470012_INSPECTIONS_20171231

r
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��I?���b#YIII�IIiI,il+ Il��I�rlr �i�'4:F1,�{IL, 41.. r �Ill:d:r ?'+� r ,Dlvisian of WaterResourees
Ij Fa-Clll Number I r Q Ot W
+I�i QIDi�I,I y aterCanscrvation .°
,� , I { ision of Sall aad-
IX���� I�,III J'�I-
il l" .I her Agency
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time; 6__,?T —a.7, I Departure Time: ;qC County: Region: 4100_
Farm Name: /y1 Owner Email:
na
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:. C"'r IGyh Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
I Y
'Eilsl¢Ig�'r►�iln@ Il Il �� 76sEl�IItIII,jt CApaCitylPlhNPOp I+k i
}I I IA tl, 4i
m III Ia1Vl ..l .� I I
ijll11
Wean to Finish
liwl�
tr
Wean to Feeder
Feeder to Finish 3 2012
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1.9
Gilts
Boars
DeSi� n I+°
g� Current I Design Current
°I�x°IYiN�et�Poultry'°-'Capacity,:s,.rPop.lrllf'3'�'1.;`Cdttle , 'CapacityF Pop.
1'
La er
Non -La e
YY�3 III, I1,�3' dr �;i.7l I I J c" I l° r:,
+
'Design Current
' "D Ppult Ca aci Po
j La ers
ail r,
Non -La ]ers.
rrllj� Pullets t' 3
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
II� r
p°-Turke s
�It1i����Yll�lr�3j incl iYHU YiIYN�ii7��F11 F s i)('' tsE`YV I �.j I �'=r �
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page 1 of 3
❑ Yes [PNo ❑ NA ❑ NE
[:]Yes ❑ NoNA L]NE
[:]Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continued

acili umber: - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
Spillway?: T
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
NoNA ❑ NE
Struc?Ure 6
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T 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 1� No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes�No
0 Yes No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes No
[] NA
❑ NE
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
Y No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload E] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes No
❑ NA
❑ NE
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ NA
❑ Outside of Ac ce able Cop Window Evidence of Wind Drift❑ Application Outside of Approved Area
the appropriate box.
12. Crop Type(s): as Q f DJPI
S
I�'vYA,�h
13. Soil Type(s): 0 web, C'01C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
10 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?
T
17. Does the facility lack adequate acreage for land application?
0 Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 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.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii 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 1P
No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

�FaciONumber: - w. 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 D NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [ONO ❑ NA ❑ NE
Phone: V33-3340
Date:
21412015

411111 Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of visit: 0 Compliance Inspection 0 Operation Review Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I I Arrival Time: Departure Time: County: ,qiQKr-,_
Farm Name: ` � Owner Email:
Owner Name: /� (/ r Phone:
Mailing Address:
Physical Address:
Facility Contact: Lme*pyt &DW r) Title:
Onsite Representative: t+
Certified Operator:
Back-up Operator:
Location of Farm:
4061 Up s
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Region:
Phone:
Integrator: _ LR -AX u
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
ury roultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Imnacts
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 D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[D Yes X] No ❑ NA ❑ NE
❑ Yes []No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J�j No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Facili Number: JDate of Inspection: 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No [P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 239
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes *0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f No ❑ NA ❑ NE
maintenance or improvement? 7—
I I .
—
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo [:]NA ❑ NE
❑ Excessive Ponding [DHydraulic 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 off�Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): L"t '&ffyu�(�Or �h _..Lry 44 0I►418J_,_C0_414 .
13. Soil Type(s): /V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�0 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�JNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question #): Explain any YES answers and/or any
Use drawings of facillty to better explain situations (use additional nae
V&4j-. A,l,le
(C,j,() 9j0_6zq_qoq1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
bl
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes [�? No ❑ NA ❑ NE
❑ Yes 1�3 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes $] No
ons or any other
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
comments..
Phone: $b—l�3-33ar1
Date:
2/4/2017

