260067_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

• Division of Water Resources
11 Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: CountyC (Y1-4T4Region: 45D
Farm Name: .�5ar� %� �� Owner Email:
Owner Name: �q� �,es�j,� Phone:
Mailing Address:
Physical Address
Facility Contact: l_r! f ;4500 Title: Phone:
Onsite Representative: AQ rA_tet 6?500 Integrator: P �
h
Certified Operator: Certification Number: 20 -?v
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 2p p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
ury ro
Non -La erg
Pullets
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairyjieifer
Dry Cow
.Non -Dairy
Beef' Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[-]Yes
[-]No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
E] Yes ® No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ -NE
Page 1 of 3 21412015 Continued

FaCilit Amber: jDate of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ERNA ❑ NE
Structure I Structure 2
Identifier:
Spillway?:
Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in): (�'}
u
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement'? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [:)Yes P 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): �O-i}Oy� , 101 Mee0 t S f1n I Cj-r�.�.v
13. Soil TYpe(s),.�1...4..U�."'J._ur`-- -
_�..__
14. Do the receiving crops diner from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, 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
[P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 6 jDate of Inspection: j2j2Ajf
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M. No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
Comments (refer to question #):,Ex0jAI& any YES.answers arii
Use drawings 6 facility to better explain, situations (use additi
❑ Yes [$3 No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
ditional reeothinendations or any" other comtnents:
ns' necessary)•
Reviewer/Inspector Name: 7<6 Phone: 110—M--33M
Reviewer/Inspector Signature: Date: d2-6 f
Page 3 of 3 2/4/2015

al'ou q0S,-nf 1U 1M
Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: I�toutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
III
Date of Visit: 1 c Arrival Time: v Departure Time: I V, so 7�. County: Cu-4,t Region:
Farm Name: Owner Email:
Owner Name: a4Ms. h Phone:
Mailing Address:
Physical Address:
Facility Contact: _ P F—O-5 tt!=� Title:
Onsite Representative: ll( Integrator:
Certified Operator: WI IZ164F`
If
Back-up Operator:
Phone:
�,�rj -i"'
Certification Number: 2. f33 G
Certification Number:
Location of Farm: Latitude: Longitude:
0 1-7 rqDtb -PC—p gz.3
0 :z o
Design Current
sign
Currenk
Designurrent
lty
Cacity
I
Pop.
Cattle Capacity
Pop,
Wean to Finish
Layer
I 1
1
Dairy Cow
Wean to Feeder
Non -La er
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
DrV Cow
Farrow to Feeder
Qqyj P.qultr,
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Lgo ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
[Dyes [ o
[:]Yes dNo
g'➢ NA ❑ NE
y NA ❑ NE
[1 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

I.Facility NtAitier: Date of Inspection:
Wastetollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 2'es
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
❑No ❑NA [3 NE
le-"" ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l_ <o [DNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [;Jo]Qo ❑ 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 [Er'&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 [�No
❑ 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 E j No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): r
13. Soil Type(s): 6 i) Lie
14. Do the receiving crops differ from those d ignated in the CAWMP?
❑Yes
[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[INo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[l No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;?*I�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3'Nio
❑ 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 ❑Oth r:
21. oes record keeping need improvement? If yes, check t appropriate box below. Eyes ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard check
Analysis ❑ Soil Analysis ❑ Waste Transfer ❑ 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 Ef No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility N mber: jDate of Ins ection:
24. Di�'the facility fail to calibrate waste application equipment as required by the permit? 'EZYes kNo
o
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check e'Yes
the propriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
G? No
❑ NA
❑ NE
[:]Yes <o ❑ NA ❑ NE
❑ Yes [rNNo [DNA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[] Yes ONo ❑ NA ❑ NE
❑ Yes
Flo
❑ NA
❑ NE
❑ Yes
❑"No
❑ NA
❑ NE
❑ Yes
4"'No
❑ NA
❑ NE
r.�any other comments•
CAL M� 6r"�'
5LAe'sIt",
y
Reviewer/Inspector Name:
Phone: i�
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21,112015

