630003_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

type of Visit: 49 Compliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine Q Complaint O Follow-up O Referral O Emergency O Other C) Denied Access
Date of Visit: I Arrival Time: U Departure Time: = County: �Ae� Region: /C;"Zo
Farm Name: j x /}-e 5_t _11 is Owner Email:
Owner Name: Iv 6- 1'LCn-uS Phone:
Mailing Address:
Physical Address:
Facility Contact: boo' Title;
Onsite Representative: N
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /U�L'^ V,j
Certification Number:
Certification Number:
Longitude:
Design .Current
Design Current
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry Capacity
La er
FROM pacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
&
Design Current
D , l:o_ultr, Ca aci P.o
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gifts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Qthsee
Turkey Puults
Other
Other
INT.iP+B,"i6'Sti?TY:[ 15�F19_bSl`5'.�:A&�?Le
IIel.LVRs.Ln"i'
Dischar es and Stream Impacts
l . 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 DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
[� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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

Faellity Number: - 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
StrucWre
1Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 'L 3
Spillway?:
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
❑No g]NA ❑NE
Structure 6
Yes
F No
❑ NA
❑ NE
❑ Yes
No
❑ 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 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
maintenance or improvement? 9
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EP 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
1,, [3 Evidence of WindDrift[3 Application Outside of Approved Area
12. Crop Type(s): C7a ` 1`i^'`o"u C
13. Soil Type(s): }�- Z,✓,}If
❑ NE
❑ NE
14. Do the receiving crops diffdr from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
T No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
[3 NA
❑ NE
❑ Waste Application [3 Weekly Freeboard ❑ Waste Analysis [3 Soil Analysis
EP
❑ Waste Tran fern
❑ 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
21412015 Continued

Fa lit Number: jDate of Inspection: /Y
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 [T No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes j No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes b� No ❑ NA ❑ NE
Comments (refer to quest€on ft Explain any YES answers and/or any additional. recommendations or any other comments
Use. drawings of facility to better exoil ' situations (use a`tlditional`pages'as neees'sary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 5 (t-
21412015

9 Division of Water Quality
Facility Number - © O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 4) Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Dp7 M Departure Time: County:
Farm Name: f �(`P GLI'S4,kS Owner Email:
Owner Name: ( G— ,rv1-1 S Phone:
Mailing Address:
Physical Address:
Facility Contact: y::2 C6�22 Title:
Onsite Representative:
Integrator:
Region:
Phone:
�C �ic,rv�1
Certified Operator: 14 Certification Number: %7� 7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
I 1E]
Non -La
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?
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)?
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
P NA
❑ NE
❑ Yes
[]No
MbNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No b NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Wo ❑ .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 1 of 3 21412011 Continued

1Facili Number: - jDate 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 I Structure 2 Structur Structure 4 Structure 5 Structure 6
Identifier: � 2�
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): q2,�
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?
❑ 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 ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes [46J 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 Aapllcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? ff
11. Is there evidence of incorrect land 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 ❑ Evidence of Wind Drift Application Out ide of Approved Area
12. Crop Type(s):O7 1 4 SSX
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t�2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
01 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
' 0 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 q 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 A] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: jDate of Inspection: 7
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 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
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? ❑ Yes [] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No . ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments...
Use drawinss of facility to, better explain situations (use additional vases as necessary). ,
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: ,drM -3 ep
Date; �" U
21412015

® Division of Water Resources 1
11 Facility Number - .3 Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ® Compliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 40 Routine Q Complaint Q Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: d Departure Time:1 47>9 County: pOgw
i
Farm Name: P%)O�e f Owner Email:
Owner Name: >'�6— { (A_uI -, Phone:
Mailing Address:
Physical Address:
Facility Contact: j pr1 ► " T Title:
Onsite Representative: _
Certified Operator:
Phone:
Integrator: u— t��.J ► J
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean ✓D
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Layers
Non-L
Pullets
Other
Design Current
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)?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
Qq NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
[:]Yes ❑ No
❑ Ye No
❑ Yes No
rj
5fl NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412014 Continued

i
Facility 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):
Sy y N
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 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
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 P 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 �D No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JIJ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

r
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? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T� 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
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
[DNA
❑ 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
ED No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
T] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
A�q No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional iecomrnendations or uny other comments .
•.,.
Use drawings of facility to Vetter, explain;.situations (use additional
Reviewer/Inspector Name:
Reviewer/Inspector Signature: yd!'tivl'
Page 3 of 3
Phone: `fro-Y3 -53oa
Date:
21412014

