470003_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qual

is ! %4� 97_ 4U& r 50
Divi"sloe of Water Resources
Facility Number - �-? J Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0_Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival TimeIC
Departure Time: County: U�C
Farm Name: t vY�,� Wti 1�1 Yrt f"'1 Owner Email:
Owner Name: O- t L� i S, Phone:
Mailing Address:
Physical Address:
Facility Contact: y! l A L Lit <<t S Title: Phone:
Onsite Representative: L( Integrator: lAt�
Certified Operator: t Certification Number:
IMF
Back-up Operator: Certification Number:
Location of Farm. Latitude: Longitude:
Region:
Design
Current
Design Current Design Current
Swine Capacity
Pop,
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
I ILayer I Dairy Cow
Wean to Feeder
5 ?-
[Non -Layer E]
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
pesign Current
D Cow
Farrow to Feeder
D.r. PauItr, C•.a aci I;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other10
Turkey Poults
Other
Other
su.czzas.iue.�ar�es.c.e;w sirrxaa�
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EfNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment �-
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ ❑ Yes -No ❑ NSA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2'9A ❑ 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[:] ❑ 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 �]Ko ❑ 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 l3K ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:Jl o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
la
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): C � {�� 6 O
13. Soil Type(s): (,tJCA,
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
❑ YesEl-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
02<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Io
❑ 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
'
—o
[I
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E 'y
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: 4CO3 Date of Inspection:
y4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7`(o,
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? C] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface 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 Dxo_�[:]NA ❑NE
❑ Yes atlo ❑ NA ❑ NE
❑ Yes 0jNd"__❑ NA ❑ NE
❑ Yes MI° ❑ NA ❑ NE
❑ Yes o ❑ NA
❑Yes ❑NA
❑ Yes rNo ❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer, do question #) Eiplaln Any YES answersrandlar any adclltional recomirienilations or anyi`otiier�coinmenfs
Use�dri)wingsbf facili .ta'better ex" laln;sifiiittigns;(use:ac[ditional`'a' esfaslnecessa'ry)�5;�� *1
Lk 1 { ®r 3, 4l
c-ell air-3�-8'_ 6 gsi
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1of l 33- 3 3
Date: ' {� A" 1 �
21412 5

I' d i� i.�:l, r 1ui� l �► �k jf �, �1 � � r ,� �,�4, Y, I ,ivi9iontQf WaterReaources ,„s ,, ,.
jr
I ,
ttc��tly Number O Divixion of Soil and Water Conservation
= 1lirlts �. l lilE 0 OtpeCl,Agpncy
Type of Visit: (ErCompliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
O 2eason for Visit: 'Itoutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: f .r Departure Time: ' %17 , + j' J County:Region: !
(( rr
Farm Name: t l� ( L � O lwner Email:
Owner Name: 0- C1v�( .uJ 14 t S Phone: Y
Mailing Address:
Physical Address:
Facility Contact: 641yLe W • rS Title: Phone:
Onsite Representative: ` Integrator: V
Certified Operator: `�l Certification Number: I 0 33 `'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
��� S Will �' ���.! � I'r� iA•.i�ly' iF' � 4,#Its 'i� ��. �'� iiG i ��,''�''s a� . �1 i�-"€��r� V .,: I ,ii' � I _ ,'V: i . �,,, .I, _ I- . .n � � i . :I�• � �.., � +, __ ...
1lylr��lrt,i�i€i�':!!ll�ii 1� � ,EMI E �rDesign yl Currents r� �E,. g i ,IM i:EI E :l, ,l �, jia>>,l D. esign4 ,Current I : ' l :; Designs. Currents
i{Eq ��l I�IIH x I i� 1 EN��! �i illfl li m IN I r Ei ` , :r I I
�„ I ,Swine .w, Il, CnpAcityPop EMI ry apacity Pop Cattle Capacity Pap.
i 1! Wet Pout, C
d IJ I�1 ,, L, krIH,J1 Ip.1 �'I'IfIV J dii! IlLr,' ! d I . u..ia c d
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Discharees and Stream lmnacts
Layer
> ,' Non -La er
����EI
Design, Current
tali+ull�.E.� Utv;�1'oultry i'l rCaaa'cifv;', Pout,
Pullets
jl Turke
Turke
Other
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
.B
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[4-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
ETNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility, Number: - 3 Date of Inspection:
Wasti Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-igA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IV-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E 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 [s]' o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental t
reat, 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 Q-To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ffNo
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes [�Io
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Ap '
tion Outside of Approved Area
12. Crop Type(s): kS e - .St, 6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EJNo
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[qNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Kc
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
Fn'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
ET'No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectionss
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
[] NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Ndmber: - Date of Inspection: Z r+�
24. Nd the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
BNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List.structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ffNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[TN
❑ 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 FrNo ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [D*No ❑ NA ❑ NE
❑ Yes [a'No ❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
[]Yes
Q'No
❑ NA
❑ N E
❑ Yes
�o
❑ NA
❑ NE
�Co'm`mentS, refer to q" ue`stion"�', i,Ez lain hriY YES iin'swers and/o'r'"an additlonalirecommendatians. or anV.oth.er comments 1€,.' !;
€€>y,p. • }-n€tS IV. ' € i(� r• r ,uall� l €t! •.1!'. ,r I €.€-:`.@.aSi! ; € ���.; r € } Y, € �.. ,� € € € t€K
SIr1 f, 1..Illi,l llll�€:. i146 It�q! till s 1 :a1.111€ �I IIN .,l ! 1 6,.<.I , ,i€ E It € t . €. } a� .� : i € � ,' €€:I�i's:• � t ! ",j �' 1 (} I €t € € € ! "
Useidraw,inkslofifacllltyito,,bOtter.explaln.?situatlopsi(use.:ad'dltlonillpoges,as
0
Reviewer/Inspector Name:
(_- 0-ti,
y, j q-11 "
r
Reviewer/Inspector Signature:
Page 3 of 3
a- 2"(
P " " , LJ
tll 910-- 308'_ �Ff51
.4
Phone:
Date:
2141201