I k5��ul�
type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
[season for Visit: (DAWuutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit:
Arrival Time:
Departure Time: I fftQ J 4ounty:
Regio�2P
Farm Name P
F1"_C%(t t "1
Owner Email:
Owner Name: 1L1t.0,A y /L'� fyI Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
en _ 191 Title: Phone:
Certified Operator:t/`K�
Back-up Operator:
Location of Farm:
,% l
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy_Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.oultr.
C•a act
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [3-11o­ ❑ NA ❑ NE
❑ Yes [:]No �NA ❑ NE
❑ Yes ❑ No , ❑ NE
❑ Yes
❑ No
[31"'VA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

1;acili Number: - Date of Ins Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®,NT
❑ 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
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
[Bwu
❑ 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
[2-90
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E] 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
0,<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®'tro
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
12 0
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): A
13. Soil Type(s): I
14. Do the receiving crops differ from those designated in the AWMP?
[] Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
l.; o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C�,Ko
❑ NA
❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
❑ Yes
�10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[lNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
F115'o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C3"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA [3 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ l-.I No Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [e]•Io❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes L-d 4 ❑ 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 ❑'MO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [30 o ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes To ❑ 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 10 ❑ 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 E;Ao ❑ 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 v ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Y:Nlo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ZNo ❑ NA ONE
Comments (refer to question##): Explain any YES answers and/or any -additional recomtnendations;or any other comtuents.
Use drawings of facility to better explain situations (use additional pages as necessary).
1-7 - I'(
%9. k � — (S_[?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �3
Date: J
21412014

8zMS z/H /2-01$ S.S
vi"ion of Water Resources
1; tecility Number - O Division of Soll and Water Conservation
I � Other Age,_cy
Type of Visit: O.Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
treason for Visit: (24toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ll tS Arrival Time: V ' OQ Departure Time: / .' O O County: (-IjmS E,pLA}A+�Region: Fie
Farm Name: C.ARRy F-ASO N #0 Ch T'PR V1 r Aft . Owner Email:
Owner Name: 6,IIII) R R y CA S o A/ a Phone:
Mailing Address:
Physical Address:
Facility Contact: �* T X LS + CA SO /V Title: Phone:
Onsite Representative: 2jT e-T C T A E,4 S 6 N Integrator:
Certified Operator: LAR R DN Certification Number: 2 b 3 - a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
37 8 2
O
airy Heifer
Farrow to Wean
Design
C*urrent
D Cow
Farrow to Feeder
Rr, P,ouItr,
Ca aclt
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
qNon-Layers
Beef Feeder
13oars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 LETNo []NA []NE
❑ Yes ❑ No t "NA ❑ NE
❑ Yes ❑ No lll,�A ❑ NE
❑ Yes gallo tE�NA ❑ NE
❑ Yes'1-❑ No ❑ NA ❑ NE
❑ Yes j0No ❑ NA [:]NE
Page 1 of 3
21412014 Continued

Facili Number: 2 - .9-- jDate of Inspection: 1.1161
Waste Collection & Treatment
•� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ] Yes 4e o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No jE2,NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesL❑'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 J2,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 L12-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesLQ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 43-ITo
❑ 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): C r7%%ON, j 0 84GL O , G G A'Y
13. Soil Type(s): A u * ��[ , A yt 67r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 23'1o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J' No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes, CJ-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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP []Checklists [:]Design [] Maps ❑ Lease Agreements
❑ Yes N.[3'No ❑ NA ❑ NE
❑ Yes j:]-io ❑ NA ❑ NE
❑ Yes Ljallo ❑ NA ❑,NE
❑ Yes J�o ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %[3'1Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1 E?'No [] NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 7 jG - 6 Date of Inspection: 2 1
24. Nd the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes d2-hIo ❑ 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)
3 I. D subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes tf�?No ❑ NA ❑ NE
❑ Yes J'No ❑ NA ❑ NE
❑ Yes Llallo ❑ NA [D NE
❑ Yes J:]-No ❑ NA ❑ NE
❑ Yes J:�No ❑ NA ❑ NE
Yes1� ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J^No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes tE'Tlo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes -LED % ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional�recommendations�or;anyother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).:
G AL.7-6,e A T -To rj g 1 IT/ i,$
ScvD6,E SUAVCy 1/2,11/L�
P —Q•/
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date:
214/2014

