260073_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

.:I;�
d(9P
3
Type of Visit 0 Compliance Inspection 0 Operation Review Q�ructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Er6t—her ❑ Denied Access
Date of Visit: Arrival Time: g`�i 3v Departure Time: I 1 ,� DO 1 County: Region:
Farm Name: 42, K , 60ns Owner Email:
Owner Name: �t'r_ ✓, ✓� ►tlr.�k Phone:
Mailing Address:
Physical Address:
Facility Contact: KYOc vti--, jA2,r:520_— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o 1
1 Longitude: = ° = 1 = 1f
i]esign Current
Design Current
Design Current
Swine C►apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
ElFarrow to Finish
❑ La ers
❑ Beef Stocker
ilts
❑ Non -Layers
ElBeef Feeder
Roars
❑ Pullets
Beef Brood Cow
❑El
Turkeys
Other
❑ Other
❑ Turkey Poults
ther
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
2LNo
❑ 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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 6No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes f �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 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 ❑ No ❑ NA RNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
RNE
15. Does the receiving; crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
RNE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA P NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
r" NE
hak
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
,®-NE
Cotnirtents (referao question #):; Eacplain any YF.Sr>lnswers and/or anyirecommendat'ons or�any4other ycomments
� .. �r A ,�
se,drawings of facility'ta better explain situations _(usc.addilional pagesias necessary') ;
(.3-3 —10 G�gq aa''' - lv& Aar'/i vt
y"tz' i_
Ale
rft ' h7ot'� �,''� G�ios rev,
Reviewer/Inspector Name ��g F y Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number• — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA MNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ®,NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
Z.NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Z[NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
XNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
KNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
aNE
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
JKNE
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
RNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
Cl NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J�[No
❑ NA
❑ NE
Additional;Comments and/os Drawings ; ;; `£`;i "A NI R �
5 �����r-.,- wd� do•ti� dui. �. �e��-,� ����r��--
Page 3 of 3 12128104

ype of visit: vx�ompuance inspection v uperanon Keview V structure Gvaivanon v I ecnnicai Assistance
Reason for Visit:__qjKo`utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �t Arrival Time: Departure Time: !chi County: u-t Region:
Farm Name: [j ��� ,-f,_, � Owner Email:
Owner Name: s;t /� Ua� I t-al f'1 Phone:
V -
Mailing Address:
Physical Address:
Facility Contact: KC✓'•� �C j Title:
Onsite Representative:
Certified Operator: ! I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:�D Z 7
Certification Number:
Longitude:
pe isgn
Current
Deslgn
Current
Design
Current
ps
Mill
ouY
Ca aci
o
acit
0 .
P
�Sa�rw
Wean to Finish
Layer
Dai ry Cow
Wean to Feeder
Non -La er
JDairy
Calf
Feeder to Finish
O
SA w
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Drx Pault , ,
CaPUT
P.o
Non-Dairy
Farrow to Finish
1—a ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
I IN
Turkeys
Other
Turkey Pouets
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?
[] Yes ❑-No ^❑ NA ❑ NE
❑ Yes [] No ET —NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑"NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes [] No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�`ICio j] NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:I No ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faci I IV Number: "Zb - 7.q jDate of lns eetiom %cT-ec
_W ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�A O NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ -N-o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ia 1Ve
❑ 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
[?I --No—
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;Ko
❑ 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
I D-Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E31No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [; ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. 0 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
13. Soil Type(s): �i'G ("'c /V/'_'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 52"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
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [✓]�No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[O"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2rNo
❑ NA
0 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
7rNo
❑ 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
[�Xo
❑ 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: - Date of Ins ection �
2 j �foo Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ l D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0-1QO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Nan -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 Z3' Vo NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ N-o-
❑ NA
❑ NE
and report mortality rates that were higher than normal?
+
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[. No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ef No ❑ NA ❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on -site representative? ❑ Yes Vo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ ]a [] NA ❑ NE
ai►�✓ ram-, — -rz0 �7
,ef 7 0 - '3 6
Reviewer/Inspector Name: `�J L ` v[, Phone:CF10`
Reviewer/Inspector Signature: t J� Date: N-ti
Page 3 of 3 21412015

