470011_INSPECTIONS_20171231

NURTH CAROLINA
Department of Environmental Qual
II

14-S 'a- F1 0 G- t
Type of Visit: Q`Comp nee Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: CMoutlne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r D Departure Time: County: sKe Region: ,Z.
Farm Name: �' � �%f G l &i -
Owner Name: o �lz'•�•r
Mailing Address:
Physical Address:
Facility Contact: GL 4 c ck e - Title:
iC
Onsite Representative:
Certified Operator: cr
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: M ff - s
Certification Number: L6 3 t
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish lift
Farrow to Wean
S
Design
Current
Daig Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Dry P.oultr: C*.a acit P.o
Farrow to Finish
Layers
Gilts
on -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑-Ne—❑ NA ❑ NE
❑ Yes
❑ No
[3-#A
❑ NE
[:]Yes
[:]No
[3-NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[:]No
QUA
❑ NE
❑ Yes
❑-Ro
❑ NA
❑ NE
[]Yes
�No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faci!li Number: jDate of Inspection: 977kir
,Tjaste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No 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 [T 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 [Z��o [DNA ❑ 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 [. J� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [a4-4° ❑ 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 Nrr ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,--,��/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I ;,N-o ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rio ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP? []Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Renuired 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
0 NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
2,4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
D-Nt ❑ NA ❑ NE
E>er- ❑ NA ❑ NE
❑ Yes I _ ❑ NA ❑ NE
❑ Yes [3-No——] NA ❑ NE
❑ Yes g No-❑ NA ❑ NE
[:]Yes QNT--❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes EJNd�❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [:] 6 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q.Na ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q,Na ❑ NA ❑ NE
Reviewer/Inspector Signatui
Page 3 of 3
21412015

ii%y4 f�I� ��It L#� €IsiSSi{�icl 1 0. FI ,III tl�CM�',��Y�l� 11 'IE-qkl I� Irl.f. lif I Illrie:,'`��Illlii l �SI ra 'd���l.. vision'of IWate r�R1'.sou rcc$ i a . a r
sq��l l� �� i �dl�� i�jo,��► ������„�i��F�k ".,��� � F ,,�4; 1 � � I �FI I . i � I � �. i ,. ; . �' �. I °. ' .
I C� Division of Spii and Water Conservation I ' !00l
�� r � F: � kJ 6 ! 1 If., rg t {,� 1 .'�€ u � � i !�E p"9 IN�'i i"il . 9',��J !.I f� q�, "I:ih� lr .iy ui ,.i� I it !',,0 Other„ Ag'efici� ' I " .r' , .
type of visit: ampiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: 42YI routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - —/ f Arrival Time: , fl Departure Time: County:
Farm Name: ,0e- [,rot✓ Owner Email:
Owner Name: 1:961, F1c1•1`-` Phone:
Mailing Address:
Physical Address:
Facility Contact: iC �- /V/rA= r f Title:
Onsite Representative:
— >o
Certified Operator:
Region:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
F sSs
j�-',fi�gkEttl[ Iq l!,'l�lii�kFlfkiPkf ir�'
Uther„
IIlLigj,,:'lil
�IIIIII� �'`I �r I iM� f ill
Other
Longitude:
iu � � I, •
Deslgn i Current Design Current
W • ultrylI + Capacityi Pap Cattle , Capacity Pap.
et Po
" Non L
6I
rl Il lir
q,l
iIIIGi !,,,:D -Pi
'; !�:• Layers
1�15Non-t,
Pullets
k'+ Turke
iTurke
Other
'er
"IDesig"n Currrent j
ilt 1 ..�.q Ca aei , 111po
'Inoc
'ers
Discharees and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes allo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
]Yes
❑No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
M
Page 1 of 3 21412015 Continued

Facili Number: &- Date of Inspection: 421
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes $Zj No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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
LL 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste AD lication
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 R�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s)-.
13. Soil Type(s):
r k
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 Rf No
❑ NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes ® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ' ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Z-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA ❑ NE
h 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�R_No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compl iance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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:
❑ Yes CR No ❑ NA ❑ NE
❑ Yes R[No ❑ NA ❑ NE
[—]Yes [allo ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes R No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Eg.No ❑ NA ❑ NE
i'ny"o.thcr coimments.
Reviewer/Inspector Name: Phone: D
Reviewer/Inspector Signature:
Page 3 of 3
Date: /'� — y /7
21412015