._J. f- -
Type of Visit: WCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
i.eason for Visit: &Routine 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: I J,,S"o p CountyttM Region: f�
Farm Name: L#a4 Eas iron P&m _ -I;j Owner Email:
Owner Name: LQr(y Ear&7 Phone:
Mailing Address: S&_ betoy
Physical Address: qh % L064 flAWf fad— Wdde f 1% ' .
Facility Contact:
Onsite Representative:
Certified Operator:
. Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: �Q
Certification Number: 00370
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
!Non
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
-Layer
DairyCalf
Feeder to Finish
g
Dairy Heifer
Farrow to Wean
Design Current
Dry P.oultr� C•.a aci P,o
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Other
Turkeys
Turkey Poults
10ther
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)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FKrNo ❑ 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): 38
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 tKNo ❑ 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 [2 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 IR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes r5i No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. C-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
R] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): h'LU
13. Soil Type(s): + u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
')-a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M^No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to 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
NJ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ER'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
15�1iVo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
C@ NA
❑ NE
Page 2 of 3
21412011 Continued

1
Facility Number: - Date of Ins ection: 51113
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
R No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
(�NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
[]Yes Z No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes CyNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
�TNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Vg 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 pnesas necessary).
7. PW;f, Nab On a -kW Ive Gfv� o7 1 117 p��fde o- a -Vewm� on P4 id-e h�
OCside. ba,k ha,- Ckcellmoco v7e
11, Pleg,e, chcr9e > ri l s�ray r� '�-o cod%, �-}o b� plan f�C-shad y� 0,1d L3 e n �e w
V'1 OAP- e- CA I lris l
a , On�M rssih� cQ
We(! Ma*i W_` ?�, a14 rietavlra
soft 044( ,5 is doze. b7 saAfm s aid I'S sown or jbs/ae-m- bufr`s ac-WIt
W-3; oc.
Reviewer/InspectorName: �45 &2�_Llb 64j,pf
Reviewer/Inspector Signature:
Page 3 of 3
Phone: $0-433,0_3 L
Date: AMI al. a
2/4/2011

Facility No` Farm Name Date ib
Permit ✓ GOC� OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name S. foespillw6y
2.
3
4
5
6
7
Design Freeboard.! Last Recorded in
Observed freeboard
Sludge Survey Date:-,
Slud a De th' ft
Li uid Trt. Zone ft
Ratio Sludge to TreatmentVolUme ifs 0.45
Date out of compliance/ POA?
V
/ -
,
��
----�
i - f • / /
Soil Test Date ; ' :
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed ; '
WUP �_
Dead box or incinerator
Lime Applied ;
Weekly Freeboard
Mortality Records 7`
Cu-i ; Zn-I
1 in Inspections
Check Lists
Needs S (S-I<25) ';
120 min Insp.
Storm Water
Needs P i
Weather Codes
- - -
in®��n�n���■n�■■a�■n�■ten
..
,.
,.
i
Verify PHONE. NUMBERS �and affiliations Qivl!1}-y— ✓�� ��Jsl13 O�CC�
Date last WUP FRO: 2tj' '� FRO or Farm Records G�
Date last WUP at farm; 1ri Lagoon # new
APp ar�wgrle I• I' !.�! ; .,r Top DikeRed
3 r �'; i i Stop
Pump t
' ;i I i � ; ;,i ;••! f Start Pump
Cortiversion-,Cu-3000=;108 iblac; Zn-I 3000= 213 Iblac a h

cehs :z
Univision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (D4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I j v. I S Departure Time: J� 5Rr't I County:(�M bFg 14n0 Region: F��
Farm Name: A A ft,A Sot—? n R in TrJ C' Owner Email:
Owner Name: L g fk RV E A jy (,) Phone:
Mailing Address:
Physical Address:
Facility Contact: �..A{{Z�l '. A ,may 11 Title:
Onsite Representative: `Jf:% M E
Certified Operator: �1. "R "E qo A
Phone:
Integrator: ppus aq F -
Certification Number: Q © 316
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er
Discharees and Stream lmaacts
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Bcef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes fjU No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No � NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No q 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes No
❑ Yes No
Ct NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

�acility 1Wimber: a - �] Date of Inspection: /
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �0 a
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[V 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
U 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
[t No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): t_C] Hon 1 R t I" _
13. Soil Type(s): _u 9 % Lu A . A g J'� -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(4 No
❑ NA
❑ NE
I& 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 (A No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

lFicility 1NLmber: -LL71 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permii 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 tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CA No ❑ NA ❑ NE
❑ Yes [2) No ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑Yes [4No ❑NA ❑NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date
• 4,tu�'� � I,��SI
���e1Ea
21412011R