Type of Visit: QCompliance Inspection 0 Operation Review Q Structure Evaluation C) Technical Assistance
Reason for Visit: CrRoutine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 6 t=
Farm Name: U0 C' ,L 4k�-Wi` It i r Owner Email:
Owner Name: W!I N { . 0, d t—_s Phone:
Mailing Address:
Physical Address:
Facility Contact: e ti t t S Title: Phone:
I tI
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: jti(�3
Certification Number:
Certification Number:
Longitude:
Region: ► GO
Design Current
Design
Current
Design Current
Swine
Gapaclty Pop.
Wet Pouitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
S Z
Stg'J
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oult ,
C•.a aci
P.o P.
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
..Ni�lLf�sh-
Discharees and Stream Impacts '
1. Is any discharge observed from any part of the operation? ❑ Yes [2�O [DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [3`9A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C3-110 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

. Facil€'' Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑'1QA
❑ 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
E3'go
❑ 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
io
❑ 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
[Bl o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
[INo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]N`o
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
0 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): le�-tiM� '•1'1at{U m a.�kv'e- J 6
13. Soil Type(s): LJ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ca< ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C3"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

r
Facili dumber: - Date of Inspection: t UL
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2'go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [f N ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El"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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 El"No ❑ NA ❑ NE
[:]Yes ❑No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
❑ Yes No
❑ Yes o
❑ Yes TNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Rev iewerllnspector Signature: Date: V _ t -ILS
Page 3 of 3 21412 14

u j,h4 s :St:F(ZT-' Tri I U
Iffilan of Water Resources
Facility Number - O Dlvislon of Soll and Water Conservation
O Other Age,.ncy
Type of Visit: om liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: b Departure Time: County: o r 1 G
Farm Name: C 4 1"t J'UK LW1_Uk0Pd(4&wner Email:
Owner Name: tj G, w l trig Phone:
Mailing Address:
Region
Physical Address: f r,
Facility Contact: W�,t,l� �/� I v Title: Phone:
Onsite Representative: l { integrator: Im f? S -
Certified Operator: Certification Number: 10 3 35
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
W'et Poultry Capacity Pop.
Cattle Capacity Pop -
Wean to Finish
La er
Non -La er
Dai Cow
Dai Calf
Wean to Feeder
Feeder to Finish
Dai Heifer
Farrow to Wean
Design C►urrent
D Cow
Farrow to Feeder
Dr, P■oultr, Ca aci P.o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L
113eef Brood Cow
Turkeys
OthersI
ITurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ElrNo ❑ NA ❑ NE
❑ Yes ❑ No ETNA ❑ NE
❑ Yes ❑ No E!rNA ❑ NE
❑ Yes ❑ No
❑ Yes No
[:]Yes No
EfNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

