430020_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Quaff

`Division of Water Resonr•ces
Facility Number ® Q Division offSoil and Water Conservation
r oQ Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �J �QQ, County: ��re�q_ Region:
Farm Name: F
C. Ownne"rEmail:"�
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ' J3'ies Title: Phone:
Onsite Representative: U Integrator: T14a
l t t f
Certified Operator: �rt Tl �/~ Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
DBes'gn Current
De ign Current
Swine Ca aci Po
p ty p.
Wet I'oult ry
i 5 i
Capacty Pop.
Cattle Capacity Pop.
Wean to Finish
t.a er
Dai Cow
can to Feeder
L lNon-!Mer
I
Calf
Feeder to Finish
Heifer
Farrow to Wean
jeesign Current
Cow
Farrow to Feeder
D . foul
Ca p ac 1?o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers ers
Beef Feeder
Boars
I Pullets
I
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 Ir No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes [:]No
[::]Yes [-]No
❑ Yes ® No
❑ Yes No
LP
NA ❑ NE
NA ❑ NE
f
NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili \Number: jDate of Inspection: q' Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No / NA ❑ NE ji
Struc re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
_I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes `P 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 ❑ (Appplliication Outside of Approved Area
12. Crop Type(s): U—I'4% syh V"r "`"�-'
13_
Soil Type(s):
14_
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RbNo
❑ NA
❑ NE
_Renuuired
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers ❑ 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 1� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes AA No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

L
Facile Number: t jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NE
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [—]Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes QR-No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [5No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
a MILD"CQis trererjo. gaesuon ff). nxptain any: r "auswers.analor any aaamonai reeommenannons or any,,otner oommen!L&a k
[Jse drawn s'of facility to better eitalaia.sifuahons'(use.sdditianal Danes as a' essai-V). ` ': n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J7-1 7
2/4/2015

IType of Visit: JT 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 0 Denied Access
Date of Visit: mj Arrival Time:
�i g&, jf =t Departure Time: Q : / County: IYARAX)F— Region:
Farm Name: 040 �t``1 1 tV 1� Owner Email:
Owner Name: re sb_4 r _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �{Xj1�`i� 5 Ly[ PA �7 Title:
UI
Onsite Representative:
Certified Operator: ° fn
Back-up Operator:
Location of Farm:
Phone:
Integrator: _ P
Certification Number:
Certification Number:
Latitude: Longitude:
.. bDesign C urrent._
Finish
Feeder
o Finish
7Z_XFeeder
ow to Wean 2.
ow to Feeder
Farrow to Finish
Gilts
� - Design Current _ -
pacity Pnp. Cattle
La er Dai Cow
Non -La er Dai Calf
TM Dai Heifer
Design Current Cow
D , P,oult . Ca aei PaoP. Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Design Current
CapaciPa
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes r No [] NA ❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes
C] No
NA
❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes No T[DNA ❑ NE
❑ Yes q
No [] NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Ds ection: 12
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No 0 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes V No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA . ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
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 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (-pa. -% X'ft%-'`0 1 ti
6AX'I
13. Soil Type(s):
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
E? No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
'❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
a No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility umber: q3 -2,0 jDatcof 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. TT
❑ 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 M No ❑ NA ❑ NE
'
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
t No
[DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or `an_-Vrther c_oznmen_ ts.
Use drawinks of facility to better explain situations (use additional pages as necessary). =
_
Reviewer/Inspector Name: � �}} v" ' l0--"19 y Phone: �l —7�7 3 r3
Reviewer/Inspector Signature: Date: 9 Z-7/fo
Page 3 of 3 21412011

r
i ype or visit: qW Lompuance inspection V uperanon tceview V structure r.vatuation V i eenmcai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Vi2 Departure Time: County: 414L 1 Region: _
Farm Name: ''6V Q/LL4' Owner
`-E``i
aml
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: u
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: P.Z�_
Certification Number:$
Certification Number:
Longitude:
Design CurrentJill
Ill Design Current
Swine Gapaeity Pop.. WetiPoultry Capacity Pop.
Wean to Finish La er
Cattle
Design
Capacity
Current
Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
till
I IT
_ _
a D .P,,oul Ca aci P.o
I Layers
lDrvCow
Farrow to Feeder
Farrow to Finish
Gilts
Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Boars Pullets
Turke s
Other Turkey Poults
Other Other
Beef Brood Cow
Discharses 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 )n No ❑ NA ❑ NE
❑ Yes [ ] No
❑ Yes [:]No
[-]Yes ❑ No
❑ Yes No
❑ Yes No
On
P NA ❑ NE
NA ❑ NE
YO
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3
21412014 Continued