Division of Water Resources
Facility Number � - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ;7ROutine
fiance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I I =0
Departure Time: County:Region: 6 L
Farm Name:` ._ n�j%444L,r _ � Owner Email:
Owner Name: leAL W,L°cl //_'I 1 I e4_e(/ ),-c Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: !
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Phone:
Integrator:P(lrC
Certification Number: •2,0o /
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
Layer I I --::]
Non -Layer
Discharees and Stream Impacts
1VVIl-1-
Pullets
Turku
Other
Poults
Design Current
Longitude:
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
E?N` ❑ NA
❑ NE
Discharge originated at: D. Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
r
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
D No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
�NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
E�-No
❑ NA
D NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ,e No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit Number: jDate of Ins ection
�Yaste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 4—❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes Q-N`6_ ❑ 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
CD4o
❑ 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
2r<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ ll o
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JD.N}tr
[] 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 �io ❑ 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 Winndd�o�w� Q❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): J C—
13. Soil Type(s): Z�_ jLc Gy- 'Afp
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes to ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes to ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes EI'No ❑ NA ❑ NE
E�()
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3<o ❑ 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 E3eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ vo 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [f"No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Wacilitl Number: Date of Inspection:,
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fffNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U2 o
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 Qlo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 9 "o
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?
cacb�4*0p'jr- p"15-6�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA] NE
❑ Yes Flo ❑ NA ❑ NE
❑ Yes [2 '' o ❑ NA ❑ NE
❑ Yes [ZrNo ❑ NA ❑ NE
❑ Yes fff'No ❑ NA ❑ NE
❑ Yes
Flo
❑ NA
❑ NE
❑ Yes
❑1No
❑ NA
❑ NE
[] Yes
[;j'5o
❑ NA
❑ NE
]ClltlS F c
?'- 3, z
Ge�191 U -a08-68s1 .
Phone: '3_ J3
Date: Nsl�a
214,12015

Type of Visit: �K
ommpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
rO
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 4 Departure Time: County:,-^'V Region:( 1z'
Farm Name: UK b•v4A _ Owner Email:
Owner Name: L'J � () JUZo� Phone:
Mailing Address:
Physical Address:
Facility Contact: (v� Title:
Onsite Representative:
Certified Operator: L
0
Phone:
Integrator: I irf°rr �
Certification Number: .7-0 0 L
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
1)esJgnjjLQ6.qKKpntA
Design
Currentnow
Design Current
Swine Capacity Pop.Wet
J
Poultry
City apac
Pop.
Ci tte Capacity Pop.
Finish
La er
Dairy Cow
-•
Feeder
Non -La er
Dai Calf
o Finish
d
DairyHeifer
o Wean
Design
Current
D Cow
EFarrow
o Feeder
Di,P,oult.
C►a aci
I;o
Non-Daio
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
INI Other
Turkey Poults
Other
III
I 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 [D-N6—_❑ NA ❑ NE
❑ Yes [:]No
[:]Yes []No
[:]Yes [:]No
[:]Yes 2VVo
[:]Yes E! No
[D- ❑ NE
DA ❑ NE
B A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

' Facil"' Number: g7r, - T7 Date of Inspection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Za% ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No Z;.*<
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ED-N-67 ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
# ❑ NA
❑ NE
waste management or closure plan?
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
WEI< ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3'11� ❑ 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
10 ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�
l d <o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
�� Window [] Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): C&U4
13. Soil Type(s): t= X b,/- IVg
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3'Nb ❑ 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
[] Yes
POVZo
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
[] 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
[J 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 ❑Cheeklists []Design ❑ Maps []Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ oVo
❑ 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
1Vo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CJ'No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili ,-Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B-W
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[E I o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[;J-?f°
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2-N-6
❑ 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
�o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
3 90
❑ NA ❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C:�Wo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[frNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA ❑ NE
Comments,{refer to question #): Explain any.,YES.answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages -as necessary).
Reviewer/Inspector Name: - 4
Reviewer/Inspector Signature: {
Page 3 of 3
Phone: 33 3
eo
Date:
21412014