Type of Visit: 10 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 0 Denied Access
I.RIII�l�I IW II�IIY� IIS III �
Date of Visit: Arrival Time: a, Departure Time: j ,Soffj County: Region:
Farm Name: �`, , Urchynh Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
r
Facility Contact: cn,'1 &OW', Title: Hurydp.fy' Phone:
-- f --
Onsite Representative:
,` Integrator: I (�
Certified Operator: l7%1�i Certification Number: j
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Design Current
No
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
❑ NA
La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
Dairy Cow
❑ NE
Wean to Feeder
Non -La er
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
Dairy Calf
❑ No
Feeder to Finish
0
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Dairy Heifer
❑ NE
Farrow to Wean
❑ Yes
No
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.nultr.
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

~ Facili Number: D - Date of Inspection: 011-7 113
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
X 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?
N Yes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):' ,S10
1
13. Soil Type(s): Vifle
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CK No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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.
JR 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
E3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
Page 2 of 3
2/4/2011 Continued

31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. JR Yes
❑ No
❑ NA
❑ NE
c Facil ty Number: ]_ Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C'No
❑ NA ❑ NE
the appropriate box(es) below.
�TNo
❑ NA
❑ NE
❑ 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
C@ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[N NA ❑ NE
Other Issues
28, Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
CR 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
CR 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
C' 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. JR Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond Other:Mjh7 *(dj
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
E@ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ 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).
7r ��eAse_ mow Ou d� �alk�la . Pe { io�.co rJ- I���r-� 4sc � serf,
bcrtss k On n cr-t� bot k (F -d j
,ej e� 1�� � s��a� ► The gt� er ban 4s aye ok.
Is-, PleVi woe. I i�Pd - r lh/acre. i4 sevo'b j ' emolo A-,
a , Pica ie. in fila l a h r ch ezk.s aid node. weed+-hf. 011 R R :� t P1 eoq ad-c�r� j� eWs. ,
Reviewer/Inspector Name: Srhhf it Phone: 910 -1 -IM -330666M
Reviewer/Inspector Signature: Date: RAP Q
Page 3 of 3 2/4/2011

Facility No. Farm Name
Permit ✓ COC
Date b 112113�
OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
r : ■ - Actual Diarn.
�_3�---��--
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -1 Zn-
1 in Inspections
Check Lists
Needs 9–(—S-1<25)
120 min Insp.
Storm Water
Needs P
VVeather Codes,
■ - - =jMkI7:1R��k7�lIL1r��■������
• 111 � J ��1!•1-�_-----
MOM .. 111111111111111121 " = . .
.,,
glob �-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO
Date last WUP at farm °f
FRO or Farm Records
Lagoon #
App. Hardware
Top Dike��.
Stop Pump 50,
Start Pump`j
Conversion- Cu -I 3000= 108 lb/ac; Zn
-I 3000= 213 lb/ac

® Division of Water Quality
Facility Number - © O Division of Soil and Water Conservation
O Other Agency
AIlz_
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 00 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 11211411 �. i Ar ival Time: Departure Time: E� County: 45
Farm Name: i/ rnG� Owner Email:
Owner Name: 1 L U Phone:
Mailing Address:
Physical Address:
Facility Contact: rain XV 4,J c,1 Title:
Onsite Representative: y
I
Certified Operator:
Phone:
Region:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[4]Layer
Nan -L Non -Layer
Nou
Other
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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes,—g No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA .t ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

4�
Facili Number: P rl- L Date of Inspection: I2,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 77❑�� No �a 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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
F4] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Ap4'1
roved
Area
12. Crop Type(s): � x!�,55 a
f
�v' z,ea,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
` TNo
❑ 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
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

t�
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes'
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�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
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4, No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations'or any. they comments '. ` aE s
Use drawings of facility to better explain situations (use additional pages -as -necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: A'/U —! jBop
Date: 2)1 012'�,
2/4/2011