Vacj!!tj Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No /91 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �j No ❑ NA ❑ NE
waste management or closure plan? /'
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes T2 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? 10
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window I ❑ EvidencSa Wind Drift ❑/Alpplic�ation Outside of Approved Area
12. Crop Type(s): � M� OLD �i r1• '"'
13. Soil Type(s): Oi
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
i3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
11B No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
Pq 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 0 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 W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T1 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of Inspection: jl
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'172
r No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes q9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Pg 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 M No ❑ NA ❑ NE
❑ Yes 1pNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑Yes MNo [DNA ❑NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer. to question#) Explain,any YES answers and/or any additional;recommendations or, any ©flier comments.
z, .
Use drawings of facility to better expo-- A s�tuiaaons (use additional pages as necessary), _� _ __
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9�03
Date:
21417014

A
15(tv,s
301) P C— 13
(Type of Visit: 0 Compliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O.Referral O Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Owner Name: 11
l
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: il F,�T Region:` -L2 3
Owner Email:
Phone:
Facility Contact: �QtS Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
integrator: 'r,-eS re
Certification Number: 22 0 6e
Certification Number:
Longitude:
Nil 1111111
Swine :.
Design Current
Capacity Pop.
Wet:I?oultny
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -La er
Dairy Calf
U h
Design Current
D . P,oult . Ca aci P.o
Dairy Heifer
Dry Cow
Non-Dai
tJ
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef $rood Cow
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?
❑ Yes R1 No
❑NA ❑NE
❑ Yes
❑ No
EP NA
❑ NE
[—]Yes
[:]No
fp NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: L41 - Date of Inspection: eat
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �Kj 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
V No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1p No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1?5 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 ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ("na's-W
13. Soil Type(s): Pd
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes T] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rye aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes]
No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JF] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -TV Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes Pg'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes `® No
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �D No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes 0
No ❑ NA ❑ NE
❑ Yes IM No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes t
No ❑ NA ❑ NE
❑ Yes CM No ❑ NA ❑ NE
Comments (refer to question #): Explalwany_ YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).,'_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qla n'?-0 g
Date: I t 1 T 1.3
21412011

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: J�eP'l I& . Owner Email:
Owner Name: ��! W e Phone:
Mailing Address:
Physical Address:
Facility Contact: �� l Title: Phone:
Onsite Representative: Qs Integrator:
Certified Operator: Sr Certification Number: 2 20 6 S
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
_Current
DesignCu.rrent
Design Current
Swine ,Capacity,;
I'op.
Wet Poultry
Capactty.P,op.
....:
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I iNon-Layer
airy Calf
Feeder to Finish
"
" p ' ""
Da Heifer
Farrow to Wean
2a /Y
esign Current
Dry Cow
Farrow to Feeder
Dry P,ouIt .
Ca achy -Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
=H
TurkeyPoults
Other
Other
Discharses and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
[—]No
�]_NA
❑ NE
❑ Yes
❑ No
E�NA
❑ NE
[:]Yes ❑ No � NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes UhNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'Po ❑ 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 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 MNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EP No . ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �QSY1 �1►1 r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes Eg No ❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? [:]Yes [P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F$] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[)g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[P 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 14 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes rWNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [�] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA []NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: -(s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Yg No ❑ NA ❑ NE
the appropriate boxes) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [� NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [A No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[5 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers. and/or any additional recommendati6ns or ainy,�other eommerits.
Use`:drawings of facility to better explain situations.(use additional pages as necessary). _ ,.
�s v-e��
5rt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ?-Y ��i
21412011