v sion of Water Quallty
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: QCompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tt! Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 110ND I Arrival Time: 7= Departure Time: F v County:
Farm Name: ISALVO-91 Owner Email:
Owner Name: ��lia� / O'wevt lje-e - Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
GS'
Onsite Representative: L `
Certified Operator: ff
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Kc. Region:
Phone:
Integrator: IDPIGI�e
Certification Number: rzk .77
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L;
Puliets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
3-1<0,13
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[5'�IA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
I2"1 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
ff NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D-N-o
[3NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

lk
Facili Number: a- r']' Date of Inspection: D
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
0.-10 ❑NA ❑NE
❑ No 2- A' ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [g-f o— ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ !]�Pi6
❑ 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
Ca_Np
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Cg.*a
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[!'5_o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ZL_Nu
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (3-NT- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t 0% 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): G(,J A
13. Soil Type(s): Eye aC I A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tQ-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Y
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP [—]Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes
[3,Xn
❑ NA
❑ NE
[:]Yes
[e]. D
❑ NA
❑ NE
❑ Yes
[,<o
❑ NA
❑ NE
❑ Yes
E] 'o
❑ NA
❑ NE
`[A Yes
` No
❑ NA
❑ NE
❑ Yes
DXo
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Ql<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: T Z - 11 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg4iQ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2.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 []J No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Zil< ❑ 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, frceboard 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 E;,No ❑ NA ❑ NE
❑ Yes U�'No ❑ NA ❑ NE
❑ Yes [9'No ❑ NA ❑ NE
❑ Yes [;. No [DNA ❑ NE
32. Were any additional problems noted which cause non-complianec of the permit or CAWMP?
❑ Yes r_tWo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes' 214o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q'No ❑ NA
[] NE
ments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:.-drawin
s of facility to better explain situations (use additional pages as necessary).
E
e Co
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-�V
L
o-9�9%
P - 3.7,
Phone: r3
Date: Lon is
21412011

b 'T-U-m1 G / `[ 1$b
Type of Visit: (:!F'Com [lance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 20utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: c)O lCounty ttK. Region:
Farm Name: r/ Owner Email:
Owner Name: G0 IVU ,J1' SPhone:
Mailing Address:
Physical Address:
Facility Contact: ke-LZ c A JALC � Title: Phone:
Onsite Representative: r ( Integrator: t t
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: a_ 007
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
CapacityCattle
Capacity Pop.
Wean to Finish
La er
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
D , P.aultr
Ca aci.
Pao ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
7.
Eg400
❑ 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
E5 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
eNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
En"'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: I Date of Inspectioncrj(J
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Cjb� ❑ 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 Sthe8rity 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 E , ❑ 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 F] To ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EI.No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ 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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
//Window ��JJ [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V W S
13. Soil Type(s): N&42446 uwr'O
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records &_Docu_ments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [D N -o
❑ Yes FZ""
[] Yes �o
❑ Yes E3<a
❑ Yes Io
❑ Yes [3 No
❑ Yes EKNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o [] NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo. ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [D>c- ❑ 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 E; o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes io ❑ 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 [ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes CJ/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3/No ❑ NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes WNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #0): Explain any YES answers and/or anyadditiouid recommendations or any other cominents
Use: drawin s of facility to better explain situations(use additional; ` ages as
-13
I �- 3o - G 0. 2-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon (0— ny
Date:
21412011

s t
VIbivision of Water Quality
Facility Number -LLB 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompl' nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �--L� Departure Time: County: �� Regior
Farm Name: Owner Email:
Owner Name: V 4. Phone:
Mailing Address:
Physical Address:
Facility Contact: TLGyt, L6?r-ct Title:
Onsite Representative: Q
1(
Certified Operator:
Phone:
Integrator:
Certification Number: 1;10 o 77
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish D a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er I I ��]
Non -Layer
Design Current
Dry Pnnitry Cenaeity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Capacity Pop.
DairyCow
Dairy Calf
Dairy Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Imnacts
/
1. Is any discharge observed from any part of the operation?
❑ Yes
[6X ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
N ❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VNo ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