194
Facililz Number: I I- Date of Inspection:
Waste Collection & Treatment
4. Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!��o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes [D Iqo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E 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 Q o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FA"Ro ❑ 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 e No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [E'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;]�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Win'dofw�, ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tiJ e�cok ['t� � P"fw�t'('l�l tIs 6-0
r -
13. Soil Type(s): _tAC
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 do ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ 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?
Reaulred Records & Documents
❑ Yes [7�No
❑ Yes �No
❑ NA ❑ NE
❑ NA NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2'Rlo
❑ 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 0 Maps [-]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacillW Number: jDate of Inspection: :Z:.,SeX- 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 ❑ NA ❑ NE
25� Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Use drawings of faelliay to hetter.ex lain situatlons (usd'edd)1
Ca\ (1.
6 C44t- �(—I L(
saf S:'O'CU7 -�Ssib � P' Z` �
�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Q io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ef NNo ❑ NA ❑ NE
❑ Yes Ej"No ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
❑ Yes [�<o [] NA ❑ NE
❑ Yes E5�10 ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes C2*No ❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: J�IZ4mp lance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: utine 0 Com laint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Aft
Date of Visit: Arrival Time: Depart ureSrime: County: Region: i 1
Farm Name: �'� W "4l s ��Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: k' ) t W C Title:
Onsite Representative: +fir
Certified Operator:
Back-up Operator:
Location of Farm:
It
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
r—p
Nan -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dt. F.oultr,
Ca aci
P P.
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
urkey Poults
Other
I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. -Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [S-N7V ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? so
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [-.IS [3 NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes O No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: -Lb 61Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-No—TD NAB❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [s < ❑ 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 [� o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [t N ❑ 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
rV l -o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ to
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[5'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P21<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1.,3N/o [] NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenc of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 04l l ~M�l
/
13. Soil Type(s):
14. Do the receiving crops differ fro those designated in the CAWMP?
❑ Yes
[]I-XV
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
+y No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 i�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rcuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [Z ,M
❑ NA
D NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesEiN-110,
❑ 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 �
❑ 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 21412014 Continued

f
Facilit
y Number: Data of Inspection —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �qoo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes R<0 ❑ 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 To ❑ 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 Q'�To ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes E2e< ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
�o ❑ NA ❑ NE
�o ❑ NA ❑ NE
E5'No [DNA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings.of facility to better explain, situations. (use , additional pages ias8riecessary),'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1
Phone: UUL
Dater
21412014

Z Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Comp lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ial;�? Arrival Time: {� Departure Time: County: p Region:
FormName: t
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: W !t 7 V-L, t A • �,l G Title: �_ its Phone:
Onsite Representative: Integrator:
Certified Operator: ft Certification Number: 3
3
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Laer
LayerNon-Layer
E�A
Discharees and Stream Imnacts
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
L.ZJ""O
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0?"N'o
MNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[Z�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
UY<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Frccboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Vo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/orlmanaged through a ❑ Yes [�<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
�No
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Lld'r''o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[?�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3<o
❑ 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): � s� I A &**—y G d
13. SoilType(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[!Ko❑
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R21 io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
k:�<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E'<No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OEY�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
hi
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
go
❑ 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
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Fa&
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L q-Ko
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

f�I
/Facility Number: K / - Q ) Date of Inspection: / / 7 11 -'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E<O ❑ NA ❑ NE
the appropriate box(cs) 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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, frecboard problems, over -application)
❑ Yes
Q—"Ko ❑ NA ❑ NE
[�'1qO ❑ NA ❑ NE
�❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑j Yes 0b o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
[�
❑ NA
❑ NE
[�No
❑ NA
❑ NE
No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. - I
Use drawings of facility to better explain situations (use additional page
s as necessary).
Reviewer/Inspector Name:
a
Rcviewer/Inspector Signature:
Page 3 of 3
Phonel(a'-1.1�'':
Date:
21412011

y sion of water Quality
Facility Number 'IjFT- V .3 O Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 6-22" /0 1 Arrival Time: 7 �30 R Departure Time: County: � Region: �`~'80
Farm Name: C I•-Q�w� Owner Email:
Owner Name: UP&Kr TW I � U S Phone:
Mailing Address:
Physical Address:
Facility Contact: Qv Pic Jfi-ti 1 " S Title: C_Q - f9LJMvi- Phone No:
Onsite Representative:: LJ integrator: ���1Q�+, - Q�'a-►,I/�/
Certified Operator: 4_10'Ye're-!L Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = 0 = { = Longitude: = o = 6 =
ds
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer — — — - —��
3$SZTsQ � � ❑Non -Layer
Other
❑ Other -- - - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey PoultS
❑ Other
Discharges & Stream Im. pacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M
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 [B o ❑ NA ❑ NE
❑ Yes
❑ No
L3<AA
❑ NE
❑ Yes
❑ No
EE A
❑ NE
j:j'NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
❑ NE
❑ Yes
2 o
❑ NA
❑ NE
Page I of 3 12128104 Continued