i ype oz visit: iW t.ompuance inspection v qjperanon rteview v Ntructure Evaivanon v i ecnmcai Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O:OD Departure Time: County:R-F Region:
Farm Name: P — KP.i'I v1—AV m .t`s Owner Email:
Owner Name: ei `�'� --dipryas Phone:
Mailing Address:
Physical Address:
Facility Contact: /r Title: Phone:
Onsite Representative: �Ia�'1�`�' Integrator: 'Pry,5—lq�'e=
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine ".
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean3
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Either
Other
Design
Capacity
I
Currents Design
PoP W Poultry Capacity
Layer
Non -La er
41--m�"r,_' "
2 Design
z'Dr -ME Ca aci
Layers
Non -La era
Pullets
Turkeys
Turkey Poults
Other
Current . '
Pap
Current
Pop
n Design Current
'Cattle Capacity Pop.
Dai Cow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
I lBeef Brood Cow
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P 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
l
® 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!R No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of inspection: 2s
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
(—]Yes
�1No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
1PNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f{
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
7P
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [�JNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc j
❑ 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): (� 64M( Bar fr- 4 S3 li�
1, SM' f�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ej�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauiured 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
[$a No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall [—]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
T 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 Condnued

J~acili Number: - Date of Inspection: 2 2__
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E14 Mj No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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?
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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes c-P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [V No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes ® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ No
❑ NA ❑ NE
Comments (refer to question:#!): Explain any YES answers and/or any additional -recommendations or any other commen � ;
r
Use drawings.of facility to better explain situations (use additional pages as, necessa(r ,)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:/zs Z
21412011

I ype of V isit: ap compliance inspection V Operation Keview iLd Jtructure tValuation U i ectlnical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County •??-7_Region: _jg3j2,D
Farm Name: �lp� ► l !moo -FRS Owner Email:
Owner Name: +'�4 A.p .-., s Phone:
Mailing Address:
Physical Address:
Facility Contact: JS Title: _ Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: PrIe-fita-.31C
Certification Number: 2Zn6�
Certification Number:
Longitude:
Design Current
Design
Gnrrent
Design Current
Swine Caaci#y Pop.
Wet Poultry
Capacity
Pop.
Cattle
Eapacity Pop.
Wean to Finish
Layer
11
Dairy Cow
Wean to Feeder
INon-Layer
I
Dairy Calf
Feeder to Finish
_
Dgry Heifer
Farrow to Wean fj 0Design
CurrentDry
Cow
Farrow to Feeder
D . P,.oul
Ga a_ci
P,o _.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
ITurkey Poults
Other
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ®jNo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [-]No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [3 No O NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 4 ] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Z7- 20 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) [P
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
RNo
❑ 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
�!o
❑ 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)
T
9. Does any part ofthe waste management system other than the waste structures require
❑ Yes
Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ac tart Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12, Crop T
e s :
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[VNo
T
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t�] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[W No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[P 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.
D Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
`l-' No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FXNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facrli Number: - f�! Date of Inspection: ! i�
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 /1� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? [:]Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
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 ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [3 NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to giiestion # ): Explain any YES answers;andlor any additional recommendations, r;any other�comme�ts:�
Use drawingsTof facElat _44' etter explatn situations (use addrtioual..pa es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i2-I �Il
21412014

v/
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral 0 Emergency O Other ❑ Denied Access
I I
Date of Visit: p Arrival Time: �S �Q�` Departure Time: : �i County: r Region: r )`—
Farm Name: ke__4� + - 4 D P-- )0
7' W Owner Email:
Owner Name: ge t -flion l s Phone:
Mailing Address:
Physical Address:
Facility Contact: + Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:,,,,,,
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = « Longitude: = 0 0
Sn�ne
Design •nrrent
Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
I I
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
Farrow to Wean
90f)
�L
Dry Poultry
La ers❑
ED Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
JE1 Other I
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairy-
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
10 Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 T
No ❑ NA ❑ NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes
❑ No
to NA
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
[?No
❑ NA
❑ NE
❑ Yes
EpNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

1 �
Facility Number: — Date of Inspection ! D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) LF
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No El NA ❑ NE
through a waste management or closure plan? j
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 nNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift El Application
�Outside of Area
12. Crop type(s) L /h Q IY SS l4a...,J , -;%.-
13.
r
Soil type(s) i
14.
Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
;R No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[� 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):
R-CO45
Reviewer/Inspector Name , `�, L Phone:
Reviewer/Inspector Signature: Date: OLA I O
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 ❑ 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 ❑ 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 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[p► 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
M No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
[jo 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
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Addat�onalkComments and/or�D�arvtn s• ��-'��'"�� " ` ' ' "
L
Page 3 of 3 12128104