MS 1 ti la bu
Type of Visit: QCo7liance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: CY Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: county: O Region:
Farm Name: GC✓t r �5 L o [tea Owner Email:
Owner Name: �� ,.� ��i 1 �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 q, A,(,C t Cel �Gi`� Title:
Onsite Representative:
Certified Operator: 11
Back-up Operator:
Location of Farm:
Phone:
Integrator: ,& 6 S
Certification Number: 10 1p
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design On en
Capacity Pop.
Wean to Feeder
Nan -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean 10DO
tUN
Dry Cow
DP■oult , C_a acl P,o Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 g!No ❑ NA ❑ NE
[:]Yes ❑ No Rl'b1A ❑ NE
[]Yes ❑ No [NA ❑ NE
[:]Yes [:]No
[:]Yes C;�No
[:]Yes [ jj o
[!f'NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facilk Number: - Date of Inspection W
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z d ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F-R--KA ❑ 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 E2fNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? []Yes [fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 dNo [] NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [SNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes u ` o ❑ NA
❑ 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 . J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S6 0
13. Soil Type(s): N tv k
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[✓]�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C3"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2*No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:�iQo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ r 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 ZNo ❑ 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 [ZNo ❑ 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

104
Facil Number: - Date of Inspection:
J4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [l]No [DNA ❑ 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)
3I. 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 7rNo
❑ Yes 91<0
[:]Yes �lo
[:]Yes QNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
LJ 'No
❑ NA
❑ NE
0 Yes
[no
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Comments refer to question #): Ezplaln any,YES
'savers nndlor any additionahrecornrriendationc ar�any other comments , ;
Use'drawings of 1ai ilit rto;better'ex lain situations. (u"se ad.diti0naL0age as necessar' ).,
I- I S -1-5
1_.�
Sa
9-- 30-f6-111
Qxf
er VL1
G
Reviewer/Inspector Name:
al qfo_ � _ figs 1
a4.L 3 3
Phone: 1b !�
Reviewer/Inspector Signature: Date: .3 \ b C r
Page 3 of 3 21412015

` a'j M r�A�ju
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: V"70utine,
lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:JArrival Time: i ` Departure Time: Coun Region:
Farm Name: �, 6G6&a`" FOUR Owner Email: 6
Owner Name:
Mailing Address:
Phone:
Physical Address: �(
Facility Contact: LUVv4�&le eM- Title: `t vL w P✓ Phone:
Onsite Representative: Integrator: w-o l J3
Certified Operator: I + Certification Number: r 4? 31 v
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean 1'10
Farrow to Feeder
Farrow to Finish ,
Gilts
Boars
Other
Other
Layer
Non -La er
ory rouury
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEZ Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�
1 =1 o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
Erl�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[a-isiA
❑ 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
&KA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[f jVo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
r 10
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

J a'
Facili Number: - Date of Inspection I VIM
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Io ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �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 [;[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 �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 [B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 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 e❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �� .UA
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[]%
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
OWo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[e,Xo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;Pfo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[IjNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[R'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[]a'<o
❑ 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
C No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Co
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

e
Type of Visit: %d'Woutine
liance Inspection U Operation Review U htructure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Na.yIpArrival Time: Departure Time: / p County:
Farm Name: C ►IG,j .C.4c x �'T�� Owner Email:
Owner Name: 6j [, `7 rr-- LgCRe!/y Phone:
Mailing Address:
Physical Address:
Facility Contact: LtA j%*-'1 Title: Phone:
Onsite Representative: N
am,Integrator: ` 1
Certified Operator: ( Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current Design Current
Swlne Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer I
Design C►►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Deslgn Current
Farrow to Feeder Dt, PouIt , Ca aci P,o
Farrow to Finish Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes l3115 ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [—]No
RE'
❑ NE
❑ NE
[:]Yes
❑ No
[�NA
❑ NE
❑ Yes
[3&o
❑ NA
❑ NE
❑ Yes
[El'Ro
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ -N v—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑c .NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[;Wo
❑ 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
ED-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q o
❑ NA
D 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
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C;.M ❑ 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 ❑ rE�vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Led'�+n�, JoL S V-0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yesl10 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0-<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [21<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 12<0
❑ Yes [24o
❑NA ❑NE
❑ NA ❑ NE
Reguiired 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
[J'<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
[2 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'N/o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 117 Date of Inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-Ne- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes [3.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C1 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [a -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 [3-No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ -No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [3-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 [B'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [],No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [5"lVo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers.and/or:.any'additional recommendatloris or any.other comments.
Use drawings of facility to better explain situations (use additional pages<as necessary):.
-R
er'4b r4t�-1
c1�ly�sµ�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�k�
°- }t � i C�107
Phone:
Date:11
r
21412014

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to
sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
Reviewer/Inspector Name:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

0 'R
•:3
0 Division of Water Quality
Facility Number ®- (� j O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Comm liance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: C8l Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
O t,U
Date of Visit: Arrival Time:.t t, Departure Time: County:
Farm Name: Ck a.-��q L,Ji a ✓- Owner Email:
Owner Name: 'i L
Mailing Address:
Physical Address:
Phone:
Region: "
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: t Certification Number: 3
Back-up Operator: (J Lcff,1 eA, -- Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean 13.00
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
]lets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes []-<o ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes Info ❑ 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 dNo [:] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes 02�go ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes []] No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continuer!