FaeiliWNumber: 7 -03
Date of Inspection lo-2Z-/D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -37
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ` No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes RrNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �`Co❑ 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 E <01 ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 El Evidence of Wind Drift, /❑ Application Outside of Area
12. Crop type(s) 1Sev-#Lt ,�,d a,
13. Soil type(s) CO ivr-t a ✓. _....... __...
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E'No ❑ NA
❑ NE
Rio ❑ NA
❑ NE
30'No[I NA
❑ NE
NoNA
ElNE
,1,._7,
Lo o NA
❑ NE
Comments (refer to quest€on,#):: Explain any YES answers and/or anysrem eom,endati.ons or any other comments, *4b�
Use drawings of facility to better explain ;+�"
situations.: additional pages as necessary) . 5AV ,,qq
LReviewer/inspector
er/Inspector Name Phone: 9/t7 r �33, 330 O
Signature:X.jg6 Date:
Page 2 of 3

Facility Number: /0 1 — Q 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
E7No ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,�.�,
2<0- ❑ 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
io ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E7No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
��o❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L�'1Vo NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
<
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3o
o ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LSNo ❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
01No ❑ 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
CreNo ❑ 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
B<o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes:No
❑ NA
❑ NE
Page 3 of 3 I2128104

' an of Watcr Quality
Facility Number - O Division of Soil rand U,ater Gnnservation
0 COthcr Agency
Type of Visit: Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: d Departure Time:1707.7 dU County: Region:
Farm Name: / C / d wl;
Owner Name: ��(��,,t,�P,� �5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: 0— /Cc n�ti e. A), 6s" S
Back-up Operator:
Location of Farm:
Latitude:
Integrator: M; B -
Certification Number:
Certification Number:
Longitude:
ZL3E
Design Current
Swine Capacity Pap,
Wean to Finish
Wean to Feeder I
Feeder to Finish
Design
Wet Poultry Capacity
Layer
Current
Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
INon-Layer I
I I
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design
Dr, l;oultr, C•_a Melt
Current
P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
[Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [Elo [DNA ❑ NE
❑ Yes
❑ No
E<
❑ NE
[]Yes
[]No
E;J�
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes
[:]No
03-IVA
❑ NE
❑ Yes
Mlo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
#01 or
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes u 'Vu ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2<A ❑ 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 E?<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 024o ❑ 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 E;�Wo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E2,i�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes IVo
❑ 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'?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2 "o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
0 PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence pf Wind j?rift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
03'lqo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3-1 o'
[] NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑.Pdo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
°
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ego/ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
/
[�6 ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3,X6 ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[3 Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
�lo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2Io ❑ NA
❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No j<'A
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2401 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6_<O'
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NEE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA E<E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes e 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 IVo [] NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes eNo ❑ 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 0--No ❑ NA ❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ej NNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes 2 o ❑ NA ❑ NE
om rnents re er.. o: q ueshon E x p I a i n an yX E S
an:,wers" or'an a bona recommendations or un others comments._ .;
Use drawings of facility to.bcttcr,ex lain situutio`ns ,(use additionfll pagestas necessary)` .,
e`er/o2 3/ ?U
cl__� &aeazzAd.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — 3
Date:
/412011

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (�2outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: !06)Ar►% Departure Time: M County: poff--e
Farm Name: V GA yA Cfl Owner Email:
Owner Name: lIL-ts Phone:
Mailing Address:
Physical Address:
Facility Contact: 41V/t£. L✓11125 Title:.0 w 1YF,P Phone:
Onsite Representative:
Certified Operator:
Region: AR'd
Integrator: AUR.O%i �e &0[..Lli
Certification Number: AU f~
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swlne Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C►apacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
[Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,©ultr,
C+_a uei
Pio ,
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [yNo ❑ NA ❑ NE
❑ Yes ❑ No [2NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
aNA
❑ 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
EvrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ErNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: -05 Date of Inspection: / l•�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:}'
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): L
[9'No ❑ NA ❑ NE
❑No 0 A ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ffNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[fNo
❑ 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
[3/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
[2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): &Amt)(A tPASTU1?.C) 6.6 d
13. Soil Type(s): CA n ne)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[31$Io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[E�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
[2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[yNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 t. 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
[4No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No gNA ❑ NE
Page 2 of 3 21412011 Continued

r
[Facility Number: 447 jDate of Inspection: ►
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
. 23*No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
[ rNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No
❑ NA G21NE
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 [yNo ❑ NA ❑ NE
❑ Yes [FrNo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes [E�No
❑ Yes [Blo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additionaf recommendations or any other cominents� 71 �=:
Use drawings of facility to better explain situations (use Additional pales as necessary).. ` Y x 1 ;:
�00� r RSV-,
Reviewer/Inspector Name
Reviewer/[nspector Signature:
Page 3 of 3
ldou S. 5�\Mnts
Phone: QIU•• taQ
Date: L41\ LA�
21412011