Division of Water Quality
Facility Number - �� O sion of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:% Arrival Time: Departure Time: <<r� County:
Farm Name: ��Um¢-5 OwnerEmail:
Owner Name: ^�5 �� S 1NG Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: K��� _fit I / Title: Phone No:
Onsite Representative:C �4 /n� Integrator: "....4, _
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O i u Longitude: = o = 4 =
di
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ l a er
❑Dai Cow
Wean to Feeder
❑Nan -La er
❑Dai Calf
Eeeder to Finis
900 ?
❑ Dairy Heifer
arrow to Wean
/ 3
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
ElNon-Layers
❑ Beef Feeder
EGilts
Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
P9 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —a (5 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in); I
't
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes Po ❑ NA ❑ NE
❑ Yes ❑ No A ❑ NE
Structure 5 Sr
ure C,
❑ Yes 1PNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA
❑ NE
through a waste management or closure plan?
TNo
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
t�No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
1 11
❑ NA
El 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
❑ NA
❑ NE
maintenance or improvement?
�o
Waste Auolication
10. Are there any required buffets, setbacks, or compliance alternatives that need ❑ Yes �INo ❑ 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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wi Evidence of Wind Drift ❑ Annifcation Outside of Area
12. Crop type(s)_
13. Soil types) pQCO-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EpNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
fl No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
T7No
❑ 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 a.,Phone:
Reviewerllnspector Signature: Date: 8
12128104 G'ontinueu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box.
❑ WIiP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1PNo ❑ 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 [M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
U9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[) Yes
� No
El NA
El 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
M 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
[PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V) No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[VNo
❑ NA
❑ NE
Page 3 of 3 12128104

I ft
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit C) Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 10-V `4ES La.-,L
Certified Operator:
Back-up Operator:
Location of Farm:
mty: f tI�QITT- Region•
mail:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 ="
Longitude: = ° = =
Wean to Finish
JLJ Layer
LJ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
-- ❑Dai Heifer
Farrow to Wean M7-
DTy Poultry
El Dry Cow
Farrow to Feeder
❑ La ers
❑ Non -Dairy
Farrow to Finish
❑Non -La ers
❑ Beef Stocker
Gilts
El Beef Feeder
Boars
❑ Pullets
❑ Beef Brood C
RAI ❑ Turkeys
ter'
_
❑ Turkey Poults
I
Other
❑ Other
Number of 5
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
es
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 discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —
Date of Inspection Zb $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes p 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 tructure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes °P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 1�No ❑ NA [I 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 fVNo El NA El NE
maintenance or improvement? 1
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
DI No
ElNA
❑ 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 [:IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Crop Window ❑ EvidenceofWind Drift ❑ Application Outside of Area
12. Crop type(s) ` znAJ �l�'a�Q C,*,% �QS`t �. Fr"U'dS 1. SA1� fir+
13, Soil type(s) R2IPTr
PALE,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
;` No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number: L43 7a0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? if yes, check ❑ Yes JgNo ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ja No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Cl 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
29 No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JO No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&jNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EffNo
❑ 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
19 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
FbNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation V I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification 40 Other ❑ Denied Access
Facility Number ZD i,ate of Visit: `r1 `l 0 q Time:
.-. O Not Operational O Below Threshold
D Permitted 0 Certified 13 Conditionally Certified © Registered Date -Last Operated or Above Threshold:
Farm Name- P ~ O County:. RArn&ri±
Owner Name:T-14 j? V-KO- —, Phone No: i10 - Z'! S
Mailing address: _ i 2 y A P el & EA C 1&S s- N.L- - ........-..._.— 2 S 3
Facility Contact: Title:
Phone No:
Onsite Representative: Integrator. _--- -_--
Certified Operator:
Location of Farm:
Operator Certification Number:
1�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �u Longitude �• �' �"
Discharges & Stream Imparts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge froth any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 . -. _ _
Freeboard (inches): Z(O
12112103 Continued

Facility Number: —2,0 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notdy DWQ)
7. Do any of the structures need maintenance/unprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenanceimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes ❑ No
1 I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Wo-s vv"Le -b vvta� e w , tL,_
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Feld Copy ❑ Final Notes
er O-TC., -TVoL'_
Date:
»i:1?m2