%dmivision of Water Quality
Facility Number ®" © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Com/�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
e Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Ememencv 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: ; p Departure Time: p ; p County: Region:.c �o
Farm Name: qj ..Li << Owner Email:
Owner Name: L, a ,A, • yaS tr,-� Phone:
Mailing Address: �j 1A �-ram �IQ? 1� tU - al, 9&aL Al-C, 2L� ' _
Physical Address:
Facility Contact: 0^— Title: Phone:
Onsite Representative: �9� f�y �Q"r,-... Integrator:r��
Certified Operator: 1�a lr e 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
Discharues and Stream Impacts
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L'
Pullets
Turkey Poults
Other
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non
-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? [:]Yes ZNo ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 RNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes &No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: — �-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): y-
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ["No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
a 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
El No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): /4
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 fait to secure and/or operate per the irrigation design or wettable
❑ Yes
®,No
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
�Vo
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists [:]Design []Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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
M No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permii 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 S 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
0. 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 �3 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Yes ZN o ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES,answers and/or: any additional recommendations pC an� other comments
Use`drawings of facility to better. explain. situations.(use'additionat pages as necessary.)
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone: �—lo - - 3_3VC0
Date: 5_"i 4 %f
21412011

ision of Water Quality 4. 3 p —
Facility Number _� O Division of Soil and Water Conservation J'�x ME
- — el Other Ageney
Type of Visit
6ompmpliance inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
U Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: rrival Time: O Departure Time: County: Region:
Farm Name: LCt ir"�1 .05c7_4 rrW n 1`A/ irc. Owner Email:
Owner Name: r �.� y %� .���� rr� Phone:
Mailing Address:
Physical Address:
Facility Contact: Z.4PIIX,_ � 96 rr, _ __ 'Title: 9;!j egg _ Phone No:
Onsite Representative: f wT9`��s�+--�' Integrator:�r�/�t�+�
Certified Operator: /,XZ4_z -' Operator Certification Number: 2-10-37 0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Back-up Certification Number:
Latitude: = e = I Longitude: = o = i = ,f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
j ❑ Non -Layer
Other
❑
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
11
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Q.No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): T /
Observed Freeboard (in): `3f�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ERNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q 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 E2,No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Rto
❑ 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
13 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
�,'.0 � 'ri-- hM, a,s y}.',.3 �i;":: �a_.k. i�aP.
Comments (refer t0 questlari'#) 'Eipl iin:apy Y1J$Yunswers and/nr any reeomm,endations or .any other comments
Use drawings of, facility to better explain situations. {use gdditioh I pagesFas'necessary} ; , , k. 1 41
�FyAfk_i
Reviewer/Inspector Name
Phone: WD /-/J_7 3 V
r x
Reviewer/Inspector Signature:
Date: = fZ[- /D
Page 2 of 3 12128104 Continued

Facility Number: (o-- 6 Date of Inspection
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z 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
[R�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues .
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IS 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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Ad ditiorialiCo�minents3andlor,Drawingsn
i
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: =Departure Time: County: Region: ZWQ
Farm Name: L alrZ yj_ r J ar"'t_ ,- e. Owner Email:
Owner Name: , �-�r� R --- �� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Lae a s - Title: Phone No:
Onsite Representative: ;���----� Integrator: T�1117
��
Certified Operator: ��:5 m= Operator Certification Number: L13 % O
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E=1 o = ' 0 " Longitude: 0 ° = I 0 "
DesiIfflCurrent
Design C►urrent
Design Current
Swine ulation Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish I JEJ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer I
I
❑ Dairy Calf
® Feeder to Finish IrgNegg0±7y0
0 Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
Farrow to Feeder
El
❑❑ ers
Farrow to Finish ❑
❑ Beef Stocker
N on-Layers
❑Gilts ❑
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turke s
Other ❑Turke Poults
❑ Other ❑ Other
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 kNo ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E,No
❑ NA
❑ NE
❑ Yes
EN No
❑ NA
❑ NE
1.2128104 Continued