t
I'm rAl5 11IC41c-I /O—oz— 7-009
Facility Number
L7 Division of Water.Quality
0 Division of Soil and Water Conservation
0 Other Agency}
Type of Visit (mom Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: d/ d1'.f-, I Departure Time: County: Region:
Farm Name: - 4J0. i ij" . &I x_,.s FYJW Owner Email:
I
Owner Name: &Agvcl _, Phone:
Mailing Address:
Physical Address:
Facility Contact: WO q 61t- ,,,,Ujij Title:
Onsite Representative: WU:jA1��.�►���i s
Certified Operator: .Jo'is
Back-up Operator:
Location of Farm:
Swine
Phone No: pp
Integrator:y'�'Prt
Operator Certification Number: 3
Back-up Certification Number:
Latitude: = 0 0 ' 0 " Longitude; a o = ' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
552 D ❑ Non-Layet
❑ Weanto Finish
can to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Populatia}q:; a
El
Dairy Cow
[I
Dairy Calf
El
Dairy Heifer
❑
D Cow
ElNon-Dai
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
[3iA
❑ NE
❑ Yes
❑ No
❑'1 f�A
❑ NE
❑ Yes
❑ No
915A
❑ NE
❑ Yes
[J"No
❑ NA
❑ NE
❑ Yes
9<o
❑ NA
❑ NE
12128104 Continued

Facility Number: '] -^ 03
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes [2/No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 9 o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D<o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require E] Yes
B<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ffNo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
' to
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of}Area
12. Croptype(s) Feri..tj,ele— t��t-= i�-� �•'"�f� turn;nJ �0uevscce,l J
13. Soil type(s) GQ AI D P'
-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
B o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Q, o
El NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[3No
l
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
C3 o
❑ NA ❑ NE
Comments (refer to questio#,):� Explain any YES Answers and/or any recommendations or any other comments,
1:1se draw�of faciltty�ta better e� plain -situations. (use additiartal pages as necessary):
/t�
C7 D 0Cx )q
ReviewP
er/Ins ector Name ` ' ✓G -S '° (: ' ' ax r Phone:
Reviewer/Inspector Signature: Date: Z ?✓f34 �/
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 ET*No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [rNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ 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
No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N ❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�No❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2No ❑ 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
2rNo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
��o❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,._,%
❑ 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
ONo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3<o ❑ NA
❑ NE
12128104

Division of Water..Quality
Facility Number 0 Division of Soil and Water Conservation x{
F
O 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: LJ Departure Time: County: 0 Ce+ Region
Farm Name: S A al C" G" rn Owner Email:
Owner Name: (KCkot LID, 1 Phone:
Mailing Address:
Physical Address:
Facility Contact:„ Title: W'f1l2.1f' Phone No:
Onsite Representative:
Integrator:
Certified Operator: �`-' �1 V�>, Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ 0 0 i 0 Longitude: ❑°= 6 0
il
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i `SS 2_1 Z a00 �� ILI Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population:;
El Dairy Cow
El Dairy Calf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
El
El
c. What is the estimated volume that reached waters of the State (gallons)?
Beef Feeder S,
Beef Brood CoNq
Number ofStrucfures:
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 V No ❑ NA ❑ NE
❑ Yes
❑ No
�[ NA
❑ NE
❑ Yes
❑ No
[LNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
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 I Structure 2 Structure 3 Structure 4
Identifier;
Spillway?: N
Designed Freeboard (in):
Observed Freeboard (in): 3.4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [R No ❑ NA ❑ NE
❑ Yes DfNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 1% No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VX(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �4,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 15QNo ❑ NA ❑ NE
maintenance/improvement?
It. 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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of, Acceptable
� �Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L...) nn!A `.G�i, ' C`] - ., 'z2m C`1 z. 0-! .. .. -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�INo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I� 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):
I
Reviewer/Inspector Name C [,C} To Phone: 3 33ao
Reviewer/Inspector Signature: Date:
12128104 0 Continued

I
6
Facility Number: Date of Inspection 0:4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �4 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
(Dvj; no. neg4 cvd, b r ,`off , lac.. S "C. �� +u
I ,n boll
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes
❑ No
)z NA
❑ NE
❑ Yes
'" No
❑ NA
ElNE
El Yes
�No
❑ NA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
❑ Yes
❑ No
CR NA
❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes r No El NA El NE
❑ Yes
[�LNo
❑ NA
❑ NE
❑ Yes
[5�No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104