0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4PRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Bate of Visit: 1611aV70,11Arrival Time: �/� Departure Time: County: H Region:
Farm Name: a �'O" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: f,
Facility Contact: �V Title:
n
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e = , = Longitude: 0 ° 0 t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La el
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
IFOO
F
FFarrow to Wean
a
i�
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other_ -
Dry Poultry
Layers
Non-L.
Pullets
Other
Discharses & 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` ` ^"Curt
Cattle Capacity' Popa1;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Broad Co
Number of.Structures:EE_
z
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 Vlo ❑ NA ❑ NE
❑ Yes
❑ No
[)tyA
❑ NE
❑ Yes
❑ No
ANA
❑ NE
DJ:NA
❑ NE
[]Yes
❑ No
❑ Yes
P�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes t5*40
❑ Yes EP40
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
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
M 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
WNo
❑ 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
DO No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
� No
El 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 Amlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
13 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift ❑ Application Outside of Area
12.
Crop type(s) ,rnudR 61-Q7,P
13.
Soil type(s) T_
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
VNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
& No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
IN 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):
U
Reviewer/Inspector Name
Re-viewer/Inspector Signature:
Date:
12128104 Continued

h
Facility Number: -,fin Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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
A 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
O;No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
b No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&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
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: i d^ 3 Arrival Time: Departure Time: �l4 M County: Region:_
Farm Name: ! — (P 0 Owner Email:
Owner Name: Pr ne 4m1P Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o = 6 = Longitude: 0 0 = 4 =
it
Design C+urrent Design Current
Desrr ign Cuent
Swine
k._.
C►apacity Population �?VePouFltry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
0�-,� a
❑ Dairy Heifer
Farrow to Wean
Farrow Feeder
'
ElD Cow
El Non
to
❑ Farrow to Finish❑
-Dairy
Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
Other.;?iti+;
❑ Other
Number of Structures:
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Foults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JP 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
ONA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
,,��{{
EgNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�lo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 4
Date of Inspection 11L1
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?
❑ NA ❑ NE
F NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: P bo k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes I ,No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
;M No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4fi 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
1W No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�9No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�! 1No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l 0 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) �� , FPSG.p Cf`f SG &rn-xy/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z?No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
®No ❑NA ❑NE.
No ❑ NA ❑ NE
®No El NA ❑NE
® No ❑ NA ❑ NE
Commen#s (refer to question #) _Ex any YES answers and/or anyrecommendai�ons or any other coni
Use drawing lof facility to better explain situations. (use additional pages as necessary): .
a
T
Reviewer/Inspector Name ".' T
e >;"17 q jL
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

.1
Facility Number: 3 —.1D Date of Inspection
Re aired 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 10 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IS No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1p No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EP No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(SNo
❑ 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
(RNo
❑ 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
[V 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
WNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IftNo
❑ NA
❑ NE
A4ditiori$1 Comments and/orArawings:
Page 3 of 3 12128104

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: 3 !o%e`r Arrival Time: %�=.ip Departure Time: County: Ha -►+�-f>t' Region: 20
Farm Name: f G o �j Owner Email:
Owner Name: Ke iA 1 is eei" /Rea — Phone: a a S- ap
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E1o= I= 1
1 Longitude: 00
0 6= u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
® Farrow to Wean �2 1 J*
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑Non -Laver
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?
Design Currenf'
Capacity Population",
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiEy
❑ Beef Stocker
M
Beef Feeder
Beef Brood Co,
!Number of Structures:
b. Did the discharge reach waters of the State? (Ifves. 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)
?. 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 R1 No ❑ NA ® NE
❑ Yes
❑ No
❑ NA
[ONE
❑Yes
❑No
❑NA
[�NE
❑ NA
[!0 NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
[51 NE
12/28/04 Continued

1'
Facility Number: q3 — 2d Date of Inspection /017-
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):
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes
❑ 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
❑ No ❑ NA ljd NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA QaNE
maintenance/improvement?
IL 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 Drifl ❑ 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
M NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
© NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[]
Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
ReviewerAns ector Name w '` w`'
p Q� r �, � 3 �,rPhone:
Reviewer/inspector Signature: Date: 6-110 lD r
7' Pro/AI !'....w.......I

l'
Facility Number: 34 Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [11 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA © NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 ❑ 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
❑ 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
❑ No
❑ NA
W 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
[0 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'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addrhonal@omments andJor.;Draaings �4bt:, ,:;
_ab s c f e ofZ 4A e- 4ra 10 o S a r. -�'a u"Jz d Ga.Q
P`�s �r +4� tQ9ooN.
12128104