0 Division of Water Quality
Facility Number 7.� - © 0 Division of Soil and Water Conservation
0 Other Agency :T
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied. Access
Date of Visit: Arrival Arrival Time: Departure Time: ',3b County.b�`,�
Farm Name: r G (y -c Owner Email:
Owner Name: T4Cjj'0W4 IPlnC., Phone:
Mailing Address:
Physical Address:
Region: rr"Z
Facility Contact: Can e, -o .-, Title: Phone:
Onsite Representative: '� Integrator: LW $2"Ve,uh . LLC
Certified 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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes [—]No
❑ YesNo
E]Yes No
rvi-Lpr ❑ NE
1P NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 2/412011 Continued

Facility NIUmber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K) No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[�LNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2pNo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
09No
❑ NA
❑ NE
maintenance or improvement? .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes Ej No [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 jCrop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): `�iJr SM •t-. t� S
13. Soil Type(s): LOA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�LNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ 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 AS 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 b No ❑ NA ❑ NE
23."If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r7l No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: 147 - 1.2, Date of Inspection: 6123
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 j No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes fM No [:]NA E] NE
❑ Yes PO No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes®
No
❑ NA
❑ NE
Reviewer/Inspector Name: e?obw - MQ,(/Ip� Phone: 1p --03-33o0
Reviewer/Inspector Signature: 4�Q.& WC 1, Date: & 17,3111
Page 3 of 3 2/412011

Q Division of Water Quality
Facility Number
Division of Soil and Water Conservation
—J=
Q Other Agency
J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [IDenied Access
Date of Visit: 12>R O Arrival Timed
" 2 Departure Time: County: V Region:
Farm Name: + Owner Email:
ell—
Owner
Owner Name: 1'G' Phone:
Mailing Address:
Physical Address:
Facility Contact: 1l K �� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=i
= Longitude: = ° = g =11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Eqa er
❑L --
Non -Layer
❑ Wean to Finish
ElWean to Feeder
fR Feeder to Finish 1 3.52 O 1 35FVP
ElFarrow to Wean
ElFarrow to Feeder
C1Farrow to Finish
❑ Gilts
[:1Boars
Other
_❑ Other----- --- -- --J
Dry Poultry
1:1Layers
ElNon-Layers
ElPullets
ElTurkeys
❑ Turkey Poults
ElOther
a. Was the conveyance man-made?
6. 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
❑
❑ D Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Caw
Number of Structures: [III
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 Skate
other than from a discharge?
❑ Yes 0
Design Current
Capacity Population
Dairy Cow
❑Dairy Calf
❑ Dairy Heifer
Discharges &Stream impacts
. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
No ❑ NA ❑ NE
❑ Yes ❑ No ®NA ❑ NE
❑ Yes ❑ No l�] NA ❑ NE
❑ Yes ❑ Na �NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes qNo ❑ NA EINE
Page 1 of 3 12/28/04 Continued
�
J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [IDenied Access
Date of Visit: 12>R O Arrival Timed
" 2 Departure Time: County: V Region:
Farm Name: + Owner Email:
ell—
Owner
Owner Name: 1'G' Phone:
Mailing Address:
Physical Address:
Facility Contact: 1l K �� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=i
= Longitude: = ° = g =11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Eqa er
❑L --
Non -Layer
❑ Wean to Finish
ElWean to Feeder
fR Feeder to Finish 1 3.52 O 1 35FVP
ElFarrow to Wean
ElFarrow to Feeder
C1Farrow to Finish
❑ Gilts
[:1Boars
Other
_❑ Other----- --- -- --J
Dry Poultry
1:1Layers
ElNon-Layers
ElPullets
ElTurkeys
❑ Turkey Poults
ElOther
a. Was the conveyance man-made?
6. 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
❑
❑ D Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Caw
Number of Structures: [III
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 Skate
other than from a discharge?
❑ Yes 0
Design Current
Capacity Population
Dairy Cow
❑Dairy Calf
❑ Dairy Heifer
Discharges &Stream impacts
. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
No ❑ NA ❑ NE
❑ Yes ❑ No ®NA ❑ NE
❑ Yes ❑ No l�] NA ❑ NE
❑ Yes ❑ Na �NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes qNo ❑ NA EINE
Page 1 of 3 12/28/04 Continued