Ur-,,- 0 -%. 9 q, Y 2
• Facility No. T, a In Time Out Date
Farm Name ��t D� ✓ n,—� Integrator(.. , 1
Owner Site Rep �QQ —1 W XVL j
Operator C,l4vtnc�.e� Wou.,,.,� ��_1� No.
Back-up No.
COC �� Circle: CGener or NPDES
11
Desi n
Current
Design
Current
Wean — Feed
o0
Farrow —Feed
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Design
Observed _ _ �Ll '
Crop Yield
Rain Gauge
Soil Test ✓A Wt,
Sludge Survey
Calibration/GPM
Waste Transfers
Rain Breaker
PLAT ~�
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop �
Weather Codes 120 min Inspections
Wettable Acres
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
O
Pull/Field Soil C rop Pan Window
-1 ryl d L

WJ
A" ►Division of Water Quality
F�acifltyNumber Q3 0 Division of Soil and Water Conservation
• Q Other Agency C`
Type of Visit *compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit $$(Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other , ❑ Denied Access
Date of Visit: Z C ] Arrival Time: � Departure Time: County:
Farm Name: CAM r Owner Email:
IOwner Name: Wl�[�`c D 1J�C� Z � Phone: _
Mailing Address:
Physical Address: --
Facility Contact: _ ;11.�L Title: S gj_!4)U_1CQJ4 Phone No:
Onsite Representative: ' ` Integrator:
Certified Operator: `-Y1C1�� �', Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: = o
Back-up Certification Number:
Region: FZO
"" Longitude: 0 0 = 1 = "A
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Egwean to Feeder 1 356 Z. 1 2-750
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et _+ I
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?
t
Design Curre, nt
Capacity. Population
❑
Dairy Cow
❑
Dairy Calf
❑
Da
jryfleifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood -Cowl
I
Number of Structures: t
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 PiNo❑ NA ❑ NE
❑ Yes
❑ No
V%NA
❑ NE
❑ Yes
[:]No
RNA
❑ NE
❑ No fN NA
❑ NE
❑ Yes
❑ Yes
k) No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection Z 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Et No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IRNA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Q
Designed Freeboard (in):
nn
Observed Freeboard (in): o�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
A 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?
❑ Yes
PLNo
❑ 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
maintenance/improvement?
❑ Yes M No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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 El Application Outside of Area
12. Crop type(s) y yy., SAJ O W , _'� Y 4Zc.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes §9No ❑ 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 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 No ❑ NA ❑ NE
Comments (refer to question #f): 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 %-w VUST f jam! J&4 PAY70 A) Phone: '170
Reviewer/Inspector Signature: Date:
12128104 Continued

y FaCility Number: �] --U7j Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 94No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
h 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
t&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ANA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,4No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes W No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JINo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility No. 9 Time In Time Out Date Z �_
V Farm Name C_ EIntegrator _ (y)
Owner kJ)at u utcl �•IS Site Rep
Operator tf No. 3
Back-up No.
COC Circle: QGeral or NPDES
Desi n
Cur -rent
Design
Current
Wean
SZ--
Farrow -feed
Wean - Finish
Farrow - Finish
Feed.- Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design
uiiiU Survey
Crop Yield
Rain Gauge
Soil Test PLAT_
Observed
Calibration/GPM ! ��
Waste Transfers
Rain BreakdT'
Wettable Acres
Weekly Freeboard Daily Rainfall ✓ 1-in Inspections
Spray/Freeboard Drop �_ ft1OQ Qa
Weather Codes
120 min Inspections
Waste Analysis:
` Date Nitrogen (N)
zi.
Z13a4� ,3
Z.
Date Nitrogen (N)
Pull/Field Soil Crop Pan ' Window
C—

R�
Type of Visit 6,mmp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
64
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I i I a Arrival Time: � Departure Time: County: k_ Region. �
Farm Name: 3k M t—, i J n i- '� I I
Owner Name: 4A V d/ a-�i�1��J1
It i
Mailing Address: 0 U" 15
Physical Address:
Owner Email:
Phone:
G �-$ 31 Ce
Facility Contact: L, %ju i Lx") > > 1 ' '-j I Title: 0 tJ'-3YleA'- Phone No:
Onsite Representative: �- `-'�!_ F 1 Integrator: t`12KA 6ko-n
Certified Operator"ZOU. -- _ Operator Certification Number: r
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: [� e 0 i F-� tl Longitude: = ° = 4 =
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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?
❑ Yeso ❑ NA ❑ NE
❑ Yes ❑ No �tNA ❑ NE
❑ Yes ❑ No
INA
❑ NE
❑ Yes ❑ No
?DqA
❑ NE
❑ Yes [ No
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
Page 1 of 3 12128104 Continuer!