of'Water Quality �/ G
Facility Number �,/,3 U Division oMI
f Soil and Water Conservation +i+
Q Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Fly / / Arrival Time: Departure Time: County: Region:
Farm Name: >�— fo D Owner Email:
Owner Name: _ __tr 1'. -�'� —T h n "!:.a- _ Phone:
Mailing Address: Lei y Q,�r;r,�e Co t. Va ssr_1
Physical Address:
Facility Contact: elUA3, ar rJ-64> Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No•
Integrator: Pr 1"A'. 1 e-
Operator Certification Number: - a?.2 04a
Back-up Certification Number:
Location of Farm: Latitude: E� o ET ET Longitude: = ° ❑ I ❑ U
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
D6 � E
La erNon-Layer
Wean to Finish
El Wean to Feeder
El Feeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
i
❑Gilts
�
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure (X Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population- -
❑ DairyCow
❑ DairyCalf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
El Beef Brood Co
i
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
a
ffl
Um Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
go NA
❑ NE
❑ Yes
❑ No
5D NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
Pa No
❑ NA
❑ NE
12128104 Continued

A 1
Facility Number: y3 — ,Zp
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
Spillway?: V e
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® 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
91 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
JZ 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 Dri11 ❑ Application Outside of Area
12. Crop type(s) &* vv.
Z
13. Soil type(s) Pd
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA ❑ NE
Reviewer/Inspector Name r Phone:
Reviewer/Inspector Signature: Date: y �
12/2&04 Continued

J
Facility Number: �j/ — �a Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [X No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ja No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
m No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
IoNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (ie/ discharge. freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Ardditioi�al Comments and/or Drawings::
I— AyQlrG�
4 -/-
,�(.� inp �/J4a wcr .
!YP
OV4J'�G
f7 sue„ ¢
t N'��a� a.�7 C
'�' / C4_ OthQK i c_, a
4--k ._ s i- t + L .
C%. ` �✓ N/i v �• � 4 L G ^ Q C �L q �� L� �O � n G � wd�C- w�.. O r C, � C: wey�
J(S- C
r d d
1 1
1 04L1 e s (} r p,o,� r j I.,.e "L`ktt h '0') 4
11/18/04

Type of Visit &Compliance Inspection 0 Operation Review O Lagoon Evaluation . \
Reason for Visit i Routine Q Complaint 0 Follow up Q Emergency Notification O Other ❑ Denied Access
Facility \umber I Date of Visit: 1� t7 Time:
t Not Operational 0 Below Threshold
Permitted ® Certified 0 Conditionally Certified ©Re-_istered Date Last Operated or Above Threshold:
Farm !Came: 4- 1 C County: k[oneu EQ cl
Owner Name: 4_ 'n 6-S Phone No: _ et 1 A*��
Mailing Address: _f �� M6,116,rA Cn ue __V C, SS (Z gi 2�34
l�._
Facility Contact: �jr�12&MJG b``Title: Phone No:
Onsite Representative: 96�rt ( Integrator: -
Certified Operator: J, Operator Certification Number:��� �
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �° u " Longitude - �• K
Design Current Design Current Design Current
Swine Capacity Population POultn Capacity Population Cattle Capacity Po ulation
® Wean to Feeder 9 gz) I PLaver I FF-1
Da'
❑ Feeder to Finish ❑ Non -Laver Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Presentj[] Lagoon Area J❑ Spray Field Area
Holding Ponds / Solid Wraps - ❑ No Liquid Waste Management Svstem
Discharges 8 Stream Impacts
1. Is anv discharge observed from any par of i? the operation? - - ❑Yes VINo
Discharge ori--inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is obsen.-ed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (if yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in saUmin?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J�j No
3. Were there an,• adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (S No
Wa a Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure ; Structure 6
Identifier:
Freeboard (inches):'
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.) L
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P No
(1f 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 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Q No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [E No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [� No
12. Crop type _- 9e-r- r'tLxA/'_ &-A_ cip6d n _CiC
13. Do the receiving crops differ with those designated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
WMP)?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 1)U No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P9 No
❑ Yes PNo
❑ Yes �9 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
`❑ No
® No
[� No
P No
No
JRNo
® No
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coo m me(refer�to cluestaoi#1) Explain any Y1~S answers and/or any recommeadattons orany other ctimtnents.
,Use,drawings of facility tto better explain situations. (use additional pages as necessary) El Field Copy ❑Final Notes
f ac'f go-1 S4 w-a-Q� 4 ' 03 ,
Reviewer/Inspector Name E °
Reviewer/Inspector Signature: ky, Date: �-)_b
05103101 Continued