Facility Number: — pate of Inspection I/y/Jv
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA [:1NE
a. If yes, is waste level into the structural freeboard? ElYes I No NA ❑ NE
St ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.) 9
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes hNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA El NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes `W No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Ap lication Outside of Area
12. Crop type(s) &:=-a. S
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N No ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes [A No ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes No ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
Comments,{refer to question #) , Explain any YES,answers andlor'any recommendations or anyrother,d6ffiments
Use drawings of facility to b4tter.explain situations. (use additional pages as necessary).:
Reviewer/Ins ector Name Y ' *` �^��
P �,i _�: Phone:
Reviewer/Inspector Signature Date: g o
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No E:1NA [:1NE
the appropriate box. ❑ WUP ElChecklists [:1Design [IMaps E:1Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fQ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Yp No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
�9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
.M.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments Andlo'r Drawings: -s t4, Al
A
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: %D: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _Qai e+rt3h gr wt ' Title:
t{
Onsite Representative:
Certified Operator:
Back-up Operator:
i
Region; FW
Phone No:
Integrator: AIA -014,4 1�rA�! +►,l LAG
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
=64 Longitude: =0=4 = 4i
J
Design Current
Design Current
Design Current
Swine Capacity Population
Wet PMr
oultry Capacity Population
Cattle Capacity Papulation
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ No
❑ Dai Calf
Feeder to Finish O D
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dai Heifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy I
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
on -Layers
El Beef Feeder
❑ NE
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ NA
❑ NE
❑ Turkeys
❑ Yes
Other
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
Number of tructures:11111111 I
Page 1 of 3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
T No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
E�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EPNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
IRNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'P No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

1� f
Facility Number: — Date of Inspection '7 z
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?
gtnieture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): u
Observed Freeboard (in): 2 11 I
Yeso ElNA ElNE
rjw
❑ Yes VNo ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Reviewer/Inspector Signature: At Date: 17/- � o9
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[BNo
❑ 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
IMNo
Lfff
❑ NA
EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[51:No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
�9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JA No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Sj 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)C=401&1r wt t c 2Q 5r, . �k,
S
n
1
13. Soil type(s)/ � [ J 6C '71
01
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C9No
❑ 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
IS No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[9 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):
P
Reviewer/Inspector Name 1 Phone: %/dZV?g /3300
Reviewer/Inspector Signature: At Date: 17/- � o9
Page 2 of 3 12/28/04 Continued

', , f
Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ORNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA EINE
the appropriate box. ❑ VrUp ❑ Checklists
❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [b No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�'No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
6 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QgNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
JgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ViNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

V
I 0 Division of Water Quality � <
Facility Number 7 0 Division of Soil and Water Conservation
0 Other Agency
J
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % Departure Time: 0qr`t7�/�r County: I Region:
Farm Name: � J Owner Email:
Owner Name: I r2 Phone:
Mailing Address:
Physical Address:
Facility Contact: rajr��r\ AroWY1 Title:
Onsite Representative:
W
Certified Operator:
Phone No:
integrator: __,L4 U& -JO k4.f
,_..,1
Operator Certification Number: _ 176o-6-
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: =0 ❑ d = Longitude: =0=1
c=1 = ff
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
_ � _ � I. ❑Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Turke Poults
❑ Other
Dischartres & 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
❑ Daia Caif
❑ 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 MNo ❑ NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
❑ No
'�NA
❑ NE
❑ Yes
❑ No
CNA
❑ NE
❑ Yes
f�No
❑ NA
❑ NE
❑ Yes
qNo
[INA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection I a/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No f`NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes CoNo ❑ NA
❑ NE
through a waste management or closure plan?
® No
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 �LNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require ❑ Yes 51No ❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Elof Wind D/�r_ift, ❑ Applications Outside of Area
�Eviideence
�
12. Crop type(s) G .'W & . i�Y A--') t S. - 6'u+M �il�e� .d i J& ff�
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
29 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
121 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):
ReviewerllnspectorNamePhone: fa 3333
Reviewer/inspector Signature: Date: P-7
12/28/04 Continued