Facility Number: �(� _ Date of Inspection L1
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): IYp
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes MNo ❑ NA ❑ NE
through a waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Cl Yes CgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift. ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
- ®No
❑ NA
❑ NE
`dat�or^auConmonyrecommenhTic�r�comm�e5�nits...,s
Use drawings of facility to better explaiuse additional pales as necessaryjj).'tt qq 4�s�,r� r� t 3FAiYp
p? !. C�t c rD? G Y aw
67 -- Z 1�) �- 1F R '2
1
Reviewer/Inspector Name -3 5
Uy
�,�"- � t c` Phone: /4
Reviewer/Inspector Signature:
Date:
12128/U4 Continued

Facility Number; —L Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
[:]Yes JBNo ❑ NA ❑ NE
❑ Yes �Z No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. N 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 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 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
5? No
❑ NA
❑ NE .
❑ Yes
5a No
❑ NA
❑ NE
❑ Yes
fj� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes JgNo ❑ NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
CNo
❑ NA
Cl NE
12128104

Division of VWater Quality
M
lity NumbeH (O'r 0 Division of Sail and Witter Conry seation
0 Other Afency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 technical Assistance
Reason for Visit ORoutine O Complaint O Fallow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l 3, I Arrival Time: I tl Departure Time: �' County: `�! Region:
Farm Name: f:L1''►'' � SOY1 _� C► Owner Email: � �j`
Owner Name: Yy SQh Phone: 61g) g3"8�i�� I�1 J
Mailing Address:
Physical Address:
Facility Contact: 1AfV'N Title:
rr
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
integrator: q7rKfdRf_
Operator Certification Number. 20370
Back-up Certification Number:
Latitude: = o = 6 0 Longitude: = ° ❑ ' = 11
Desi n Current
Design Current
Design C*urrent
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Daia Cow
❑ Wean to Feeder
I
❑ Non -Layer
I
I
❑ Dairy Calf'
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
❑Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Puitets
ElBeef Brood Cow,
El Turkc s
Other
❑ Turkey Poults
❑ Other
❑ Other I
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? (Ifyes, 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 tite State
other than from a discharge?
Page I uj'3
❑ Yes 0 No ❑ NA ❑ NL
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
rNA
❑ NE
O NA
❑ NE
❑ Yes
[:]No
❑ Yes
9TNo
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
12128104 Continued

Facility Number: at5 - 7 Date of Inspection
f
Waste Collection & Treatment
i
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 3 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 66 t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
&§No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
JUNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
$ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
JRNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
S No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Y] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #). Explain any YES answers andlur any recommendations or'Any,other comments
Use drawings of facility to better.explain situations: (Use'additiooal pages as necessary):'
�1
A�
62 I_k5
Reviewerllnspector Name -- — — _ , — — — E Phone: —3360
Reviewer/Inspector Signature: Date: 3 ZS CQj
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes li No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �5No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5) No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
K,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'A No
[N
El NA
El 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
D9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J9 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NI?.
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 6
Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit"* Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: OP gM Departure Time: _Oe�' County: CuRegion: FX
Farm Name: %A.t^w F-gSon ooa Irirw+ Pin Owner Email:
Owner Namc: � tr+-G y\4 R. R�4�n Phone: U . 0
Mailing Address: `TRJ-DnntQ " ' to
M
Physical Address:
Facility Contact: Lar' F050►i Title: Phone No: MIDI'8q g
Onsite Representative: Integrator: Pres.611e
Certified Operator: Operator Certification Number: 20370
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =1 e 0 101f Longitude: 0° 0 d 0
11
Design Current Design Current
Swine " Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
❑ La er
❑ Non -La ci
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkex Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
El
-Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: 71
1. is any discharge observed from any part of the operation'?
❑ Yes
[PNo
❑ 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
q2 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
N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

11, 1
Facility Number: — ''� Date of Inspection I y/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
1�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36 "
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
[ No
❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA ❑ 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
[j, No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�§ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s) $ Co
n SM, 6' -, Q
13. Soil type(s) dp
14. Do the receiving craps differ from those designated in the CAWMP?
❑Yes
ti No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
$1No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LP No
[INA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/inspector Name
e Phone:
Reviewer/Inspector Signature:
Date: a 0
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ( No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes *No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�LNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
In 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
93 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
ligNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