-.
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3-K5`__❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L7 "'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
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
0.>K'
❑ 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
NA
❑ NE
maintenance or improvement?
Waste Applieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑.14o
❑ NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [jKo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Csf f� 4 le_'- I — S G 0 U e s� (✓ . ____.
13. Soil Type(s): FAL6Ed-1c
T
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 []-I o- ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [LN6_ ❑ NA ❑ NE
❑ Yes M N-o ❑ NA ❑ NE
[]Yes [ZIX-o ❑ NA ❑ NE
❑ Yes []4o ❑ NA ❑ NE
[:]Yes io [DNA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'LK "'o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes nTlo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: IDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3'Y oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [B-N—b 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 ❑ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Mo ❑ 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
[3 o ❑ NA
❑ NE
❑ Yes
To ❑ NA
❑ NE
❑ Yes
[bo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
[] Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 1 0 L( 9 `} 1
Date: I S ✓ I"-6k(
Page 3 of 3 U 21412011

NQ.
In �_
-acfixty
, e
TirgQ Out �.
Date
Farm Name
integrator
-
owner
Site Rep
"
C)peratof
No.
Back-up
No.
C4C
Circle: :. General or ' NPDES
Qv
1(
. .
i
�0
-7 Awl
.. Desi n
Weari--Feed -
' Cuner►i
Farrow -- Feed
n
C,xrrent
Wean -- Finish'
Farrow — Finish
Feed — Fnish
Gilts 1 Boars'
Farrow; Wean
others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge -
Sniff Test
PLAT.
Weekly FraebMrdy
Daily, Rainfall
Spray/Freeboard Drop
✓
Weather Codes 120 min Inspections
Waste Analysis:
Date Nin en (N)
Observed `d
Calibration/GPM' 1
Waste Transfers
Rain Breaker
Wettable' Acres
1-in Inspections
Date Ni operi (N)
Pul ield
Soil
Pali
window
a
a1 v r'
t
IV
+:!
Ky
% 1 { -qi�1 i •-47

0
type of Visit: WCompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Q } q Departure Time: County: Pelke Region: Me)
Farm Name: ht1R�4'.S �IX A 1 BAR 1 ARM Owner Email:
Owner Name: t., P. Phone:
Mailing Address:
Physical Address:
Facility Contact: ChpS,\@*l,czc�K\L t2 Title: �j i,-� n2 Phone:
��. ---
Onsite Representative: MPa,t4_r CiL J-t)C V, Integrator: 421JR p AV &Owiy
Certified Operator: M1NUfkMC_f_ kInc-x jf.fka Certification Number: 1 14i
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
C►urrent
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Fop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
AC50Ilr,
P,ouitr,
Ca uci_
P,o ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthe.r
Turke Poults
Other
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes EZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes Q No G'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [' NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [ZNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [yNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

4
i
Facility Number: L47k -D t 1 Date of inspection: $ 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ga"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?: .
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
.#�:--
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ❑ No �IA ❑ NE
Structure 5 Structure 6
❑ Yes [[1No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q/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 (B"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ZNo ❑ 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2fNo [DNA ❑ 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): ZFEmu CA Hf�i 5 . G • �
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 G2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
rv—rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
FrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[vrNo
❑ 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
Eallo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2/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
[gNA
❑ NE
Page 2 of 3
21412011 Continued

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes '° No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [21No
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 C9440
27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification? ❑ Yes [TNo
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 1. 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 foliow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
[]Yes allo ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes
2/ No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments':;
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.A � .10Q%0V% ° 0A�
Phone:
Date: 5 lon
2/4/2011