Facility Number: Date of inspection 08
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 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
[A—DNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
b No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E9 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
R' No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2TNo
❑ NA
❑ NE
General Pennit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[?TNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection 0 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 ❑'benied Access
Date of Visit: Arrival Time: Departure Timer County:
Farm Name: ZG,�U.i'Y _'2;C` Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
M
Facility Contact: ..._ �1Yt�"G�� row i) Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
e Region: ARO
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1
= Longitude: = ° =' ='g
Design C►urrent
1111111Design Current
KNo
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C►attic CO. it.- Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
El Dairy Calf
Feeder to Finish a0 ��0
❑ NE
❑ Dairy Heifer
Farrow to Wean
pry poultry
❑ Dry Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
NA
Boars
PuFllets
❑
❑ Beef Brood Cow
[�JNo
❑ NA
❑ Turkeys
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
❑ Turkey Poults
❑ NA
❑ Other
❑ Other
Number of Structures:
EE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�JNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
§j No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/2$/04
Continued

F'acility�'Number: "j — Date of Inspection �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 13 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 8 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M 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 El Evidence of Wind Drift
�, [I Application Outside of Area
12. Crop types) CO �'-rpV11 J(3"I , P_irm4ida [°ri>7z (Ia..
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
[:INA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): 'Explain any YES'; answers and/or any recommendations or, any other comments
Use drawings of facility to better.explain situations.'(use,.additional pages;as necessary): }s`:
Reviewer/Inspector Name - Phone
Reviewer/Inspector Signature: Date: '7
Paee 2 of 14 12/28 04 Continued

Facility Number: -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1;9 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 W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
59 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IN 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
�9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IN No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Cl Yes
[�g No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[,Q No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A.
Page 3 of 3 12/28/04

2 -
Type
Type of Visit O'Compl ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 Arrival Time: Z Z Departure Time: ; County:
Farm Name: / " i9exlyck? rwrrr Owner Email:
�) r
Owner Name: . �/�CyllJ iC y? Inc— „_,,,,,,,,,__„_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representati
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Integrator:
Region:
Phone No!
Operator Certification Numb:
Back-up Certification Number:
Latitude: = c =' 0 Longitude: = ° =' =
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?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
Design Current
Design Current
Design CUGrent
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
Layer
J91gA
❑ Dai Cow
❑ Wean to Feeder
LEE] Non -La er I
I
❑ Daia Calf
ceder to Finish i wo
[INE
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ La ers
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Beef Feeder
❑Beef Brood Cow
❑ Boars
Other
❑ Other
❑ Turke Poults
❑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?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
U�XA
❑ NE
❑ Yes
❑ No )RINA
❑ NE
J91gA
❑ NE
❑ Yes
[:]No
❑ Yes
10
❑ NA
[INE
El Yes
�To
E] NA
❑ NE
12/2/8/0.4
Continuer)