- . ,*
Facili Number: - CU
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in);�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
2o ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ 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 [D-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[:]Yes ❑'N'o ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑l ,<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need C] Yes [3 o ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes B'_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 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): A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [1[4 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes io ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes rNo
[] NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [—]Yes ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ 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 ff 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
o
VNo
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 EalIGv ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes %Koo ❑ NA ❑ NE
Other Issues �y.��
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ ivu ❑ 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 []�Kb ❑ 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 0'l<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes C! No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3-No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Eg No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes []Ko ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5 c - (r--�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone.
Date:
21412011

/n/a� Ira
(YDivision of Water Quality
11 Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency '_ - t 4
for Visit: GrUoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (?1 Arn Departure Time: ;► County:Region: 17P-6
Farm Name: OK IFIANM-S Owner Email:
Owner Name: tUs_ n a I Phone:
Mailing Address:
Physical Address:
Facility Contact: 1<9—U3_0 k '� &9-T Title: Q W nix Phone:
Onsite Representative: aAyNP Integrator: Q.REsl Agq-
Certified Operator: $)•OwnL Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream IMDacts
.Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Non-L
Pullets
Other
Poults
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 [-]No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No ❑ NA ❑ NE
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
❑ NA NE
❑ NA TE] NE
A ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: a u- - '1 Date of Inspection: U da
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea"No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑NA [3 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: *I ---
Spillway?:
Designed Freeboard (in): 1 �i
Observed Freeboard (in): Qc�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[:]Yes &No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0�fNo
❑ 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
[r"No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
YNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes G] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): COOW, A NS h 1= AT'
13. Soil Type(s): EtAr, HAI' R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes FiZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2No,r❑ NA [3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [v�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [21No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[Tlo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑1 '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
2rNo
❑ 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
[31INo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E. rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - -lb IDate of Inspection: 1515777
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box(es) below.
M 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
E.J'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
G2 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[Ej"'No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes allo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes CjfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [E�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes O�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? []Yes [B/No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). _y
Reviewer/Inspector Name: Phone: a\(3'�)0:6-la
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

ivision of Water Quality S 3 teary
Facility Number - '73 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ErVo`utine Q Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ? fl Departure Time: County 26— Region:'
Farm Name: © n /Carrns Owner Email:
Owner Name: r7 U / Phone:
i7 r,
Mailing Address:
Physical Address:
Facility Contact:Uj Title: ���t� Phone:
Onsite Representative: f�lei _����P, Integrator:
Certified Operator: ����� vL i�t�� l Certification [Number: 27
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
liry rounry
Layers
Non -Layers
Pullets
Turkeys
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes CE�No ❑ NA [] NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JKNo
❑ Yes E.No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit Number: 4EUP - 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. Il'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):
S. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes �R No
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes V1 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?
KYes ❑ 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 2 .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): /n_ fr
` l
13. Soil Type(s): -�C /r y/ a ---
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �gNo ❑ 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
nNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3-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 gNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes % No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M.Alo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facilit Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, 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 tail 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 ,�j No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
JkNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
2INo
❑ NA
❑ NE
❑ Yes 4 No
❑ Yes t No
❑ Yes gZNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question.#): -Explain a'ny'YE5 a°nsw' rK'and/or any, additional_recommendations or any, other "comments �
Use drawings of facility to better ex lain situations (tNe additional pages'as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

ivision of Water Quality���/
Facility Number L�J - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: ; C Departure Time: County: 6�.�Region: FXv
Farm Name: f C ra/-*I
Owner Name: i/ i F2r f]�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: -L &%Y._s%— Title: 6?Ae-x - Phone:
Onsite Representative: _Jr-W110 _ Integrator:
Certified Operator: ,S',y� _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E I La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
[] Yes El No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes ❑ No
❑ Yes [-]No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