Facility Number: —603 Date of Inspection i G
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
_WNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1911
Observed Freeboard (in): S 1 r
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 .ANo
❑ 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 *o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )71�io ❑ 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 El Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste AyOieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yeo ❑ NA El NE
maintenance/improvement? \
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))E�o
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �❑ Evidence
of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � Ml.Jld a., — GC=-`iaA f , �-�0. � l G mi� n .-- C-1lrox�
13. Soil type(s) &r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes IgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yesql No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes *No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[--]Yes 'R�Vo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any, other crnmments P%
Use drawings of facility to better explain situations. (use additional pages as necessary):
*arc y r?a ;.R
Reviewertinspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
0
1

Facility Number: —M3 Date of Inspection 7
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'ANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes)QNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? '
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comments and/or Drawings:
❑ Yes No
❑ NA
❑ NE
/1q_
❑ Yes to
XVA❑
NE
❑ Yes
ElNA
❑ NE
❑ Yeslo
o
❑ NA
❑ NE
❑ Yes 'XNo
❑ NA
❑ NE
❑ Yes ❑ No <NA ❑ NE
❑ Yes KNo
❑ Yes ANo
❑ Yes 0 No
❑ Yes "10No
❑NA El NE
❑NA ❑NE
❑NA El NE
❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes h No ❑ NA ❑ NE
Ie�co�ds CLY-e- ±� e))(,CZJler,� GYCk-r
lfC�,.VVn I S We ( _8�arLd 1'1'Li. 1"4&r n e-)
Page 3 of 3 12128104

I
Facility Number `Tl - C-) C7 3 Date_ Time IN-'olk Out
Owner_ W 0901uY e\,
Farm Name, QVVw
0.1.0 CA�911/C,e. W No. 1�
C.O.C. Gene l NPDS
Des, Current Des' n Cuff t
Wean to Finish
Feeder to Finish Farro o Wean .
Farrow to Feeder Farrow to Finish
Gilts Boars-
Otlir =
.Soil types�Y
Crop Types -S4�lQn� aIr, C7 atR Pan
Window f
Sail Test V Plat[� '
Designed Freeboard ` , Observed Freeboard
Rain gauge Rain breaker Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
Sludge; Survey �"� Crop Yield 120 Minute inspections
1-in. Rain inspections Weather code Weekly Freeboard
Pumping time Ib- 0 31
S' 3/ Vib
Waste Analysis % & MonthMo
Comments
Wa,,� G Qvluk
4

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number �/ ,� W`� crate of Visit: -G' ~ C Time.
rQ�Not Operational 0 Below Threshold
Permitted 0 Certified Q Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: e 3 rar t'` • County: 140 k e f�0
Owner Name: IJRI:t+ 61 ur dklLrtl� 1, "4, iz r L." it S Phone No: 110 • '� 9.f"- a o 1A—
Mailing Address: 1 �3n 13d X
Facility Contact: Title: Phone No:
Onsite Representative:
Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude 0' • 0 " Longitude 0 �•
;Design .,: Current Design Current': Design Current
Ca ac# Po ul
3
in [BVcan to Feeder i � .
�!
ation �� Layer . Ca achy ,.',Po' ulation Cattle °Ca acity ''Po Population
' ❑Dai
❑ Feeder to Finish , I, Non -Layer I ❑ Non -Dairy{
Farrow to Wean
❑ Farrow to Feeder 10 Other
[] Farrow to Finish
+ � Total Design Capacity �
❑ Gilts i
''
Boars Tots1 S SLW'
Y
�, (' =d 6€ €E � -
�i��iENunibersaf LBgaons % II�; : Subsurface Drains Present Lagoon Area Spray Field Area
Holding Ponds 1. Solld Traps ❑ No Li uid Waste Man a ement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
s` c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteCollection & TreatMent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:.
Freeboard (inches): __ d
05103101
❑ Yes 3'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes No
[:]Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued
i

lFadlity Number: -- 3
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, notify DWQ)
7. Do any of the strucmres need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ 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 atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
'-�.��� r .�.su, r',� rrx�+ :ra�p,,. �xr-
�CAnmm�rnts (refer to °9nesbo )` Explaiw arp''IfB.S wlrSrBRtI/Or any teaamme�atiwts or agyJOtl! AOm1l uts.
f r> t tNBi- 7 i4ia eggv^ u uyE,¢ E .`Lrs..keE,
t NiL
„ � ss ,r �' r3')- ❑Field Copy ❑Final Notes
Jr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: M — Qel
12112103 Continued