>F'aci*ty Number —LO ]
Date of Inspection
Waste Collection & Treatment
❑ NA
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 l Structure 2 Structure 3 Structure 4
❑ Yes �p No ❑ NA ❑ NE
❑ Yes ❑ No **MINA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ft
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'KNo [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo ElNA ❑ NE
through a waste management or closure plan? II ``
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 Vo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo [:1 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'qZNo ❑ 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 Winnndow ❑ Evidence of Wind Drift
❑ Application Outside ofArea
a
12. Crop type(s) 0Cr 1 . PlAG Amin . �ou6Qr1s . � 1L1'ih� 4Y 1A, . y1'Yi2_/I r-.r.;..0VfrWQ
13. Soil type(s) L pxl/
14. Do the receiving crops differ from those designated in the CAWMP.?
❑ Yes
Z�(Vo
❑ 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
Rq No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Oo
❑ NA
❑ NE
tb 'rM Tf
Comments (refer to question 4): Explain any YES answers and/or any recommendations or nny other'comm'ents', 1- I L
Use drawings of facility to better explain situations. (use additional pages As necessary):
i. �6,%--�� � W y,iClrl
7 G ros;o, on Nor--em��Q
In'1n u
++� 1
bk
P's Sova Q 5 pons, r Rekf/led 4 FX�OW5,dn S.erV+Ce
�r �U� &nCe. 6�
nras5 Cove.Y .
F_rYt_q n brw_✓1t -�a &e oho w- Ir n ic-a f I
Reviewer/Inspector Name PL LtqA
J7'2)AI.
I Phone: D 333 0
Reviewer/inspector Signature:
Date: 'If '�00
Page l q I IZ/ZktV Continued

Facility Number: Y3 --0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tLNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Po [:INA ❑ NE
the appropriate box. El❑Design El ❑Other
WUP ❑ Checklists
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �Vo ❑ NA [:1 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �kNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J7No
-❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes El No
❑ NA XNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes PrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes )allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ^No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes DdNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes '%No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes`�No
❑ NA
El 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 7No
❑ 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 tO No
❑ NA
EINE
33.
Does facility require a follow-up visit by same agency?
❑ Yes N2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
e_a_U (moo. tm Wz Vf(d LXA.)1 16 4a4tV'
&Ct 6vi Fa-E'M
PLAT' AJd a1 ���E�s 'leeoY��d �!; �j l a PST
iI us+ 6t vd�ea rc U
Page 3 of 3 11/28104

r
Facility Number 4 -Date Time IN Out
OwnerIJ
T
Farm Narne, f p Cly uY A �JQ ✓ir
r
O.I.0 rgl"� /�'La'Lljk� No'.
C.O.C. General NP
.Design Current' Design Current
We Wean to Feeder'
eeder to Fini _ _35.2 Farrow to Wean
Farrow to Feeder Farrow to Finish
Gilts; -Boars
Other
Soil types ,f �2 GL
JL
Crop Type Cc 'I Pan 55,
LA
Window3 15 r- ! yl
• _ _ 37 �7�
-�_7
Soil Test Plat V a �•-
Designed Freeboard ( Observed Freeboard
Rain gauge Ll" --Rain breaker t, Daily Rainfall
Waste Transfers
Calibration of spray egui ment G.P.
Sludge -Survey Crop Yield 120 Minute inspections,
I in. Rain inspections
Pumping time
i/Weather code
l /� 311 �I �
Waste Analysis % & Month
Comments
3,
Weekly Freeboard
5 _.),/ -94 - /I s
am

Facilitv Number r hate of Visit: �t6 Time: a
of Operational Below Threshold
© Permitted 0 Certified E3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: �,_ �eLl: f� _ County: !c I -
Owner Name: l--� ��.�_ -S
sA, [] (� Phone No: �/ e
r7Z
Mailing Address: FD �.7 o x 1 S�i�4 Fe. r, dra r�_ . Al C & JP? 0 (a
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
['Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' �• 0" Longitude 0 �• ��
besign . 'Current.
Swine"m oeanae'ity Poniilation
We er
to Feed
F
ederto Finish
rrow to Wean
Farrow to Feeder j
Farrow to Finish
❑ Gilts
❑ Boars
Design
Current `'Design Current
Poultry Ca achy
: Po ulntion , Cattle Capacity Population
❑ Layer
❑ Dairy
;. ❑ Non -Layer I
I
ED N on -Dairy I
�.
44,
❑ Other
i . ., .
Total Design Capacity
:Total'SSLW
❑Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
! Hglding`Ponds / Sa1ld Traps ' i ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [Yes ❑ No
Discharge originated at: ❑ Lagoon Qrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): 2 e
05/03/01 Continued