lFacility 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
Lahk
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): 3,3
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? [&Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RA No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes &No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Typc(s): n' �lt�k�-,tS�1>/her-s s --
13. Soil Type(s): r f AJ,�,_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E, 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
❑ Yes E�No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z[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
allo
❑ 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
5g No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
T
NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -ZZ Date of Inspection:
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?
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
=,No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[B No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ;&No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes OLNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes f2 No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
--]
Use drawings of facility to better explain situations (use additional pages as necessary).
7
Xt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

exyDivision of Water Quality
Facility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit ompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , 3 D Departure Time: ,�la County: AQZ '77'�Regio": /fa�
Farm Name: 21K 626015 _ Owner Email:
Owner Name: k� ui cUYs'f� �f��G' �Gu�st�r Phone:
Mailing Address:
Physical Address:
Facility Contact: WrS'r Title: Re4 1.01Y•'- Phone
No:
Onsite Representative: Integrator:.
Certified Operator: Operator Certification Number: "�Ao0_�q
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
Back-up Certification Number:
Latitude: = c = I = 11
Longitude: = ° = 6 ❑
61
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I IEll
❑ Non -La er
Other
❑ Other -- --- J
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
❑
Dair Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: =1
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 E[No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ NA
❑ NE
[:]Yes
[:]No
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: 6 — % Date of Inspection o
{ Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZLNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / �}
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fZ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a 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 tp question #) Explain any YES answers and/or any recommendations or,any other comments
Use drawings, of facility 16. betterexplain situations (use additional pages=as'necessary)
9
�
Reviewer/inspector Name }""�►,ti '"'" Nyp' �y,t �� y Phone: Wo-4133-33tao
Reviewer/inspector Signature: Date: G _� 14 —9b ► D-
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
k
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $K;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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,Yes ❑ No ❑ NA ❑ NE
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ 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
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
g No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
Cl Yes
BNo
❑ 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
ZNo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R1 No
❑ NA
❑ NE
a
�dditionalComment's and/or Drawin s �,� ��. ; �a���f. 4t��
AL
Page 3 of 3 12128104

V
V Division of Water Quality
Facility Number 73 Q Division of Soil and Water Conservation `I��7
Q 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 ❑ Denied Access
Date of Visit: I"— /—OC%—Arrival'Time: WET] Departure'Time: 0 County:
Farm Name: �+ rk o'wf Owner Email:
Owner Name: �tl I_- _ 1 w C sI` Phone:
Mailing Address:
Physical Address:
Facility Contact: ✓ Title:
Onsite Representative: ✓`��—
Certified Operator: - - -- __'J'&'O�
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
Region: r �D
Phone No:
C� !
Integrator: G"
Operator Certification Number: .2�
Back-up Certification Number:
Latitude: = o ❑ 6 Longitude: = ° = d = 66
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
^ — ❑ Layer
❑on -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: Q1
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 R No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '5 O
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 ®,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ;3.No ❑ NA ❑ NE
[]Yes L&No ❑ NA ❑ N E
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? 23-yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,LNo ❑ 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 D� No ❑ NA [3 NE
maintenance/improvement?
] I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZLNo ❑ 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 ❑ Evidencee 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
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ 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
[Z.No
❑ NA
❑ NE
' ;f : -es� , r y o'4StHh' �er: .c.,m... men�t�s.Comments refer to<gtitm
cornUs idrawings of facility to better ezpiai'n sitnatiomjuse a.dditionai pages, as necessary)
_ Y
-
AL
Reviewer/Ins ector Name
p "�
�'r-'�: " Phone: 3�
,..
Reviewer/Inspector Signature:
Date:
V v 12178104 Continued

c�.
Facility Number: i — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ZI'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
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f, No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JKNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
j] 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,®.No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,MNo
❑ 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;ZNo
❑ NA
❑ NE
12128104