Facility Number: 43 - :)O Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes FkJ No
❑ Yes ONo
❑ Yes J9 No
❑ Yes MNO
❑ Yes ❑ No
05103101

State of North Carolina
Department of Environment. F15VA
Health and Natural Resources • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 4, 1995
Thomas Brothers Farms
Box 1647
Buies Creek, NC 27546
SUBJECT: Compliance Inspection
Harnett County
Dear Sirs:
On August 3, 1995, an inspection of your animal operation was
performed by the Fayetteville Regional Office (FRO). Please find
enclosed a copy of our Compliance Inspection Report for your
information. It is the opinion of this office that this facility
is in compliance with 15A NCAC 2H, Part .0217, and that Animal
Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to
contact me at [phone].
Sincerely,
M - jl4vu%—
D. T. knes
Chemist
DTJ/sc
Enclosure
CC: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5M Telephone [phone] FAX 910-48"707
An Equal Opportunity Affirmative Acfion Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: f - 3 , 1995
Time: 3•� av�°.i!
Farm Name/Owner: -rh:. A s Ae, 1h4AS rIMIK
Mailing Address: & aK !ads �r 1�'s/y�/Y ���7Sr►<6 4%1 9/0' -s93 .7-SrSa
County:
Integrator:
On Site Representative:
J
Phone:
Physical Address/L.ocation: [-gyp eat !�Z/ �Sgw A,/l.'w#ly v evjy1ma.Mx-jld 1 K47 3
M 11 S a u f Tit R�✓ R,�ory �r.�_uT� �eb �/.� l�na� S /td ��� �%�-e cn-t1 � �J�� - � ��
Type of Operation: Swine L,," Poultry Cattle
Design Capacity:
Number of Animals on Site: '3 BQ G
DElM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° , -„ Longitude: ' • H
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inclus) r or No Actual Freeboard: �t. Inches
Was any seepage observed from the lagoon(s)? Yes or & Was any erosion observed? Yes or to
Is adequate land available for spray? 15 or No Is the cover crop adequate? or No
Crop(s) being utilized: cDW s7l¢L ✓ � u _ _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Strearn? Yes org
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes CC%
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 0 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 9e or No
Additional Comments: 1fS • ?-off So
/Soo - 0 r�g41s.
�41,Cs
Inspector Name
7,
Signature jr
cc: Facility Assessment Unit Use Attachments if Needed.

WMTH CAROLnM DEPARTKMT OF EZWMR0HPCMT, BEALT71' & NATWUL RESODRCPS
DIVISION Or ENVIRONMENTAL MANAGEKENT
Fayetteville Regional office
Animal Operation Compliance inspection Form
-icw�^.�1"�s���s.. ,�s..� .`,�..:,.:.... ..,....%»'...rc....♦r�p'v,.°;:"' ..�:'���"y'�'�h .::;:.r �'���_
rn':.w.�:%o ':�nw ..J:::a^^^�"
.y:.��;r��;: ': ::�:o a.`. �:r..:sa�.;�..
L]M
li
Kei+h Thvmas Bi-m TY)G, N�er#fi Thor,
.«..- V� � ��,+ N,Kk
�aa.: ,gyp . r5r� r«.•.
A=A;'i1L1\G �i71i RRi.Oi�_ a!
Box 1095 Li l 1 i NOZ7
C) 10 -803
G
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
S=ION I
Animal aeration Type: Farrow -cj-fi-qede-r
Horses, cattle, 'Swin poultry, or sheep
CjECTION II
Y 1 N 1 COMMENTS
1. Does the number and type of animal melt or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
systam)j .
2. Does this facility meet criteria for
Animal operation REGISMATIOP?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIM ANIM
WASTE NW-991P 9M PI.l1lq'?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

&8LZ'iON III
Field Site Management
1. is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Lisle Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Slue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application -site have a
cover crop in accordance'with the
CERTIFICkTION pLAPP
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved MTTFIC.ATIOW.
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SE=ON IV
Comments

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dx IG 117
CeA�EK iYG
Dear :
r
DIVISION OF ENVIRONMENTAL MANAGEMENT
SUBJECT: Compliance Inspection
County
1
On an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
J.
y Dobson
Eaua i n e e r
Enclosure
cc: Facility Compliance Group