` Faeility Number: e19 -- t I -
Date of Inspection o a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
b. 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenancelimprovement?
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 (CAWNT)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
^9s..mim1�� S""'Lat""k. �t .vl_ .W.•:;^".•L'sr�Y��!";3 N3-i"� c u .'a.
Comments {refer�taigaestron #): plmn agy YDS aiaswers anuT/ar'aay�e,eoommendatiorts ar aqy aliier comments.:
N 6BIPi�kti t4...w88fNN?` ^YAt:' +iL'tjY�,99 �sy,;� .MtE°""4Wt�! ..
Use, a,sFf�6acclh W1Dettar ]sin.sit;tiaras. use=Iaelditian�al as,
i f, � I 1F=` "MINp �:s ,nece t7')= ❑ Field Copy ❑Final Nous
i.li 4l.id�-#41i. „gP:lIIe3:.4d. N l.3 .kaw § f
7
Reviewer/Inspector Nance 1111A > ,. o'� ,xgp,'/ MM ' a
Reviewer/Iaspector Signature: Date: I - 10 - •
12/12103 Continued

�. � .wro Tr°I:"�' - t � '� . Gk a, i 7 ''"{ ��T�" rL•iCR"-�i� n,j.�:y�'�° "t.; ' a � �' - 'w •�' sig r X t �.
7t
.'xi��" nil �ir� �1.� �q1f , "�i�r�,: t,�fs�,�p� OtlteCr., Ct3C',�a� � .»;r_:. Ga t, �"_ �� '.w •�L « , x ,, s � � r
IType of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility !Number Date of Visit: Time: U
Not O er tional 0 Below Threshold
0 Permitted 0 Certified M Conditionally Certified C3Registered Date Last Operated or Above Threshold:
Farm ?Name:( (� 1�� r �i, i.sr� rviG County: T_"Iclb
Owner Name: T, A lit ac_,Li Phone No: _5 d BSS -3�1
Mailing Address: A U. f3 UX 16 ,SS
Facilith•Contact: C,6yAef-nr% l3r_sj-r,.___Title: Phone No:
Onsite Representative: y.,-ezrl6 R'ML'T=- integrator: rd
Certified Operator: C, a U -S& rs,.. rnOperator Certification Number: i 71� 121'
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 4 Du Longitude ` ��"
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca achy Population
❑ Wean to Feeder
JE1 Laver
❑ Dai
® Feeder to Finish ,6A'0 I
❑ Non -Laver
❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder
El
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons i I I ;aim Subsurface Drains Present IIL.J Lagoon Area ILj Serav Field Area j
Holding Ponds /Solid Traps " ❑ No Liquid Waste Mana emetnt System
Discharges S Strom cts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lasoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsen�ed, 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 & Treatmen
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):
0510.3101
❑ Yes J� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 10 No
❑ Yes 5 No
❑ Yes M No
Structure 5
Continued

Facility Number: Date of Inspection �! i
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes j No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ®No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M No
YW
W tste Au_nlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes QlNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes PNo
12. Crop type -4
13. Do the receiving crops differ with those designated in 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?
Beectuired Records & Documents
17. Pail 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 Pail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes Ep No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�bNo
❑ Yes [�JNo
❑ Yes 5, No
❑ Yes ®No
El Yes e9w No
❑ Yes N No
❑ Yes [I�No
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes ® No
24, Does facility require a follow-up visit by same agency? ❑ Yes t No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes R,No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
a� s a•; ..,i: fig..Mp
, a,s -_-.--'akir.Tl rA'SY' - _st.S�'C e•.d4:v
tCammentsreQr t6iquestion ft); Explain any{YES answers and/or;any recommendations or any oilier` com'�;
ments:
kUAraw. ks o.�Uiciltyb_ laln situatiBs b (use.�iidditional'p;.,ui_n s c_s.aass-ry...)i ig.
.. ❑Field Copy ❑Fina] Notes
7tllf m , (Y' ('9 'rte (- I &_
I C S 1'ri' It t"C-':5rc_.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
f j ll -j r-�y j I
s2b"dam --&,r
Date: 7 11Y
05103/01 Continued

' I t
Facility Number: Date of Inspection D/ r
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �E] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [n No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments;and/or Drawings:
05103/0]

M
State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor .
Jonathan B. Howes, Secretary
Mr. L. M. Upchurch, Jr.
P.O. Drawer L
Raeford, NC 28376
Dear Mr. Upchurch:
IDEIHNF;Z
DIVISION OF WATER QUALITY
April 2, 1997
SUBJECT: Annual Compliance Inspection
T.B. Upchurch Swine Farm
Registration No. 47-12
Hoke County
On April 1, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facility. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facility was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
John Ray - Hoke Co. NRCS
Wachovia Building, Suite 714, Fayetteville FAX [phone]
North Carolina 28301-5043 N An Equal Opportunity Affirmative Action Employer
Voice 910-486.1541 50% recycled/ 10% post -consumer paper

Rorltine O Complaint O Follow-up of Dw2 Ina ecdon O Follow-up of DSWC review O Other
Facility Number 2 Date of Inspection VP.071
Time of Inspection zo Use 24 hr. time
Farm Status: .._„C « Total Time (in boon) Spent onReview
or Inspection (Includes travel and processing)
Farm Nana: T a r.Z"!ayc. County:or
Owier Name: L.Erwl �.rsc.�� �� ✓.a . ,� .,� Pbone No: VL O)
Halling Address; G .�'' � L�, ir�I�idf. Y _..��
Onsite Representative: htegrator. ,G'r.G014Y
Certified Operator. L.e.-%s &&I- 4. At,6 ...” Operator Caffleation Number. AiPJ C
Location of Farm:
Latitude Longitude
ra Not O eratlonal j Date Last Operated:
of Operation and
Other Tyree of Livestock
1. Are time any buffers that need maintemncxJmnpravement? C1 Yes ® No
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was tate conveyance man-made?
b. If discbarge is observed, did it roach Surface Wates (If yea, notify DWQ)
c. If discharge is observed, what is the estimated flow in pMnin?
d. Does discharge bypass a lagoon trystem? (lf yes, notify DWQ)
3. Is titers evidence of past discharge from any part of the operation?
4. Was tbere any adverse impacts to the waters of the state other than from a discharge?
S. Does any part of the waste management system (other than lagoonsUlding pontis) require
maintemcc mtprovernmt?
93 Yes 0 No
13 Yes ® No
C) Yes ANo
C1 Yes 19 No
O Yes JO No
13 Yes JKNo
C) Yes JR No
Cond owed on bark

6. 1s Scl'lity not'm compliance with any applicable setback criteria?
7. Did the facility fen to have a certified operator in responsible charge Of inspection dwr 1/IN7)?
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponce
9. Is structural freeboard less than adegtmtie?
Freeboard (ft): Lagoon 1 -Lagoon 2 Lagoon 3
10. Is seepage observed from any of the struchm?
D Yes 10 No :.. .
D Yes JO No
E3 Yes M No
E3 Yes ®No
Lagoon 4
Yes 13 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes IQ No
12. Do any of the structures need maintenanWimprovement? Yes ,N No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate,public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Avolication
14. Is there physical evidence of over application?
_(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type�*� 4��--
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
IS. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified. Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
11. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewfinspection with owner or operator in charge?
® Yes Wo
Yes WNo
E3 Yes XrNo
13 Yes MNo
13 Yes No
E3 Yes eQj No
0 Yes JUNo
Yes ,Q No
j$( Yes E3 No
® Yes ED No
E3 Yes jo No
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Reviwer/Inspector Signature: 2::Z�Vle-eo�-00, Date: Y-/- f 7