Type of Visit: 0 Zou'tine
ance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit.or . Arrival Time: Departure Time: ,pp County:
Farm Name: -.- -. Owner Email:
Owner Name: �, %_� L E�G,,� Phone:
Mailing Address:
Physical Address:
Region: T
Facility Contact: LLCllE�w- Title: (04i(Jv_qr— Phone:
Onsite Representative: 6 , [C, /_41 Gr— Integrator: M_ ^
Certified Operator: ,Luc- Certification Number:
Back-up Operator: Certification Number:,�p
Location of Farm: Latitude: Longitude:
Design
Current
Design
Currcnt
Design
C•urrcnt
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
O
Equylumulf.
Ca .acit
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turke s
C1.the
urkex Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Erlfo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ff<A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes [] No ffNA ❑ 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 ED<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes R llo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Eg o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

le
lFacility N mher: - Date of Inspection:
Waste Collection & Treatment
4. Is 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 Q<A ❑ NE
Structure1I 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
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
0-<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
52'110
❑ NA
❑ NE
maintenance or improvement'?
Waste Apillication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�lo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E21<o
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site. need improvement?
❑ Yes
EKO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Cg<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
//Io
E3 o
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E 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
U 'Yo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
F2��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 EnNo ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑v'10 ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [} Yes ❑ No ❑ NA P_N_t�
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:
E
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 2'No ❑ NA ❑ NE
[:]Yes E3 1C [DNA ❑ NE
❑ Yes 2<oEINA ❑ NE
❑ Yes 2-< ❑ NA ❑ NE
❑ Yes
E] 1!o
❑ NA
❑ NE
❑Yes
2<o
❑NA
❑NE
❑ Yes
10
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommend --ations-or' any other,comments -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ,zd
21412011

j-31 S-o �r - zoI o
ivision of Water Quality
Facility Number 7 O// Division of Soil and Water Conservation
-- -- --- O Other Agency
Type of Visit CO ommp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % -3D - �d Arrival Time: /�3SA Departure Time: /n•� .SOS County: �0��
Region: FClQ
Farm Name: (2t Clr le-5 Lo c- kl e. g-+— FdYM
Owner Email:
OwnerName: 04ay ley
Loc-1Cteu. t'
Phone:
Mailing Address: iZ5 La La
b vY e.
1-clue i'V /OC4 ✓� , A/C
Z83 Z
_
Physical Address:
o- `S pc.
Facility Contact: IHAU ice' oG
�1I NC.1�
Title: OTC
Phone No:
Onsite Representative:
Integrator: Alurp� I - 81-0
Li 1"i
Certified Operator: Auk1_c-
Lockle- v
Operator Certification Number:
Back-up Operator: CAI C_S
Lock(t.4 v✓
Back-up Certification Number:
Location of Farm:
Latitude:
❑ e
=
1
=
11 Longitude:
❑ o
=
1 =
gl
Swilxe
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other----_�_... __ �� _j
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
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 O No ❑ NA ❑ NE
❑ Yes
❑ No
D<A
❑ NE
❑Yes
❑No
21NA
❑NE
❑Yes
El No
[P<A
El NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
2i rvo
❑ NA
❑ NE
12128104 Continued

Facility Number: 47—Q/l I Date of Inspection i- O-�0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L7 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30,5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
El"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
ZNo ❑ 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
B' No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
ENo ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
L+YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
L'7 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) g µ,,� � �. (} �A � SVV%4L I se
..
13. Soil type(s) _Ao y-fod -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ffNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L1NNoo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
B No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ NNo
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
LLI'No
❑ NA
❑ NE
' ft'. "c.�t Jy ' ^i fit' •'" '� ,���".
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments &. ° � }
1Jse arawmgsaf facility to better explain situations.p(use' additional pagesas
Reviewer/inspector Name ; L jC i . V: ` e S . �. �' �� Ph one: `'? l c� . 4 3 3, 33a U
Reviewer/Inspector Signature: Date: 0�0
Page 2 of 12128104 Continued

Facility Number: Date of Inspection ' 30 — /Q
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspectionss El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LTNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�.�,, //10
B o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-110
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Bolq'o'
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
� , l
GHlo
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the hermit or CAWMP? ❑ Yes ' No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
,,.�,,<
l_
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
El2 Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
..,,��
o
NA
El[I32.
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,2
L'� o
❑ NA
❑ NE
Page 3 of 3 12128104