DiyWo►n of Water Quality
�Factltty Nurtibcr-=Davnttin of Soil: and:V1'atcr Conservatton
- Q°Other r#gcneyP
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 17 Departure'Urne: Q; � County: 6a(%Region: FvW
Farm Name: `- � WxS Owner Email:
Owner Name: =o&, t�jps�{- e 7vmrly 4' l�!�PS�- - _ Phone: Cq1y) TW I Rel 0
Mailing Address:
Physical Address:
Facility Contact: - 14PyNN Title: yf•'eS�l, Phone No:
t t i
Onsite Representative: Integrator: ___ e ,
f!
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 g =16 Longitude: 0 ° = i =
11
.
yP Desi n Current,.,
Design r Current t petirgn ' Cum
zic:i ;Capacity Population Wet Poultry Capacity Po�iulat►on Cattle Capacity Poplu
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
;� 2
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
;.Other A
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
ODry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters ofthe 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 ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes QgNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
Z] NA
❑ NE
I�UNA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
(9 No
❑ NA
❑ N E
12128104 Continued

4
Facility Number: a$-73 Date Of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: F
Spillway?:
Designed Freeboard (in):
rl n
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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?
i
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 -Structure 6
❑ Yes [A No ❑ NA ❑ NE
❑ Yes LPL
M 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 ZjNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
ERNo
❑ NA ❑ NE
(Not applicable to rooted pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[5 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
q No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
50 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable ❑ Evidence of Wind Drift El Application Outside of Area
(Crop rWindow
12, Crop type(s) coLQ Y'11 , WhG+ r 9&,,jj y is
13. Soil type(s) ExU1M-67cA i & ct�4v, — Qtr , )Ua k" _A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
cW No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D9 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES'answcrs And/or any recommendatigns or ttny.3o#her comments. `
Use drawings of facility to better explain situations. (rise additional page's as necessary):
7
Reviewer/inspector Name,r ,e Phone: l0 73 '3
Reviewer/Inspector Signature: Date: 3//$ZOg
Page 2 of 3 12128104 Continued

FA,
Facility Number: d�6 — Date of Inspection !�—
Required Records & Documents
0. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F) No ❑ NA ❑ NE
the appropriate box. D WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
❑ Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[6 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U] No
❑ NA
❑ NE
Additional Comments and/or Drawings: .;
Page 3 of 3 12128104

V Division of Water Quality
Facility Number D
E
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 10%149 G/►y Departure Time: ; Q' County: Region:
Farm Name: %wIh P`Ud'VU Owner Email:
Owner Name: 1_`GyL► _� s TorAPAy WA) � ��f Shone: _610)
Mailing Address: 'TO59 Cida.r' l.l^e V • 1 Q*Q t N C .1g3 /A
Physical Address:
Facility Contact: i e4l'yl% Wf jj . Title: Phone No: (110) 4'0)97S610
IA
Onsite Representative: Integrator:
Certified Operator: Ll Operator Certification Number: A0076
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: 0 ° = ' ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Hcifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Dumber of Structures: 711
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ),
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[--]Yes
❑ No
§§ NA
❑ NE
❑ Yes
❑ No
[?4NA
❑ NE
PNA
❑ NE
❑ Yes
❑ No
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
V.No
❑ NA
❑ NE
12128104 Continued