W Division of Water Quality
4Facility Number 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:[ j3Jy� Arrival Time: ii8t off! Departure "rime: 10 30 County: d Region:
i
Farm Name: ° G Sw 1 ne Owner Email.
eg ���jj I� � _0 9�o-� 3
Owner Name: '�a O I'1 Phone: J
Mailing Address: Pe{- 5_6_1't�ra RA u))n�_ oPB33 `'/ P37-661 640
W
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: I Integrator:
Certified Operator: Fori 1t e— >ffior1 Operator Certification Number: --�0,369,,,,-„
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
0
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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?
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
Longitude: 0 ° = ' =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
El -Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �bNo ❑ NA ❑ NE
❑ Yes
❑ No
EPNA
❑ NE
❑ Yes
❑ No
."NA
❑ NE
❑ Yes
❑ No
[�NA
!❑
El NE
❑ Yes
cm No
NA
El NE
❑ Yes
rpNo
❑ NA
❑ NE
12128104 Continued

FacilitySumber: T 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
F NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
/� q
Observed Freeboard (in):y� /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
io No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuct u'es lack adequate markers as required by the permit? ❑ Yes ® No [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) r
9. Does any part of the waste management system other than the waste structures require ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CR 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 Drill ❑ 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
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ig No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
51 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name14�6+MA9 Phone: IQ -33CO
Reviewer/Inspector Signature: Date: 3 0
12128104 Continued

.
Facility Number: Date of Inspection
Required Records & Documents f
19. Did the facility tail to have Certificate of Coverage & Permit readily available? ❑ Yes P9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes FU No El NA ❑ NE
the appropiate box. ❑ WUP [I Checklists [I Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 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 �fl No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
59 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
N 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
N 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
RNo
❑ NA ❑ NE
12128104

Type of Visit Q ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 67 County: Ctendr✓
Farm Name: ! a rt-t a Sf�r a '1 Y- �a � � Owner Email:
Owner Name: F-aee �� & c rr, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 4e yY y .Fa." eru Title: Phone No:
Onsite Representative: -Z4w a Integrator:
Certified Operator: Operator Certification Number: 1:2 4 3710
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = I Longitude: 0 ° ❑ 1 ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer f
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F7
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 KNo ❑ NA ❑ NE
❑ Yes
IZI No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: — &-7
Date of inspection D�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [2�No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ' No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [9No ❑ 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 5 -No ❑ NA ❑ NE
maintenance/improvement?
1 I. 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 U.
Window ❑ Evidence of Wind Drift ❑ Apppllicatiioon Outside of Area
12. Crop type(s) .3rr�rnct Itc 1__L'�� lC�7r.� cU r /.�Jr�v�izs r^ 0d�s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑
Yes
0 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
�D No
❑ NA
❑ NE
'dVt?_f 0f' .-r-Sr vd on-e-o tV, wv5 KO 10 w4 4�vt-�up..
vi'l l be Ate— ®(� c19HZ>V ' ejeD p-
Reviewer/Inspector Name°tart ll 11 Phone:
,...
Reviewer/Inspector Signature: Date: $ 69 &
12128104 Continued

t.'
Facility Number:(p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes •R] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 171
No El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q!�No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
f-5 �'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
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I& No
❑ NA
❑ NE
Asdditional CoEnments afidlorDrawings: `., z;ti a Y `"
rrt
12128104
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit: EQlw Time:
--• --ro —Notoperational erational Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Dame: County: k-kwV,t�A 4-/26
Owner Name: r rm Phone No: _ _`� i b 14 sm — Rm Re
mailing Address: -,✓ C . �8,3 q
Facility Contact: rv,. jo Title: Phone No:
Onsite Representative: Integrator: ice SL,.
Certified Operator: 6-4 Operator Certification Number: d37-o
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude 0' 06 " Longitude 0' �0
Design Current
Design Current Design, Current
Swine Capacity Population
Poultry
Capacity Po ulation Cattle Ca acity Po ulation
❑ Wean to Feeder
I
❑ Laver
I
1
❑ Dairy
® Feeder to Finish
❑ Non -Layer-
1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow' to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area S rav Field Area
L
Holding Ponds I Sblid Traps �, h
p L..__� ❑ No Liquid Waste Management System j s
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav 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 K Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches):
05103101
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes F&I No
❑ Yes 0 No
❑ Yes 191 No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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? (If any of questions 4-6 was answered yes, and the situation poses an ❑ Yes No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
W. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®,No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E� No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
W No
16, Is there a lack of adequate waste application equipment?
❑ Yes
(,�No
RegWred Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes P No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes &No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes PiNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes $,No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Q�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) El Yes pbNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes PNo
24, Does facility require a follow-up visit by same agency? ❑ Yes qjNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes V&No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,. is a w .:.�,�
Comments (refer'to questiiin #):aplain?isity YES,.iinsws andlor'any recnmmeqdatlons or any tither comments
tJ
Usedrawln �s<af foci// to better explain sltuatinns: (use t<dditlonal_Pages as necessary) ❑Field Copy ❑Final Notes
-4d" U43 0 ke ek a v�
6
AL
Reviewer/inspector Name.
Reviewer/inspector Signature: kdfi.,Date:
05103101 Continued