O,y„A S _r_ ._ / I _0
IType of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit Arrival Time:; r�T� �D�.3/ Departure Time v ,' County:
Farm Name: G�harMPS !-�GCIC/PQr lgrl" Owner Email:
Region: 270
Owner Name: C1,N-le's Z': �&ea-L- .. Phone: aX0— !&66L
Mailing Address:
Physical Address:
Facility Contact: C l�icr�£�S���'— Title: Phone No:
Onsite Representative: SQL GS Z4cile4z— integrator.: 10-13
Certified Operator: L4r1 L`P� —. .&Z=�'ea-r— Operator Certification Number: 127,314
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ ' = Longitude: = ° =' =
ign C►urrent Design Current
Flien.acity Population Wet Poultry Capacity Population
Design Current
Cottle Capacity Population
ean to Finish
❑ Layer
El Dairy Cow
an to Feeder
PE]We
❑Non -La er
❑Dai Calf
eder to Finish
Dry Poultry
,
La ers❑
Non -La ers❑Beef
❑ Pullets
Dairy Heifer
❑ D Cow
❑ Non -Dairy
rrow to Wean
r0]
rrow to Feeder o�v[7 .
rrow to Finish
ts
ars
BeefStocker
Feeder
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [-Io ❑ NA ❑ NE
❑ Yes
❑ No
t"iA
❑ NE
❑ Yes
❑ No
940A
❑ NE
EjNA
❑ NE
❑ Yes
❑ No
❑ Yes [t- Ko ❑ NAB ❑ NE
❑ Yes ❑ No 0'NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection G —O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: _--�-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 +L' <0 O NA ❑ NE
❑ Yes ❑ No i'NA ❑ NE
Structure 5 Structure 6
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes Pilro ❑ 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 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes DK ❑ 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 �io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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 24o ❑ 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) w'c' ( I &-V: " g S
3.
Sail type(s) � or
r
l k_ I .
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
,..,,/'
[2 o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
2<o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2"No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
EK0
❑ NA
❑ NE
Comments (refer to question'#} Explain any YES;ansrrers and/or, any recommendatioons�or+uny. other comments.
Use drawings of facility to Better explain siivatlons. (use additional Pages as necessary} T
Reviewer/inspector Name
t ;r tY hone: d-
�3.3,35
Reviewer/Inspector Signatur -
Date:
// G 12128/Q�� � ntinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2'10 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? 1f yes, check the appropriate box below.
❑ Yes
E o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 No
E,:1, NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ No
L'NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Elgo-
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
+[<oo
❑,, NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Q<
❑ NE
Other Issues �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E?Io ❑ 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?
❑ Yes
2<o
❑ 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
[�io
❑ 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
SNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L1k o ❑ NA
❑ NE
12128104

Facility Number
Division of Water Quality
Q Division of Soil and Water Conservation .
O Other Agency
Type of Visit 0 compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit * Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: It 8� Arrival Time: 0. Departure Time: County: «- Region: ' -CJ'
Farm Name: �L! IXA [ D9.1re Qr 1--0-Ir_0 _ _ - Owner Email:
C
Owner Name: f_klt/ Lnck &Q r Phone:
Mailing Address:
Physical Address:
Facility Contact: (' &A UGL kO-r Title: O UJY-10 f _ �Ph'one No:
Onsite Representative: 1 / ! Integrator: ^ —6
Certified Operator: Co4Ck__ a ✓ 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
Other
❑ Other
Latitude: 0
Back-up Certification Number:
=" Longitude: =° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
^ ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream I, ml2acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: F1 I.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _P§.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): —�—�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'qNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �Q 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 6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window j❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) &Xn'M j a _t i _ _ � C-1 r 6 1_5
13. Soil type(s)
14. Do the receiving crops differirom those designated in the CAWMP?
❑ YesNo
❑ 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
53 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
B 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):
clReviewer/Inspector Name L Phone: l
Reviewer/Inspector Signature: Date: bat1
12/28104 Continue

Facility Number: — 1 Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 'r�LNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
`gNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑NA
❑ NE
Other Issues
'I
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�rNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NNo
❑ 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
'ANo
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
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
Additional Comments and/or Drawings:
V-'oa.r rr, �, �Qq e e�?ZX4. of k cry-,
o
�Zrm e s�, a -�� q5v v ,n4 ear o S w'
VybA��a ht lmz s+cy p use �n l5 - o c-� 3 tkt- --a
Page 3 of 3 12128104

Facility No' �� r Time In Time Out Date
Farm Name Ch2ZILA boCki _ fur r•r _ _ Integrator
Owner C �g,p luoC_k.- Lc)._ r/ Site Rep lka_ , w
Operator_ U�GE:te► K r, �;r No. _ „I,"o
Back-up No. -
COC �% Circle: eneral or NPDES
Design
urrent
Design
Current
Wean — Feed
arrow — e
Wean — Finish
crow— ' ish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test
Wettable Acres
Weekly Freeboard C /" Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
XI ]
Sludge Survey 61 Y ,
Calibration/GPM 1 ��
Waste Transf �_'—
Rain Breake'r-----
PLAT `---�
1-in Inspections
Date Nitrogen (N)
g .Z
2 2-
Pull/Field Soil Crop Pan Window
OY a