Facilith• Number 3 Date of Visit: 3 �Time: qTTT077771
IQ Not Operational--- 0Beiou' Threshold
❑ Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 4' County: 140LAk,
rk
Owner Name: l+ Phone No: _. 21
illailing Address: A 0, 3CA f 50 ���� N_C,-
Facility Contact: — Itdj�& C Title: Phone No:
Onsite Representative: A; c lam] , { jI s Integrator: C elira (E�
Certified Operator: A,w A � [i i-x Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° " Longitude 0 • •4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po ulation
® Wean to Feeder 1 10 Laver ❑ Dairy
❑ Feeder to Finish ID Non -Laver ❑ Non -Dairy
❑ Farrow to wean
❑ Fatrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ;' ❑ Subsurface Drains Present ❑ Ls oon Area IEJ S rji • Field Area
Holding Ponds I Solid Traps ;�=" ❑ No Li rid Waste Management System .. :,
Discharges & atrggM JMRacts
1. Is any discharge observed from any part of the operation? El Yes ]No
Discharge originated at: ❑ Lagoon ❑ Sprav 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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from 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 Gellution & 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:
Freeboard (inches):
05103101 Continued

Facility Number; -- 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 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. 1s there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [R No
12. Crop type r`rv.t. A 4- .S(n..
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
nNo
16,
Is there a lack of adequate waste application equipment?
❑ Yes
® No
RegUired
Reed's & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[91'No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R] No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Q No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[ENO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [A No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
05103101 Continued

I
Facility number: — 3 Date of Inspection 1 I�
F-
Oder Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes R] No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
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.) ❑ Yes �r"M' No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Addititinal ConimLntsianalor,�I)ra*ings: °:,,
05103101

I'm Routine O Comnlaint O Follow-un of DWO inspection O Follow-un of DSWC review O Other
Facility Number 'i .3
Farm Status: ElRegistered ❑ Applied for Permit
Certified ❑ Permitted
Date of Inspection �- O
Time of Inspection ' d 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:.1.25 for I hr .15 min)) Spent on Review
or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ................................................................................................................. *..Q...�.....
FarmName* .... C.... It ... i. !.. �........................ .............................................................. County:.. �.. f.....................................i........1�-+�...
Land Owner Name:. ... .. .. :..... ..e .r.1` - Phone Nc> l.r ..........�........�...................
Facility Conctact:...bG3. vl... I.: Y1 .............. Title: �RuI.Ce..I.ef° 5.D6- Pho a No:.
MailingAddress: ...... P.0...8............1.5.—o............................................................. 4� O[ l.!�. ..............., 376..
n f 7 l
Onsite Representative: ..... .1./a.U..G..D..... M.Pr..l.4m.......................................... .......................................
Certified Operator:...4 .� e hCe- ! - . w,. O tS ................. Operator Certification Number: .... 1.�?..3 ............
Location of Farm:
Latitude Longitude
Gengral
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes �10
❑ Yes ANo
❑ Yes No
❑ Yes OfNo
❑ Yes �No
❑ Yes XNo
❑ Yes *0
❑ Yes *No
Continued on back

� F
FFacility Number:................ -3.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
L
❑ Yes Q No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes )�No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes XNo
" `
Structures (1,ggoogs and/or,lioldine Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ANO
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
3
Structure 6
10, Is seepage observed from any of the structures?
❑ Yes *0
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes .14No
12. Do any of the structures need maintenance/improvement?
❑ Yes O'No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes No
Waite Applicath
14. Is there physical evidence of over application?
❑ Yes No
(If in excess of WMP, or runoff entering watersof the State, notify DWQ)
�.ls!L
15. Crop type .........6 ��,�.....1;X.'k...............................................................................................................
16. Do the receiving crops differ with those designatedin the Animal Waste Management Plan (AWMP)?
❑ Yes Q�No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes O(No
18. Does the receiving crop need improvement?
❑ Yes M�No
19. Is there a lack of available waste application equipment?
❑ Yes ONO
20. Does facility require a follow-up visit by same agency?
❑ Yes *0
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONO
For Certified Facilities Only
22, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes XNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
XYes [:]No
24. Does record keeping need improvement?
❑ Yes XNo
Comments (refer to question #). Explain any YES answers and/or any, recommend at ions or any other comments
Use: '&awings of facility to better explain situations ,(use additionatpages as necessary) L
r
,..
11.
2 3 . %4 GV0.S`� 0.ha� �SLS tiC�S T� S4�Owi �' ' w �'�'1ti i ,� 6 D
'�X
FcLr~wt is ik gaoJ ge Sure i at wQ-s E 'n'-vXXj ySiS
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 7—
cc: Division of Water Quality, liter Quality Section, Facitity Assessment Unit 4/30/97