1
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus stoma storage plus heavy rainfall) less than adequate? ❑ Yes '�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 407
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P 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 4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect 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 101bs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 17�
Window ❑yyEviidence of Wind Drift El Application Outside of Area
12. Crop type(s) Cor n I W w+, Sty, m S
13.
Soil type(s) 7-1k) C"r) Ng
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
1� No
1
El NA
El NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: D IJ
Reviewer/Inspector Signature: Date: D
12128104 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 09 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 $1No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IF No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 159 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Q§No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 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
El2
,,��
9 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
X1 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Vlsit "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: &—O` Arrival Time: Departure Time: / iDi) County: +
Farm Name: O K Fa r ►-►u Owner Email:
Owner Name: fj i "L I.V c�, ` e�"� /!/r WeS i 1, , Phone:
Mailing Address:
Physical Address:
Facility Contact: _�1l., '�-- Wif Title
Onsite Representative:
Certified Operator: JA 0"-A
Region: /"-IE 17
Phone No:
Integrator:
101
Operator Certification Number: AD P2_____
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: ❑ Q 0 ` Longitude: = ° = ` = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish O (d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:.Other.
Other
} ❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dty Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of 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?
El Yes jpNo ❑NA El NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
J' No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
91 No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
QJNo
❑ NA
❑ NE
12128104 Continued

Facility Number• —J73 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
G�No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;7j,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[Z 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
[RNo
❑ 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 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) CO✓i'Z
i
13. Soil type(s) 44 lf7-I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
L& No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jallo
❑ NA
❑ NE
romment9 (refer to question # l xpl.ain�anyxY)JS answers and/or any recommendations or any other comments.
Use drawing of facility to better caplaio situatiaos:(use addition I pages as necessary7):
Reviewer/lnspecta r Name t ... w. ...R of?' ..'::< .�� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number,, ,— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
{R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J4 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
ZI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 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
ElNE
If yes, contact a regional Air Quality representative immediately
3 L
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
MNo
❑ NA
El NE
7 �( 4
AddltionttlComments,undlori)rawin s a �,�" t �4r '' y .
. z v .. a€ t'� .m A
12128104
12128104

► ..
Facility Number
Date Of Visit: � Time: t-f�
'�-3�
hot O erational 0 Below Threshold
® Permitted Certified M Conditionally Certified 0 Registered Date Last Operated or Above Threshold,.
nl � _L Farm Name: — ��. �lbf r� County: CL4.l C-111a tca
Owner Name: _ keU. "V Phone No: 7id4P4a
Mailing Address: 4:L 5 &J r , `C,rec Lt ild F� � <r'": i
Facility Contact: ut' UCA L, Srn-- Title: Phone No:
Onsite Representative: J�c►f. ,L. n integrator:
Certified Operator: kxga L-AgAt Operator Certification Number: -'ZO0'�-
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Population
❑ Wean to Feeder JE1 Laver I ❑ Da'
® Feeder to Finish U 10 Nor, -La er I Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑Other
1❑ Farrow to Finish Total Design Capacity
❑ Gilts
E] Boars Total SSLW
Number of Lagoons F7 ID Subsurface Drains Present ❑ Lagoon Area " ❑ Spray Field Area
...
Holding Ponds 1 Solid Traps 0 ' ❑ No Liquid Waste Management System
Discharges 8- Stream Impacts
1. is any discharge observed from any part of the operation?
Discharzr
ce originated at: ❑ Lagoon ❑ Spray 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 C 1jeatMent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes gqNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ieI trees, severe erosion, ❑ Yes (C No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes PNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [�],No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 11 ��
elevation markings? ❑ Yes PR No
Waste Appliclition
10. Are there any buffers that need maintenance/improvement? _ ❑ Yes 5;No
1 I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Cl Yes (�iNo
12. Crop type iA CiV-- L. A ' C . G_1171i. ,A () I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CXWMP)?
❑ Yes
PNo
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
?o No
16. Is there a lack of adequate waste application equipment?
❑ Yes
E;jNo
Rgdnired Records & [%uments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[5a No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®.No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22 Fail to notify regionai DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes (N No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes (S] No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ci mme t (refer toequestioii #):#Eipla n ahy YES a swers andlor,any recommendations or, any oche co megfs r ;t
..�- . ,
llsc:�drawings�ofdfacllitytto better ex a, (use>additiana! pages as necessary+{' ❑Field Copy ❑Final Notes
(�( �.Gl C�VI.� �� � � e CGc.I`✓a✓cac. � '�' - � �� � li1.t� 4S
L-6
Reviewer/Inspector Name I .
Reviewer/Inspector Signature:
r
Date:
05103101
Cantinued