. - .
i Division of Water Quality I a
Facility Number Division of Soil and Water Conservation
0 Other Agency
Type of Visit gk
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
xRoutfne 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 15 I Arrival Time: 1 3 0--l`Departure Time: j County: Region: EFL?
Farm Name: �� I�S ty l} �1� !-'OrrlL—__ Owner Email:
Owner Name:�Cknj�&.s 1.0&&aL _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 104
_ p-' Title: Phone No:
Onsite Representative: Lll & 1 Q./L Integrator:
Certified Operator: _Malk"i CR. �te" Operator Certification Nu her:
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
Design Current Design Current
Capacity .Population Wet Poultry . Capacity Population
❑ Layer
-__� ❑ Nan -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 1 urke Pouits
❑ Other
Discharges & Stream Imnpacts
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)
Longitude: ❑ ° = ' =
Design Current
Cattle Capacity Popplaiioi
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
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?
FT
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes
❑ No ONA
❑ NE
❑ Yes
❑ No _4NA
❑ NE
❑ Yes
,lid No ❑ NA
❑ NE
❑ Yes
9 No ❑ NA
❑ NE
12/2"4 Continued

Facijity Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes NNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
�NA
El NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: -
n
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
V
ElNA
[INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes P(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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PfNo ❑ 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 6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (RNo ❑ NA ❑ NE
maintenance/improvement?
I. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 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) LAP y m uAn Hh. A/ , '_> ' ►,
13. Soil type(s)
14. Do the receiving crops diffeurom those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[O)4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
b�jNo
❑ 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):
a
Reviewer/Inspector Name Phone: /D y,33 33(M
ReviewerAnspector Signature: Date: JM
12128104 U Continued

Facility Number: — 7 Date of Inspection / d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes T&No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �iONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes "" No ❑ NA ElNE
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
&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
IN No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge'?
❑ Yes
IMIio
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No �ANA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'X1 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
56 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
'K 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 requTired by
❑ Yes
[WNo
❑ 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
9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IM No
❑ NA
❑ NE
Additional Comments and/or Drawings:
YCsz C hna.n� b"Ji 6QAJ 0 k_ x1 ,
12128104

Facility No. -7 - f Time In Time
Farm Name FQ yvrv-
Owner PMIIQV GQ"O-r
Operator C.Q.. I Ock- �Qj2 A
Back-up
jCOC
)ut Date 5. 1 — U"7
Integrator I / 1
Site Rep QIQ zL
No. i
No.
Circle: General or NPDES
Design
Current
Design
Curre t
Wean = Feed
-
00
Wean - Finish
Farrow - Finish
Feed, Finish
I
Gilts 1 Boars
Farrow -Wean
Others
FREEBOARD: Design y
Sludge Surrey V/
Crop Yield
Rain Gauge
Soll Test O
PLAT
Observed
Calibratlon!GPM
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard ✓ � Daily Rainfall t1-in Inspections
Spray/Freeboard Drop Nvy �t n
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
3 0
16(o
Date Nitrogen (N)
8 1,
Pull/Field Soil Crop Pan Window
L 3
3

=a
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: Z-22-moo Arrival 'Time: I Q # 5 1 Departure Time-. County: A/0 ke
Farm Name: t-a Owner Email:
Owner Name:.,-._ _Lo_ck/r d v- Phone:
Mailing Address:
Region: F�
Physical Address:
Facility Contact: C110V_IC-S. b. 0ckito_i,-.- Title: e�1"iNr-4, Phone No:
Onsite Representative: Integrator: " tnJAJ
Certified Operator: 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: = e = i = Longitude: = o = 6 = 1{
Design Current Design Current
Capacity Population Wet Poultry Cgpaeity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
'[No
❑ Yes
I$ No
❑ NA
❑ NE
❑ Yes
(J No
❑ NA
❑ NE
12128104 Continued

Facility Number, A:A f pate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
O�No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .2 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�[ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
['No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7, Do any of the structures need maintenance or improvement?
❑ Yes
[ ko
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D?No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
%No
ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'4'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
%No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) se.kwt u .Ir_ 6'
13, Soil type(s)
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
j�.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
%No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5rNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[WNo
❑ NA
❑ NE
Reviewer/inspector Name Phone: (giQ) ' g(p "/ SS%L
�W��,..
Reviewer/Inspector Signature: Date: Z Z Z D O (Q
12128104 Continued

:Q
Facility Humber: *'7 — j ` Date of Inspection OZ'zx-O
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 ❑ Maps ❑ Other
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil. Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C.No
❑ NA
❑ NE
❑ Yes
&� No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
[VNo
❑ NA
❑ NE
❑ Yes
rR No
❑ NA
❑ NE
❑ Yes
[5No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
D(No
❑ NA
❑ NE
❑ Yes
'M No
❑ NA
❑ N E
❑ Yes
.M No
❑ NA
❑ NE
'AddltlaRal Comaients and/or Drawings: yyT, ' 71
12/28/04

