e, Owner Email:
Owner Name: D"�,J LT"�is*n C-01!i`er Phone: _
Mailing Address:
Physical Address: /1
Facility Contact: 0&eZd/ C�O I�1 r'� Title- alu�� Phone No:
Onsite Representative: J'�'�� „ Integrator:
Certified Operator: ` `r Operator Certification Number:
Sack -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
Back-up Certification Number:
Region: 6
Latitude: ❑ o ❑ I ❑ 11 Longitude: = ° ❑ d 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
n _ I ❑ Non -Layer T
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurke 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
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
U
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
Page 1 of 3 .,; ^ 12128104 Continued

Facility Number — Date of Inspection
C�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed freeboard (in): 19,
Observed freeboard (in): A3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [M�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
5LYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
J2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) FA
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes_ J9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate'per the irrigation design or wettable acre determination ? ❑ Yes Jq No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes f ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes fallo ❑ NA ❑ NE
'Coriim.ents (refer .to questionV)':,.Explain any. YES answer`s and/or anyIrecomm'endations,or any other comments
Use drawings, offacility to be'tterexplain situattonsi (use additional pagesas necessary): �-
Reviewer/Inspector Name ' 4 �� t �"
R r. Phone:
Reviewer/Inspector Signature:
Date: er--2:7�/4rb
Page 2 of 3 `/ 12128104 Continued

Facility Number: —J Date of Inspection
d Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKVo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C�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 C&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;BNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14 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
UZNo
❑ 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
ERNo
❑ 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
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C9,No
❑ NA
❑ NE
Addltional.Commentsand/o'r�Drawing r:' t �� '� r�'�� 'y,a � j �.i4,w°�
Page 3 of 3 12128104
Page 3 of 3 12128104

0
sion of Water Quality c✓
Facility Number I O Division of Soil and Water Conservation t
-� O Other Ageney 7
Type of Visit t7compiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L :J Arrival Time. I 10, 06 1 Departure Time: : p(7 County: Region:
Farm Name: C O 11 1 &e— r O orr►? S 17-4 e• Owner Email:
Owner Name: OGUJId &1.1'=� Cn i l r C' Y" Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Atli ie-0 Y-- .,
Certified Operator:�^~--�-�
Back-up Operator: S
Phone No: r
Integrator: l! �co'e
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ & ❑66 Longitude: = ° ❑ 4 = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other ji
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dahy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ES No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[]No
❑ Yes
[3,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Facillty Number: L — Date of Inspection
Wnste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard'?
❑ Yes
NNo
❑ NA
❑ NE
Structure I Structure 2 Structure Structure 4
Structure
5
Structurc 6
lden ifier:
Spillway?:
Designed Freehoard fln): +I9
Observed Freeboard (in); L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(9 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
g No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[.No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5Q No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
dyes
�o
❑ NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo
❑ 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 l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [].Application Outside of Area
12. Crop type(s) �-
13. Soil type(s) JU
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P4No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
N No
❑ NA
l❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[9 No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
I-e-aIDS to
Reviewer/inspector Name r�z<. G- �i Phone: WL')--a T 3 -330
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Rec uired Records BSc Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5d No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (RNo ❑ 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
gNo
❑ NA-
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eallo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
"--'No
El NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
N 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
❑ NA
❑ NE
Comments and/or
12128104

Division o11Water Quality
acuity Number1 71Division of Soil and Mater Conservation
Agency
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i `ram Arrival Time: lQ Departure Time: r County:
r^
Farm Name: C f r Owner Email:
Owner Name: aytt l ,,J Al lee i,llf�PiV Phone: _
Mailing Address:
Region: [`20
Physical Address:
Facility Contact: �L tkd CDI [r`ely- _ Title: Phone No:
Onsite Representative: Integrator: FloukledFae—M'(
Certified Operator: N Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = d 0 Longitude: = ° = t = 1I
� �' M�
Kc.,
en Curtgn
Current
Desne
ipa�c[ty Population
Wet Poultry Opacity
Population
Cattle
Capacity
Popuiation
❑ Wean to Finish
❑ La er
❑
bai Cow
❑ Wean to Feeder
❑Non -Layer
❑Dai
Calf
59 Feeder to Finish
l7
❑Dai
Heifer
Farrow to Wean
Ury Poultry
❑
D Cow
❑ Farrow to Feeder
❑
Non -Dairy
❑ Farrow to Finish
❑ La ers
❑
Beef Stocker
Gilts
❑Non -La ers
❑Beef
Feeder
EP Boars
Pullets
❑Beef
Brood Cow
❑ Turkeys
Other
❑ Turkey Puults
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[--]No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the ,State
❑ Yes
)allo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Date of Inspection
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JoNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No lA ❑ NE
S
ructure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
&No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
tff No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�j No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[!�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JpNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
25No
❑ NA
❑ NE
1�: 5.'i .:..i:.rvrS�t,.�LS 'iS.At..f�@'i4�t'•ffi .. �.. �&•f`.$'V .. ,:: -• ..q
(refer toquestion #} Explain any YESanswers�andlor any recommendations organ othercomments.
Use drawin s'of facilit' °to better e luin.situatigns n9C.'niiditiniial °a` es;aslnecessar° .��#� 8Y�� f 4F '111z"���
. g y p ( 5 .. p g y) r t �Y; 77 , jj jJ dd
e4'y s i' .:�. i -$'7 ir! / ` [Sa' •te s.;. r. 5e. _ },ks''7�J.d'�'.
�omments
Fa/w\ .
F.,co, 11e f V c&-d
I
Reviewer/inspector Name _ ... - m Phone
Reviewer/Inspector Signature. Date: `l 3
Page 2 of 3 %, 12128104 Continued