Type of Visit: ! Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: . Oar. Departure Time: 2r` County:�rG� Y� Region:
w
Farm Name: p/�/�111 Owner Email:
Owner Name: ! ' Au. J is Phone:
Mailing Address:
Physical Address:
Facility Contact: /✓�� Title: Phone:
`t c
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ����
Certification Number: 9%'7Z61
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
(240
Non-Dai
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
F—To—ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
rM NA ❑ NE
0 NA ❑ NE
gftZ'NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes [9 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 Struc re 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S�
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 No [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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? W
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E? No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Y 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 differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
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 N] 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

acilii umber: Z jDate 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? ❑ 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
M 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
i
[P 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)
f
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;0 No
❑ NA ❑ NE
33. Did the Reviewer/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 ft Explain any YES answers and/or any additional recommendations or any other comments,: .
Use drawings of facility to better explain situations (use additional pages as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j0 - 3
Date:
21412014

$ f Ih
7 Division of Water Resources
Facility Number ®- © 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 46 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: JM,�Qr__ I Departure Time: D' County: O®/L- Region: F%20
Farm Name '� T�V"L-'S
Owner Name: /v RolW6
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: integrator: PW cl r�
Certified Operator: 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.
La er
Non -La er
rou
Non-L�
Pullets
Turkey P
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 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?
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
❑ Yes [—]No
❑ Yes ] No
[:]Yes No
®NA ❑NE
TP NA ❑ NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: IDate of Ins ectio
Waste _Wlection & 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 a NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 —2— 3
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 ® 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 1p 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? 7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n 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 rop Window] ❑ Ev'dene of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s,' 5 Jam►
13. Soil Type(s): ".—L(e
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 P No ❑ NA ❑ NE
acres determination? TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
CP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ 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 [;g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ANo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412014 Continued

Facili Number: CA- Date of inspection: 8
2.4. 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
® 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
tj 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
N No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question:#): Explain any,.3YES_an wets andlor4r y additional i•ecommendi tionshor.'a;pyyother coniinents E ,'.
Use drawings of facility to better ex lain situations (use additional pages as`necessary).
Reviewer/Inspector Name: Phone: CL4�Y4��33`�
Reviewer/Inspector Signature: Date: 9 /�
Page 3 of 3 21412014

V Division of Water Quality
11 Facility Number - © 0 Division of Soil and Water Conservation
Q Other Agency
for Visit: 0 Routine 0
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: it Arrival Time: Departure Time: O County: ' Region: 420
Farm Name %�� iC ��}��/YZS Owner Email:
Owner Name: �/}�g— /�(,�.if/l 2�%►15 �7-L. Phone:
Mailing Address;
Physical Address:
Facility Contact: ! c5lit-� /% !� Title:
Onsite Representative:
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
11
Latitude:
Phone:
Integrator: CT / rii3
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy_Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes �o ❑ 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 I of 3 21412011 Continued

acility umber: K 3 7 Date of Inspection: J
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: _ 2--
No ❑ NA ❑ NE
❑ No DIVA ❑ NE
Structure 6
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.) IR
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) 'T
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
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 11 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 differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes/j] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ 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
❑ 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Z- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes jp No
T�j
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA ❑ NE
the appropriate box(es) below.
TT
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes [ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes M 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?
24. 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:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes M 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 irecdmmendations:or any. ther comments:°'.
Use drawings of facility to better explain situations (use additionaFpages as necessary).,:
Reviewer/Inspector Name: 4e �. YKp .
Reviewer/Inspector Signature: Y� 440
Page 3 of 3
Phone:
Date:
21412011

r
Division of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
i'ype of Visit: 0 Compliance inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: 2K I Arrival Time: Departure Time: (O : ti County: n WRS
Farm Name: D110m ` r s Owner Email:
Owner Name: A., S Phone:
Mailing Address:
Physical Address:
Facility Contact: 0I'L -_-_-_Title: Phone:
Onsite Representative: r Integrator;
n,61-
Certified Operator: �.
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop, Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean p 19 b
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
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)?
Region: CXO
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes ❑ No
EPNA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No M NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2PNo [DNA ❑ 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 umber; - jDate of Inspection: Z
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: 7— 3
Spillway?: ,
Designed Freeboard (in):
g�gr—
Observed Freeboard (in): 1 V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rM 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 ;g 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
rp 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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KnNo
❑ NA
❑ NE
maintenance or improvement?
1
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window irk),
of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): P`',r Q $S l rk), g , ?-�,,e G rr, ik Ov".91�
13. Soil Type(s): GCV7 at:2a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q` No
❑ NA
❑ NE
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes Fn No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑Othcr:
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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No (DNA ❑ NE
Page 2 of 3 21412011 Continued