Facility Number t Date of Visit: 4 i 3 O Tune: /0: S
Q Not O erational O Below Threshold
C3 Permitted 13 Certified 0 Conditionally Certified Cj Registered Date Last Operated or Above Threshold: .._..»..___._»..
Farm Name; ..... _... C,46AXffA�.....lr..O�__ __ 15 .. ...................... County: _.» _.__.. ....... ..»....__._...._.
Owner Name: ...�rf�.1`....».»._..........cc�GiC......»».....»_._..... Phone No: ....... q.»...»».
Mailing Address: _ » »_ t Z S!-f .. 9 �� +� t f�, ». . �»._ ... _ »».. L a t� r_i,K (0 V. r..q
Facility Contact: Tide: Phone No: 1! - $ y ?Z
Onsite Representative:
Integrator:»...».»»....».».....W»».........»....».»»...... ».».»...........
Certified Operator:.„ .................. ..... » .». ....».» » .,�... ,.., _..........». Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude ' 6 44
# 911
Swine Capacity
Wean to Feeder
❑ Layer
❑ Non -Layer
Feeder to Finish
Farrow to Wean
'
G
Other
❑ Farrow to Feeder
Farrow to Finish
�Y', "' TateY DeSy
`t r
❑ Gilts;
❑ Boars,m�
NiiniWdEigooas h ✓'� E xNuM7fis (: fir , rx a w✓ 3 (-1s
.•Hnldma:AnndcN/�.Cn]tir1�Tranc _. Wlx�'e:s, ,. is r�kf ., s :u "�.. :^�.: •,
Disebarses - Stream ImUcts
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)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...»..........�»..» ... _.... _ ...». .... ___ ..__. ................. »_.»_...... » .._.._ ... ____._...._�. __.
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12112103 Continued

FacililvNumber: Lri — ll Date of Inspection 9 1 d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(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?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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
I5. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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.
Moj e_ OL
- (low op
mtar+e•t
6v bw6L
s+vk. -6
Reviewer/Inspector Name
Reviewer/Inspector Signata.re:
s!ry). ❑ Field Copy ❑ Final Notes
/FrZ�
I 1 e-(+
KO OkQ_ Wet S
s.-�ra`�vrc
,Z "&A -ft, - � (
�K
`t4 6_i to
-fa ot; se. us S 4t�A_
Date:
r17ir1M

i
������ w� x,§�,Sf c�`"' .�3 - s*`".'� �: ;rii• 4rr� 'Y F7�'w"7? ?," � -"'' >: -� �
.'�. In d ; �Frt i W�: t.� $:hd.®Division of ■y�ater li%lii{,�r `� Ce :�i �'; k I�,; +: .Y t Y. h i` sk eoE t �';.t !"i
��, � , t M ,;�;,•,�' ,sr'�Q'Divisian of Soil`and Water Canservatlon F =�'`
.r`�`R`�N}��.��:��,:'S, ^••�.�.��€�,i��.�a'xN.17°%!i`��.��.P�-a;�.[fy�,. ,:duw�l��� ;r•'-i r;:7. .. a.E..,, I .:. :#.�. : [, y U ..�»..:. .. .._+, ,M ..I�`.,4�r.. 4'. �.a., L .. ;;�§.r .. ,...�,e._. �i
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number pate of \visit: g. Time:
Not Operational Q Below Threshold
® Permitted ED Certified © Conditionally Certified ❑ Registered Date Last Operated or Above .Threshold:
Farm ?dame:Ua C%CLAj__QQQ 1C6.r r6.rb1^ - _ County:
Owner Name: c'G "A L.. cs Phone No: 6 ..
Nlailing Address: ! a.5 [I l z-V-e t-.I'n U-P_ _ a jl.n kl
Facility Contact: A __ Title: Phone No:
Onsite Representative: Gila ?o ,."5-k"t— - Integrator: l
Certified Operator: d4.A&' -T --- --- ^^ Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude Longitude �a �
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca eelty Population Cattle Ca acits, Population
Wean to Feeder ❑ Laver ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder I p'A ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I i _ I '° _ ILJ Subsurface Drains Present k L1 La oon 'Aiea JLJ Spray Field Area
Holdia Ponds / Solid TrapsLiquid
g p � "�;�_;.; � '' ❑ No Waste System ;: ,,'•.A,' f
Discharges 8 Stream IMpacts
1. Is any discharge observed from any part of the operation?
Dischar,C originated at: ❑ Lagoon ❑ Sway Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Trmatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strucnre 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): a5
05103101
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E�l No
❑ Yes Ej No
❑ Yes S No
Structure 6
Continued