Facility Number: aL — -f3 Date of Inspection
Odor Lmu
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? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes [1 No
❑ Yes [&No
❑ Yes 9j No
❑ Yes ® No
❑ Yes [� No
❑ Yes ❑ No
05103101

Division
-.._._..._�....m,._....._.��............_.�. _........�.�...._...�....�...._
0 ' 'tston of Sail and Water Conservation 0 Other Agency �� '
Division of Water Quality 1-4
[toutine O Complaint O Follow-u of DIVO ins action O Follow-up of DSWC review O Other
Date of Inspection z
Facility Number
Time of Inspection ® 24 hr. (hh:mm)
13 Registered Certified d Applied for Permit 13 Permitted 10 Not O eratianal Date Last Operated: ..........................
Farm Namc:...u.1,s'4........5..r1'�. 'County:..,C.!''`..rr........!r.�4................................
......................................... 10-G z.
OwnerName :..... 1(av i,.►c4...................... . ...... ..... Phone No: ................................................
Facility Contact: ,.,,X�..�..U..i..✓.4......w.e S...... ............... Title: ... .14I.LJ.�e r.... Phone No:...,...............................................
Mailing Address- .......... ....1�..7....................................................... ...e�-...Eecl f.�....1..Y.0 ............ ..2.!
OnsiteRepresentative:............................................................................................ .... Integrator:...r . ...................... ................................................
Certified Operator-, ................................................. ........ I .................................................... Operator Certification Number..........................................
Location of Farm:
Latitude =0 =, 0is Longitude =• =' ="
.. Design Current•
Design Curirentj Design Current
Swine Citpacityk,Population
Poultry ,, P
Y < p.. Cattle Ca acit Po . ula#ion _ Capacity I?opula#ion
❑Wean to Feeder
.
JE3Layer Dairy
s
Feeder to Finish s $rj
❑Non Layer ❑ Non -Dairy ,
❑ Farrow to Wean
ElFarrow to Feeder
❑Other '
❑ Farrow to Finish
Total.Design Capacity
❑ Gilts''
r
❑ Boars
L'W^
K ;
',. u" Total. SS--------------
. . .......
:Ntimber of Lago,;ons CHoldm Ponds � ❑ Subsurface Drains Present ❑ Lagoon Area M Spray Field Area
n
❑ No Liquid Waste Management System.
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Ye.
No
Discharge originated at: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water'? (if yes, notify DWQ)
❑ Yes
❑ No
c. if discharge is observed, what is the estimated flow in gaUmin?
A Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
7, Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued o bark

`.
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds Flush Pits etc,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes �No
❑ Yes Ity,No
Structure 5 Structure
Identifier: .....................................
Freeboard (ft): ........... ............
...................................
10,
Is seepage observed from any of the structures?
❑ Yes
No
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
No
(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
XNO
Waste Application
14, Is there physical evidence of over application?
❑ Yes
P(No
(If in excess of WMP, or runoff a tering waters of the State, notify DWQ)
15.
Crop type �,.0.. ...... .....................................................................................................
Y
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
ANo
18.
Does the receiving crop need improvement?
❑ Yes
P(Na
19,
Is there a lack of available waste application equipment?
❑ Yes
[�No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
J� No
`❑\No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
.
22.
Does record keeping need improvement?
❑ Yes
XLNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0- No.violations-or. deficiencies.were noted-dtiring this. Visit:• You:will receive•no further .- ,
. Oerespondeke Ei ottt this. visit,."".'.. ,... :
,- _..zvaa .. .. ... � oe � t �x:�� v v-t sm�� -
Ca_mtnt tits (refer tv question #) txpluin any YES :answers and/or any r ecom tendations or any�other comments.
Use dri,Mngs o0acility,to Wtter.explain situations. (use additional pages as
k'.i k
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7/25/97
Reviewerfinspector Name ; I t
Reviewer/Inspector Signature: Date:
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