a
Facility Number: — Date of Inspectional/D>� I
Required Records & Documents I 1�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ['�'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KINo ❑ NA ❑ NE
❑ Waste Application []Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
(RNo
❑ NA
❑ NE
❑ Yes
ISNO
❑ NA
❑ NE
❑ Yes
6No
❑ NA
❑ NE
❑ Yes
[$Io
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
f9 No
❑ NA
❑ NE
❑ Yes
KINo
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
+QNo
❑ NA
❑ NE--
❑ Yes
DjNo
❑ NA
❑ NE
Additiiinal Comttieitfs and/,or Ur`uwlnnflh
T
Page 3 of 3 12128104

'r,
}Division of Water Quality A� v
Facility Number `j Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit �ft Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Fallow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: of 1� Arrival Time: CX_0 Departure Time: � County U+l!�Ll ll+CilS�_. Region:
Farm Name: l isl�u�' iY1� 1i1Q.,�^ Owner Email:
Owner Name: 1', `-� ., w Phone:
Mailing Address:
Physical Address:
L
Facility Contact: �' Title: _ C In Phone No:
Onsite Representative: Cz
t J Integrator: QA6)" iza r`z
Certified Operator: ) qw _jC3kUQAv Operator Certification Number: 919 -D—y
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:: Other
❑ Other
Latitude: =
0
Back-up Certification Number:
=" Longitude: =° =, 0 4i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
„_.. ❑ Non -La er
Dry Poultry
Non -
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No NA
tNA
ElNE
ElYes
[INo
❑ NE
❑ Yes
❑ No JANA
❑ NE
❑ Yes
PhNo ElNA
❑ NE
ElYes
5%No ❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
A
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: I
Spillway?: ~`
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
X
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1,Ii1No
El NA ❑ NE
maintenance/improvement?
j
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drifi Application Outside
12.
�of�Area
c❑
Crop type(s) &f t't'1U& — ► 1 �CD C�Q t �Tl'11 O-4..-
13.
Soil type(s) P00. LkL
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�ZNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
1ANo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ANo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
UNo
❑ NA ❑ NE
1$.
Is there a lack of properly operating waste application equipment? ❑ Yes
�bNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explaain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 3
Reviewerllnspecter Signature: Date: d�-7
e�l` 12128104 ( Continued

Facility Number: — OS 11 Date of Inspection 5 S o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I 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 t" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
[I NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
)0o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
04No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[MNo
El NA
[I NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
/ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 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
E
12128104

S
facility'No.2 (x 1
Farm Name C�
Owner .% d W'
Operator
Back-up 4 i
COC
C
Time InC8
�QyrrnS �.c.
General or
Time Out Date O�
IntegratorYv--
Site Rep dL
N L19 @-1
Design
Current
Design
Current
Wean —'Feed
Farrow — Feed
n — finis
Farrow — Finish
Feed. Finish,
Gilts ! Boars
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge �✓
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Observed i Z
Calibration/GPM !
Waste Transfers
1� Rain Breaker
PLAT r Wettable Acres
Daily Rainfall 1-in Inspections
120 min Inspections
Date Nitrogen (N)
li)D,g 10O,qD
(4P
Date Nitrogen (N)
MR1
.�. ' �

Type of Visit 0-�om pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G rcvUtine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3— 010(a I Arrival Time: l D a Departure Time: 3 li County: ���✓ �+r� Region: F-1Q`0
Farm Name: C Q�� f r'r Faem =a 4 Owner Email:
Owner Name: Uj ' ,. OA2G C a 1-L c-_w _ _ __ Phone:
Mailing Address:
Physical Address:
Facility Contact: ._,2 a,. if ok -_- _C,-, I I + C-r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: C a fa(
Operator Certification Number: v2 O l 7 ig
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° = S
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er - -- __ -
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy -Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L No ❑ NA ❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ENNo
❑ Yes
[MNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continuer!