Facility Number: Date of Inspection ' L
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 at permanent/temporary cover?
❑ Yes ❑ No
❑ Yes F,�! No
❑ Yes ES No
❑ Yes R No
❑ Yes C� No
❑ Yes [9 No
❑ Yes ❑ No
05103101

0 Division of Soil and Water Conservation [3 Other Agency
' Ision of Water Quality
lutioutine O Contnluint O Follotir-un of I)IVO insnc-ction O Follow-utt of DSWC review O Other
Dale of Inspection 2
Facility Number Time of Inspection � 24 hr. (hh:mm)
13 Registered ertified 13 Applied for Permit © Permitted rot Operational Date Last Operated: ..................
..
FarmName: ............./t/........a........�+�................ County:.....................................................................................
OwnerName: ................ t ter.e............................................................... Phone No:.......................................................................................
FacilityContact: .............IaGr. e! K......../.r- e............................ Title:............%r"i1" v`Z............................ Phone No:..................................................
plaitingAddress: ............. J71/... ...................................................................................................................................... ... I......................
Onsite Representative: ..................Integrator:...........�
Certified Operator................. !f`'.......................................................... Operator Certification Number .........................................
Location of Farm: G6vzk wn,�-- / ?�3 'L— , Sj,,,• 8 Z.D
Latitude • 9 =11 Longitude �• �' ���
i
.:Design ;.Current
r Swme' • Capacity Population Poultry
lid , �.
❑ Wep o Feeder
eeder to Finish
MIZO
0090
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:sign, .::.Current
pacity. Popuiatton ,;,.> Cattle
Dai
— - ❑ Non-E—
❑ Other
Total Design Capacity
.Total SSLW
Non -
Number of Lagoons / Holding Pnnds ❑ Subsurface Drains Present ❑ Lagoon Area © Spray Field Area
# Eb { ❑ No Liquid Waste Management System =7?Y 11,: ..r..,< .�
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field . ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated -flow in ga[ min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ,�L-+'moo
❑ Yes tdtqo-
❑ Yes
❑ Yes LJ�No
❑ Yes o
❑ Yes o
❑ Yes 1:o
❑ Yes Ld'No
❑ Yes [1 0
❑ Yes L Nao
Continued on back

�r •w
Facility Number:' — `'
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes Leo
"tructures (Lacoons.11olding Ponds lush Pit.' etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �CNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: :.:) ................................................................................................................................................................................................
Freeboard(ft):.................. ..................... ............... ....... ...................... ...... .................................... .................................... .........................
_............
10, Is seepage observed from any of the structures? ❑ Yes [3,5-0
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes E vo
I2. Do any of the structures need maintenance/improvement? ❑ Yes Q.AFr�
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes
Waste Application
14. Is there physical evidence of over application? ❑ Yes P-K°
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ��......-!T........u�``..'............................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does, facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilitieti Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Wq�any additional problems noted which cause noncompliance of the Permit?
E"No.viol ations or deficiencies. were noted during this.'visit. Tou.will receive no ftirther
correspondence about -this. visit: :.. .. .
❑ Yes
_a o
❑ Yes
J-2�O
❑ Yes
❑ Yes-1Qo�
❑ YesL(
o
❑ Yes
Imo
❑ Yes [ to
❑ Yes 0 <No
❑ Yes No
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`necessaty);
7/25/97
Reviewer/Inspector Name �jr re.GLv /'ns�
Reviewer/Inspector Signature: /r�i�L_ 64r,:� Date: