620012_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

o" n f Water Resources
Fgcility Number Division of Soil and Water Conservation
"'©
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: ! (,Zi^, Departure Time: —' County:ge- Region: 01lAo
Farm Name: �fri �y. Q� ��-+� �c-� Owner Email:
Owner Name: /' u^ �`S Phone:
Mailing Address:
Physical Address, /]
Facility Contact:Title: Phone:
Onsite Representative:
N
Certified Operator: Sri'ix N ► I oLwtt Hz h
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 4L /' "-t4tS
Certification Number: _ M /
Certification Number:
Longitude:
Design Current.
Swine Capacity Pop.
Wean to FinishI
Design Current Design Current
Wet Poultry Capacitin Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
? o
Da
Laye
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
D—Myl E;oult . Cs acl P.o Non-Dai
Layers Beef Stocker
Non -La ers Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I Pullets
Turkeys
Turke Pouets
Beef Brood Cow
t�M
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes ❑ No
NA ❑ NE
�]NA ❑NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No JENA []NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes $ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

rF acIIi umber: Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yeses waste level into the structural freeboard? ❑Yes
Structure I
Identifier:
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
2
No ❑ NA ❑ NE
No }DNA ❑NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): �11 36k
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.) 7�
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes V§ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? []Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ® No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 % ❑ Evidence of Wind Drift ❑ Application Outside of Approved A a
',
12. Crop Type(s): nsla1& -ir�.�^6tQ 6�rqS s
13. Soil Type(s): A14._' t tj- q
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[DNA
❑ NE
❑ Yes J] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® N
o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

1Facili 'Number: A 2 jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[P No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fai l 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
M No
YV
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes P 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 EP 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 [�g No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 1� No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[] NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? .
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer torqueetlon #): Explain any YES :answers: and/or any additional rec6fbtnendations or any other,comn ents! 1
Use drewines of. faclllitvao better explain situatii►ns'(use atlditionul pa&es as;necessarv) ' '
a .;' , :y'
�.--r y ,-,
�;i. T.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: .? `?3Ct7
Date: $r
21412015

r `
®_ © i�-Division of Water Quality
Faclllty Nu mber 'L 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:/40MWywtPkWRegion: P90
Farm Name: 1401 W Cy-edc RLW-.,- Owner Email:
Owner Name: {j-- Pu- ✓ " �^'�^� C Phone:
Mailing Address:
Physical Address:
Facility Contact: ny 114O ►^e Title: Phone:
Onsite Representative: If Integrator: /� 4, "'C?
Certified Operator: FY-'t)�LN P 1.6 n
Back-up Operator:
Location of Farm:
Design. Current
Swine . Capacity Pop.
Wean to Finish
Wean to Feeder r D
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: ly 3,9 5
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non-L
Pullets
Poults
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?
h. 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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® 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 [8 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rV No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes T� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

t
Facili Number: - Date of Inspection: 619 Ile)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑No �NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SS5- ri
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ZM 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 fCrrop Window DD❑ Evidence of ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ta ( 60,,4'r�,9(4 /Y LiSA,-e 5vt , cvv.�k e A4,f
13. Soil Type(s): it ,QtJ off-, Lla { tel
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
T
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 F No
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r" No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I
Facili Number: n- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
[� No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E 0 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
[P No
❑ NA
C] NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
[�g No
❑ NA
❑ NE
Comments refer to uestion # Explain an YES. answers ,, y� ments1' ' q ) p y and/or.. any a t ana recommen at ons or an of er cam,
iOWn
Use drawings of facili to better explain situations use additional pages as nccessa`�y
%o0 2 C"►-'e' f1 y S 1(4 d -C jea-plue
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

t ype of v isix. ® %_ompnance inspecnon v vperanon xeview lJ structure Lvaivanon V I ecnrocai Assistance
Reason for Visit: 46 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: KI 1 t{►J b I Arrival Time: 2 ,.^ Departure Time: " County/ua Region:
Farm Name: �a�cll�� 1' � Owner Email:
Owner Name: G &V , S Phone:
Mailing Address:
Physical Address:
Facility Contact: /V/ p Title: Phone:
Onsite Representative: Integrator: NG--p"l-u l S
Certified Operator: ri 4t11 Hf� �7*DYt Certification Number: 186501
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Deslgn Current Design
Current
Swine Capacity Pup.
Wet Poultry Capacity Pop. Cattle Capacity
Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder-.2
QI00
Non -La er Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
besIgn Current Dry Cow
D . Pry poultry Ca acit Po Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turke s
Outer
T key Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �g No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes [:]No
❑ Yes [� No
❑ Yes No
�NA ❑NE
NA ❑ NE
® NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
T No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i
Structure 5
Struc
re 6
Spillway?: T
Designed Freeboard (in):
Observed Freeboard (in): N
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes]
No
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
TT
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 [y� No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IT No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidgncq of Wind Drift ❑ Application Ou si8&of Approved Arga
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes No
❑ Yes No
❑ Yes []i No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
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
E�] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ep 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
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EP No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

FacilityzNumber: IDate of Inspection:
r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ 3 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.
T
X Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
6 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M A-r
Phone:
Date:
21412014

do
0 Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation11
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review C) Structure Evaluation C) 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 Time: Departure Time: County G&bt0/-15Region: A/_0
Farm Name: �Q C".r1_6= "'�a..•L... Owner Email:
Owner Name: IVG`Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
H
Phone:
Integrator: A C ! 4,,rj-
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder D 7 O
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -Layer
Design Current
Dry Poultr Capacity Pot).
Lavers
Non -Layers
Pullets I
Turke s
Turkey Poults
Other
Dischar¢es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy-
Jl3ccf Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
Yes No
❑ Yes ® No
[j5 NA [] NE
1PNA ❑NE
®NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

vacili Number: - Date of Inspection: ?
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 d4 20
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M9 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
[A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
[] Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind�Drift ❑ Application Outside of Approved Are4
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diff6r from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes
❑ Yes
❑ Yes
R No
® No
No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
[DNA
[]NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�g 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 [3 Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
4q] No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
[] NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Fgeili Number: 2 jDate of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:)Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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
�j] 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
LP No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[9 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments ; ; 1 ,
Use drawings of facllity'.to better explain situations (use additional pages as necessary)•' :
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9 r&-77f —,?-W
Date: g 7
21412014

g • Division of Water Quality 11
Facility Number ®- ® O Division of Sol] and Water Conservation
O Other Agency
Type of visit: 6 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: ! ZOtt County:/MCAr f
Farm Name:,Region: ,n
�G? g^Q2 L� �W% Owner Email: r
, � - --_ ---
Owner Name: yok �t S�,pC� k+'n I L Phone:
Mailing Address:
Physical Address: ff II
Facility Contact: Y'I`Ct xlQ t'N h Title: Phone:
Onsite Representative:
u
Certified Operator:
Integrator: '4e!
Certification Number: r3o%
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.
Layer I I Ed
Non -La er
Pullets
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-DaiLy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes N No ❑ NA ❑ NE
[]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 21412011 Continued

Facility Number: (o - Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �R No 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-311— 304
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
%
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FMNo
❑ 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'?
7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E)� 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
, Wind w ❑ Evidence of Wind/Drift El Application Outside of Approved Area
12. Crop Type(s): COQ.Sm1rFl` ry 4 �K�, �Gsf�`�� i �►'tl?-+'r�� o1r{,✓ 1, { r'"«.e.,. >
0. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes m No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Eacili Number: Z- Z Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes { No
Other Issues
❑ NA ❑ NE
❑ NA ❑.NE
❑NA ❑NE
❑ NA ❑ NE
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)
T
31. Do subsurface file drains exist at the facility? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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 M] 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/wany additional: recommendations or"any other comments* ,
Use drawings of faellity.to better explain situations (use additionaupages as necessary. )° ,F f �„ j;, F „':ti,.iP 'i a ,' ;'.; i, q, $ea:
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l0-' t ? —� P
Date: g
21412011

ype of visit: w i,ompnance tnspecttun v tiperatiun meview v Structure r vaivamrn v t ecnmcai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:' Arrival Timer Departure Time: Q Q County: MQ►�om Region:
Farm Name: AhW CteCF p� Owner Email:
---
Owner Name: 40ke_ Wye_5 A.L F&rrl.j' Phone:
Mailing Address:
Physical Address:
Facility Contact: 16'\n� l a4,.+, Title: Phone:
( M
Onsite Representative: { Integrator: 1 � ! Q1V_0 L1 4- e,0
'
Certified Operator: Certification Number: 18 30q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current llesign Current
Design Current
Swine
Capacity
Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
i : -'
Design Current
D-, ,_Poultry . C.a ael PAo
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Non-Layers
I Beef Stocker
Beef Feeder
Gilts
13oars
Pullets
Beef Brood Cow
h _
Turkeys
Other
Poults
Other
—Turkey
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
�NA ❑ NE
�NA ❑NE
N NA
❑ NE
[DNA
❑ NE
❑NA
[]NE
Page I of 3 21412011 Continued

Facilit , Number: -I Date of Inspection: 2j 1311.
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA
a. if yes, is waste levei into the structural freeboard? ❑ Yes No NA
Structure 1 Structure 2 Structure 3
Identifier: A
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _
—
Observed Freeboard (in): O� 36
5. Are there any immediate threats to the integrity of any ofthe structures observed`?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
❑ NE
❑ Yes 9�1No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes 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 ;S No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Dg No ❑ NA ❑ NE
maintenance or improvement'?
11. is there evidence of incorrect land application'? Ifyes, check the appropriate box below. ❑ Yes Z] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN >.10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops di ter from those designated in the CAW MF!
U Yes
No
U NA
U 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Dg No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JR 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
13 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections [3 Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1)] No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�j No ❑ NA ❑ NE
Pare 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:
2& Did the facility fail provide documentation Oran 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
T
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
1 "
❑ 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
0
❑ 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
TT�� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orkanyK ther commcnt9l ¢ , A,-
Use drawint!s of faellity to better ex0ain situations (use additional onues as necessar►1._ .: = .. ..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4?10`- 17:Z CD
Date: ,2,,h3 %�
21412011

Division of Water Quallty
Facility Number O Division Of SOIL and Water Conservation
n Other Agency
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: D : ZO i., Departure Time: County: Region: =+ "0
Farm Name: AakedCretk
ff � Owner Email:
Owner Name: {a��'ae_5 t7GL , (-LC Phone:
Mailing Address:
Physical Address: j j _[
Facility Contact: __9 n✓v P1Qv►''1 r 7� _Title:
if
Onsite Representative:
I�
Certified Operator -
Back -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: u-✓O L4, � CC( -
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = t Longitude: ❑ ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
t ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischary.es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current:
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b.- Did the discharge reach waters ofthe State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �] No ❑ NA ❑ NE
❑ Yes
❑ No
Q2 NA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
LCj No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes []No MNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
, y
Observed Freeboard (in): 7y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ElNE
IP
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [29 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 Lr+2rNo ❑ 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)
4. 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 Ep--No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [PNo ❑ 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 Df�r�`iift_ El Application Outside of Area J
12. Crop type(s) c�L &e W1r. {�Lq Gy-a5S (4� ) , Sn^' l?ra4In 0t�-4 j St,(WWke.,r 4h"
13. Soil type(s) X6 , , c yd..y 1 Pq *4/1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CFPNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[)5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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
E] No
❑ NA
❑ NE
Comments refer to.: uestion. : Explain an YES answers and/or an recommendations on aiu other comments
(. t# ) P Y Y Yet �
Use drarvingsl of facility to better explain situations. (use a(iditionA pages`as necessary):;
Co
«,.d5 . Qaod FdA-A, .
L+GI'+v,l. L CQ�t`f"'6^ `F�`e. uetzc
A 14s, y
393 a, nks � t
Sago,, S ,r, 5 NG
Reviewer/Inspector Name ' 'dk "
Phone:
Reviewer/Inspector Signature:
Date: 0
Page 2 of 3 1212`8104 Continued

>H acility Number: — Date of Inspection
Required Records & Documents I
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. floes the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes [WNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
K;; No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J�j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[F�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
f�) No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
I
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P 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
Page 3 of 3 12128104

r
-Division of Water Quallty
Facility Number 0 Division of Soll and Water Conservation
0 Other Agency
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I
�/Arrival Time: O7:IS[Z Departure Time: County: Region: �
IUAj l.h2o—
Farm Name: ��t k 61'►n_ Owner Email:
Owner Name: dD i�e_ u,64yC�- r,,m u-C Phone:
Mailing Address:
Physical Address:
Facility Contact: brig , �Q1 14n, Title:
ti
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
01
Phone No:
Integrator:lYl�- ceakon
Operator Certification Number: 19302 _
Back-up Certification Number:
Latitude: o =1 Longitude: [� o = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
ILl Turkev PoultsI I
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No [P NA
❑ NE
❑ Yes ❑ No IFNA
❑ NE
❑ Yes ❑ No [;aNA
❑ NE
❑ Yes [ No ❑ NA
El NE
❑ Yes [RNo ❑ NA
❑ NE
12128104 Continued

Facility Dumber: CZ=
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P9 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spiliway'?:
Designed freeboard (in):
Observed Freeboard (in): a9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(iel 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 1j§ 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 P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FRNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)' � DUV-,otq (.-wo_ s 1K4+, ) ,3m.
13. Soil type(s)
414
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
f�LNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ZINo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
'21 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Commeneferta question,#) ,Explain any¢YES�answcrs and/or any recommendations or aElm ny other comments.
t� 4 4F ti"M t t r^r� .irM1�be ' '1
Uxyr��stl,rya,winggt�of tacllity .tu bcttwexplain situations (use u, ditlonaI pages as necessary}:
�Sk�Ji'sJ?aW�� Phone: [phone]
Reviewer/Inspector Name _
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

V .
Facility Number: Date of Inspection +�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 15�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R9,Vo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �PVo ❑ 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 ❑ No [ANA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[,909,10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�D NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
29 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 nonnal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility tail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit'? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
EgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V9 No
❑ NA
❑ NE
Additional Cbmmentslandlor Drawings Vpp x,
,. �'i v � 5*l'J
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Sail and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date or visit. 3 0 Arrival Time: Departure Time: M 7 �h L County:
Farm Name: /Vat`.C[rt `�-' —Ak �m Owner Email:
Owner Name: d olk_- b1ye S'JL_ 65 i LLC _ Phone:
Mailing Address:
Phvsical Address:
Region:
t
Facility Contact: rim, Yr►, Umh Title: Phone No:
h I
Onsite Representative: Integrator: _ 1if
+'
Certified Operator: Operator Certification Number: /83cp
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 c = t Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made'?
Cattle
Design Current ,j,
Capacity Poptl ition_? :�
El
Dairy Cow
El
Dairy Calf
❑
DairyHeifei
El
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
El
Beef £hood Cow
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)?
i
ow .
Number of Structures: "
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [P No ❑ NA ❑ NE
❑Yes ❑No §2NA
El NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No 'NA
❑ NE
❑ Yes (0 No ❑ NA
❑ NE
❑ Yes 0 No ❑ NA
❑ NE
12128104 Continued

5
• Facility Number: � �j_ Date of Inspection 1 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ERNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
t�)NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
aa
Observed Freeboard (in): �Ufl ����
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
*No
❑ NA ❑ NE
(icl 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 ofthc structures need maintenance or improvement?
[ LYes
❑ 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
RNo
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
00 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
N 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. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
1, Ke 6? ��Y� t1 hGj o n bare- ckr?o 5 D YN 0
1)
J1
5
o,, remove
Reviewer/Inspector Name iW b Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4� 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EDNo ❑ 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 PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZjNo ❑ 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
ZJ 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
SNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$,No
❑ NA
❑ NE
Additional Cofinents and/or Drawings:
a
12128104

Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival "Time: Q Departure Time: County: Region: '
Farm Name: Naked ce%e k /ah_t7l Owner Email: %(
Owner Name:". LI'ytS _ i�xmS uc Phone:
Mailing Address: I' �jC) Box 1559,
Physical Address: Uct
Facility Contact: nQ N �7 Title:
LI
Onsite Representative:
Certified Operator:
Back-up Operator:
I
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 [� 4 [� fil Longitude: 0 ° 0 , =
11
Design Current
Design Current
Design
Gurrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder 10 1 1 W Ion
-Layer I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow t Finish
❑ o s
❑ Gilts
❑ Boars
D out .21 I
❑ La ers
Non-L
❑ a ers
❑ Pullets
❑ Turkeys
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Other
❑ Other
❑ Turkey Pouets
❑ Other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IF No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[P NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
1�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
[ INA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
E�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 I of 3
12128104
Continued

acility Number: Date of Inspection 1 `
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CpNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Stllructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
fr
Observed Freeboard (in): r�
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes
EjNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
F314o
❑ 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
T�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
qLNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
V No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑/1 Application Outside of Area
� �
12. Crop type(s) &'ry1L o, �GSS
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91 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
[I NE
17. Does the facility lack adequate acreage for land application?
[3 Yes
IS No
IS No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
�",7
.Comments (refer to question #): Explain any YES answers and/orkany recommendations or any other comments a ,',a.
Use drowings,ofpa ,facility to better -explain situations. (use addittonal,ges as necessary):
a a-• .
Reviewer/Inspector Name ] �, ',; Phone:
Reviewer/Inspector Signature: Date: ' J .240�7
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 1 a4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Callo ❑ NA ❑ NE
the appropriate box.
❑ WIJP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? i f yes, check the appropriate box below. ❑ Yes P 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 [4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1p No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
;SNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes �(LNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N 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
0 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
�K 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
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
SNo
❑ NA
❑ NE
AdditionaVComments and/or Drawings: ;
Page 3 of 3 12128104

f
Type of Visit ErComPliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up 0 Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: 0 1. 00 1
Departure Tinie:
I ,j County: M44-2-L�[ Region:
Farm Name: —I1 I a e-J
__ C_'e-ee t-, _
_ _Fa rm_
Owner Email:
Owner Name: _ _1 o _-
6) 1 ,,y e 5 7—or-
k 6f#"'&L_
4 G C Phone:
Mailing Address:
Physical Address: IIJ l
Facility Contact: !' i ct.�1 f-1 Gam+-tCi, r -ILD"1- Title:
Onsite Representative: 2'u7
Certified Operator: , -fa -C
Back-up Operator:
Location of Farm:
Phone No:
Integrator: %%?u ✓
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = Longitude: = ° = `
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder
Oj-
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
❑ Laver
❑ Non-Layet Ii
I ,
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pulicts
❑ Turkeys
Ulurkey Poults
❑ Other
Disc-harp,eti & 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®} I
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
E4No
❑ Yes
9 No
❑ NA
❑ NE
[:]Yes
%No
❑ NA
❑ NE
12128104 Continued

r _
Facility Number: — Date of lnspection
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?
El Yes
ZNo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: f .21
Spillway'?: —Y-e_3 _ - - � rs
Designed Freeboard (in): 1 � _4
Observed Freeboard (in): 121 j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(iel 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?
O.Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C.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
(9 No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable ❑ Evidence of Wind Driff [I Application Outside
of Area
fft�Cropff,Window
12. Crop type(s) �!! i Lr�tel "- /Smw�Ir rai Y+- �'Dd rf / Si. tom' anzl
13. Soil type(s) W GL l� u_ ll G� / C'czC D ►'-' + Y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�9No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
PrNo
❑ 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
ie drawingsf fticiiity�to'"b ttcr�ezplain situations (use�additional�page��syg�,-,�a�s necessary,): �
Mow l vow- 73 ..k r d- s r r� ba.s®,6 L...a--
Reviewer/inspector Name ,'i w'� �k I
� %�%i
Phone:/D- %Sr�i� u .P�
Reviewer/inspector Signature: Date:_-p2,-t7p(p
.12128104 Continued

Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropirate box.. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
CA
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking KCropYieid ❑ 120 Minute Inspections 0 Monthly and I" Rain Inspections ❑ Weather Code
130
22.
Did the facility tail to install and maintain a rain gauge?
IN Yes
gNo
❑ 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
[K 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 rail to have an actively certified operator in charge`?
❑ Yes
®No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
M NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance ol'the permit or CAWMP? ❑ Yes L4 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
J9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JW No
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
I ID K1,/1 Aa: k-
�u FDar mot A)o
Re"77 0 4el— y� u A-) Y r dt SL- t4�� e 17L7L---
12a8/04

Facilin lumber a bate of Visit: y Time:
Not Operational 0 Below Threshold
Permitted 0 CerPtifsed 0 Conditionally. Certified ❑ Registered Date Last Operated or Abase Threshold:
Farm Name: l� &ILe a C-^2tL4-, �G.rrv— County: M &Wl�G 61, f _ f n
Q If
Owner Name:-----ii el_t.l&reel c i [��l�y„1�tSln Phone No: _� JDJ4 ci 3
Mailing Address: .,�/t - _
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: cC r
Certified Operator: .l e5<SI C-4 �-�i3>_�%-�. Operator Certification number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0` �" Longitude 0
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Po ulation
Wean to Feeder
104
❑ Laver
I
I
I[j Dairy
❑
Feeder to Finish
10 Non -Laver
1
10 Non -Dairy
❑
Farrow to Wean
❑
Farrow to Feeder
❑Other
❑
Farrow to Finish
Total Design Capacity
❑
Gilts
❑
Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present J ❑ La oon Area 10 S rav Field Area
Holding Ponds / Solid Traps lj JE1 No Lig uid Waste Management System
Discharges _& StrUm IFURActs
1. Is anv discharge observed from any part of the operation? ❑Yes No
Discharge oritinated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen ed, 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 lCo Iecti2g 8 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 6
Identifier:
Freeboard (inches):
05103101 Continued

t,
Facility Number: — f Date of inspection
No
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes �]
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes q 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 W No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �@ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes V9 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [�JNo
12. Crop type ja -1-r^ 4- sm G'rd_IA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes
W No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[ No
19. Does record keeping need improvement? (ic/ irrigation, ITceboard, waste analysis & soil sample reports)
❑ Yes
® No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
® No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
[ 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
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
VJ/VJ/V[ \.Vr/rLr,NG-

Facility Number: (.,a-- f,L Date of Inspection [�
Odar ?sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
3 l . Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes [2FNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No

Type of Visit ® Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Faciliry Number Date of Visit: G aG Time:
Not O erational Below Threshold
® Permitted ® Certified Li Conditionally Certified 0 Registered Date Last Operated or Above Threshold-.
Farm Name: I.S'CJ" Gr'f r k' County: 0,1' i-e2 n
Owner Name: -- --I dLJw-A^ Phone No: O �g
Mailing Address: 4,1 rCl d i �.�, 6t� �ri -_ sp h_L'sjr
Facility Contact: 144"! d&_M . t4' t' Title: Phone No:
Onsite Representative: 2a r Integrator:
1 Certified Operator: (3 r, G`n � G. rrl I rk Operator Certification Number:
Location of Farm:
1ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude a Or
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle capacity Po ulation
® Wean to Feeder ! C FMLaver ❑ Dairy
❑ Feeder to Finish JE1 Non -Laver I ID Non -Dairy
❑ Farrow to NVean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
JLi Subsurface Drains Present I J Lagoon Area LJ SPrac Field Area 1 1I
❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen�ed, 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 & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i" .s'-rt
Freeboard (inches)-.
05103101
❑ Yes tP No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
El Yes No
❑ Yes EANo
Structure 6
Continued

Facility Number: — f a I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ire/ trees, severe erosion, ❑ Yes IgNo
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 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
W-asteApplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes M No
12. Crop type 13 erm w j e_ -4-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
IL'dLmj No
c) This facility is pended for a wettable acre determination'?
❑ Yes
P No
15. Does the receiving crop need improvement?
❑ Yes
E[No
16. Is there a lack of adequate waste application equipment?
❑ Yes
b No
Required Records & Docum
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available`? ❑ Yes '® No
19, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes n No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [� No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes CO.. No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ER No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Q No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
v✓i v�i v J �r VliN/J NGN

Facility number: (� — 1,Z Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
iiquid level of lagoon or storage pond with no asitation?
27. Are there amdead animals not disposed of properly within 24 hours?
28. is there am evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure. and/or public propem )
29, Is the land application spray system intake not located near the liquid surface of the lagoon?
30. NVere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover.?
32. Do the flush tanks lack a submersed fill pipe or a permanentltemporary cover?
❑ Yes C� No
❑ Yes No
❑ Yes ® No
❑ Yes [�l No
❑ Yes 1�O No
❑ )-es [2 No
❑ Yes 5Q No
Additional Comments and/or Drawings:
w
•
05103101