Facility Number: —
Date of Inspection
t
a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
.K No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (RNo ❑ 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) �rltlsr�a�e�_�f-�tl.Prrs^-
13. Soil type(s) f71 IZ,2 S sI :dQ& ! Ra
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
2-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations[]
Yes
®.No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Reviewer/Inspector Name �, YrJ�: =1 � TW ,. s � ` '1 R Phone: HeZ_ — / 1V
Reviewer/Inspector Signature: Date: J--,TZn
12128104 Continued

Facility Number: — Date of Inspection
} Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2[No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. CZ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ffl-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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than nonnal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
[,No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
(Z No
❑ NA
❑ NE
❑ Yes
5.No
❑ NA
❑ NE
❑ Yes �?No ❑ NA ❑ NE
❑Yes ®No El NA ❑NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes DQNo ❑ NA ❑ NE
A'ddiiion,ul Comments and/or Drawings
12128104

Pt
Type of Visit ® Compliance inspection O Operation Review ' O'Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility -
Number Date of Visit: Time: ! C D
10 Not O erational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: _ {a�firs- �a.-w.s �C County: C fA rnAy"i<bg3L% d� Fw-A
Owner Name: _�� LiGJ� r" II i:rr` Phone No: __q t6I4 93 - G lea G
Mailing Address: 12-85 Ss l..,44a Sel-0d %loin _
Facility Contact: DC'Via C' I,'el' Title: Phone No:
OnsiteRepresentative: b"cc2 � ll1tr Integrator: C,- I6,i.f,C.r<n ec'czc
Certified Operator: l 6azd WM Operator Certification Number: X0I IR
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Ca act Population Cattle Ca acity Population
❑ Wean to Feeder
❑ Laver
I
I
Daily
® Feeder to Finish
IEJ Non -Layer
I
1
101 Non -Dairy
❑ Farrow to Wean
Farrow• to Feeder
Other
❑ Farrow- to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 0 O ❑ Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
Xolding Ponds / Solid Traps 0 r f ] No Liquid Waste Mana ement'Svstem
orE, C.t.(=rue. l c�.Ga,�-n fit. vlesd�
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ LaRoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (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 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ( No
❑ Yes No
❑ Yes R No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes CANo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ®No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes 4 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[�LNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15, Does the receiving crop need improvement?
❑ Yes
RINo
16. is there a lack of adequate waste application equipment?
❑ Yes
W No
Reuuired Records & Documents 1
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
SWo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
(S No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R No
24. Does facility require a follow-up visit by same agency?
❑ Yes
P9 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7
❑ Yes
1� No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,
iCammcat s,,(refer to questibn #) Expht ii,any VES answersa and/or any recommendations or any other-�camments.
Use -drawings of faciiity to better e: piain situations `,(rise additionfiLpag s MIN
§�x� _ ': ❑Field Copy
❑Final Notes
1. �w.
rQ t:D m9 W n" c d .
UK, �e�bt-� �.� cover d'6.5�1 o-t.,
Reviewerllnspector Name
Reviewer/Inspector Signature:
Date:
05103101
Continued

1. Facility Number: qG -- y q Date of Inspection V
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes ®No
❑ Yes [21 No
❑ Yes MNo
❑ Yes ,M No
❑ Yes ❑ No
05103101

Site Requires Immediate Attention: RrQ
Facility No. �--
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representativ
Physical Address/Location:
DATE: A/,,t-Lo , 1995
Time: 2. 6-0
Phone:—
_ Phone:
Type of Operation: Swine _jg—_ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hSor
sufficient freeboard of 1 Foot + 25 year 24 hour storm event (approximately I Foot + 7 inches) No al Freeboard:A? Ft. _4Inches
Was any seepage observed from the 1 n(s)? Yes or TWas any erosion ob ed? Yes or No
Is adequate land available for s ray? r N Is the cover crop adequate? Wor No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 1por No
100 Feet from Wells? C"T"eb or No
Is the animal waste stockpiled within 100 Feet of USGS B1ue.Line Stream? Yes or io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orQ
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or % If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: - AA __ - _--!.^ � _ to A1P. C _S_ Z a
6V 1
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cc: Facility Assessment Unit Use Attachments if Needed.

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