Facility Number: — f
Date of Inspection 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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? (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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 1
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 3 eS—'Vti i—A x _ •dam Q r_ ! S wk — O . (_•
13. Do the receiving crops differ with those designated ir'the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16• Is there a lack of adequate waste application equipment?
Required Rem &Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Q'No
❑ Yes '10 No
❑ Yes R1 No
❑ Yes Q No
❑ Yes QNo
❑ Yes Eallo
❑ Yes M No
❑ Yes Q No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes (1 No
❑ Yes $allo
❑ Yes ® No
❑ Yes 9No
❑ Yes 9jNo
❑ Yes &No
❑ Yes F;No
❑ Yes &No
❑ Yes g No
❑ Yes �No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.� 4Mb€'- ' '(' re fe -. ,..... .. .,.... - .. m 2.rf.:. -' ..
o[nifienta{refer to question #) Explain any YES answers and/or "_any recommendations or any other coriiments.,�' �a'� �
t�= , :•.i ce...R.
•Use drawings of facilitkjiiiebetfeJ'explain situations. (use'a`dditional pages as necessary) �,
❑Field CopVFsnal Notes
;. .•.:.:
ReviewerAnspector Name .( '
Reviewer/Inspector Signature: Date:
0S103101 Continued

s
Facility Number: 4- - — f Date of Inspection 3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 9No
❑ Yes [ R No
❑ Yes No
❑ Yes ❑ No
r
Additionalf,"omirnentspnd/nricw '.' Fe ' ..�.� ;#am4
05103101
05103101

1
❑ Applied for Permit
❑ Permitted
❑ Not Operational Date Last Operated : ....... .......................... ..................................................................................................
Farm Name: .....q.l.:....L aC�CI...��.r....r......................... County:....1!......... ........................ ....
d.....
Land Owner Name:.. -!' r.L4Q .... .... ...... Phone No............... z %.....1..ZZ Z.....................................
Facility Conetact................... 5. .E......................................... Title:.....,. ujm er................ Phone No:..,.. r ' � e.......I......................
Mailing Address:....z .f�.....Z-Aker{J....r.............................................. q!A.r1.Y��u.r�....f....:1tL�.................2F3.J Z.
OnsiteRepresentative: ......... .5 e............................ ............................ Integrator:.... ..Q..r rb.(../.........................................,
......
Certified Operator:.....j!�:4r.1fu............ .LOCI) � Ql ...................... Operator Certification Number:.....................
Location of Farm:
ti . e..11P......... ..........s.... ...........,.SRh..l... ...a4......i....�....� ...!±n . 'eta.....w..%........1......o..?.,,.. n,a .................... p..............
4
LkS.RAI.. !C!Z �...L. ne.:.......................................:........................... a
Latitude • 4 44 Longitude • 4 iG
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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
4/30/47 maintenance/improvement?
❑ Yes ANo
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yesa
❑ Yes ANo
Continued on back

t
Facility Number: ....7...... Lt...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P(No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 1T0
Strug1ures (Ijaiwons and/or ilgjding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
3
10. Is seepage observed from any of the structures? ❑ Yes ANO
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ANo
12. Do any of the structures need maintertance/improvement? ❑ Yes KNo
(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 ANo
3jaste Application
14. Is there physical evidence of over application?
❑ Yes 'RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
IS. Crop type ............�..tc.rN!. 4L � P............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
gNo
18. Does the receiving crop need improvement?
❑ Yes
9No
19. Is there a lack of available waste application equipment?
❑ Yes
[XNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For Certlfigd Flicilitles Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
D(No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Xyes
!❑ No
24. Does record keeping need improvement?
AYes
❑ No
Comments`„(refer to question #) Explain any YES'answers' and/or any recornmen ations or any other comments..`
Use drawings'of facility to better explam'sittations:' (use additional pages as necessary)
2.3. �}�r1�wtP Ne s -6 k2-"' re aJ1 _t e i 4 �M0.IO1�I I KG J&t l ►l i4-. NEB 5e�
(tJiT�- ���1►1<<'iC� j�eC:10.1rST- l ue if t ie> W!� air ebKPb/t�ILTs.
*�4L, IU eed 4v,5 9d1' w %+f,... xjec-ial i 5� -it �Ajo- MC65 es4n�1 ii-A cd
a.-J -la c u d-ee Z4 k Z -e&'►n •
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc. Division of Water Qua io Water Quality Section, Facility Assessment Unit 4/30/97