Facilit 'Number: - 3 1 Date of Inspection: Y
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. T
❑ 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �9 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?
Cl Yes 16 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 No
T
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #); Explain any YES answers and/or any additional recommendations or any other. comments.
Use drawines of facility to better explain situations fuse additional naves as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: • Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 13i iZ Arrival Time: Q Departure Time; County: Don
Farm Name: 17t)or A*-eK5 Owner Email:
Owner Name: / v G Pcc.v-yt � 9.,yyK S A.,o _ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ` jB Vt /%1O D%—k'2 Title: Phone: Q ``
Onsite Representative: u Integrator: o- 1 u'►ri14�
Certified Operator: G Certification Number: /?6 q$
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
'ILLa
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
er DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current D Cow
Dr, ZU[tr. C•.a aci P,o f. Non -Dairy
[Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
EETurkeyPoults
ther
Discharees and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Ir NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
IV 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
�E 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?
T
Page 1 of 3 21412011 Continued

Fiellity Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Identifier:
Spillway?:
D dF b d
❑ NA ❑ NE
[� NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
esigne ree oar (m). _p 44
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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
[PNo
❑ 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
PVDNo
❑ NA
❑ NE
maintenance or improvement?
TT
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 'gyp] 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 Area
12. Crop Type(s):
13. Soil Type(s):
T60"r
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Ep 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
EP 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 T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z
No
�]NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Maeflity Number: - Date of Inspection: Q13 I I L
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 [n No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �D 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
[�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
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
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
C�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other commen#s�A'°"
Ilse drawings of facility to better explain situations (use additional paftes�as necessary).
it T�
Reviewer/Inspector Name: Phone: 1/V Y33 pCD
Reviewer/Inspector Signature. Date: 3 �i
Page 3 of 3 2/4/2011

i. .
Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 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: I b 1 Arrival Time: RMMEJDeparture Time: p; County: +j cop'e_
Farm Name: �j1�j cQ Rw" s Owner Email:
Owner Name: IV t& Phone:
Mailing Address:
Physical Address:
Facility Contact: ��l+ij� Title:
Onsite Representative: (If
Certified Operator -
Back -up Operator:
Location of Farm:
N
Latitude:
Region: Fft
Phone:
Integrator: Integrator: /`) 61 pcL.�
Certification Number: . 176918
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts, �.
Boars
Other
Other
Layer
Non -La er
pry ri
Layers
Non-L
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?
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?
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes CSNo ❑ NA ❑ NE
❑ Yes
❑ No
[�t NA
❑ NE
[:]Yes
❑ No
P NA
❑ NE
❑ Yes ❑ No
❑ Yes I;r—No
❑ Yes 1 No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
n No
[DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
N NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: j 2 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):---i'--a^----
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
n 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
[�JNo
❑ 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
29 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 8 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
//Window Evidence of Wind Drift �❑ Application Outside of Approved Area
12. Crop Type(s): MalAGt [9-enC'5i wa,'► i9-r�iSS 4..
13. Sail Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes t5 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
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.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Yes En No ❑ NA ❑ NE
[:]Yes P No
❑ Yes 2S No
❑ Yes C2 No
❑ Yes IS No
❑ 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[3 NA ❑NE
❑NA ❑NE
[DNA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑NE
❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [P No [DNA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
M 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
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or,Anyn,otherjcominent`s.
IC Use drawings,of facility to better explain situations (use additional pages<as necessary) t := r ` a ` j-Al
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q 33-33cO
Date:
21412011

(Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other El Denim Access
Date of Visit: 10 Arrival Time: ;OQCtw. Departure Time: O, old., County:
Farm Name: !YT Owner Email:
Owner Name: G t dar � Phone:
Mailing Address:
Physical Address:
Region: JW
Facility Contact: zjarsw mvione Title: I Phone No:
Onsite Representative: Integrator: /VG✓IDS
Certified Operator: N Operator Certification Number: 1176G
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ e = Longitude: ❑ ° = ` =
d
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
to Finish
❑ Layer
❑ DairyCow
to Feeder
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
r to Finish
OO Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
w to Wean
b
El to Feeder
to Finish
Eoa
❑ Turkeys
❑ 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 fe No ❑ NA ❑ NE
❑ Yes
❑ No
FNA
❑ NE
El Yes
❑ No
11RNA
❑ NE
�9 NA
❑ NE
❑ Yes
❑ No
❑ Yes
C�No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes N�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
IM NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z 3
Spillway?:
Designed Freeboard (in):
l/
Observed Freeboard (in): 1q It � SaN
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
ElNE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 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 nNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Its No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Lei e,c, I Be,.-J. C", CIL.,
13. Soil type(s) Q-9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
03 No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
W No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments u Q r
Use drawings of facility to better explain situations. (use additional slpages as necessary):
. <i.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: n
Page 2 of-3 12128104 Continued

Facility Number: 65 — Date of Inspection I g
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes
t?No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
[D No
❑ NA
❑ NE
❑ Yes
(9 No
~❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[�No
El NA
El NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
[]�No
❑ NA
❑ NE
❑ Yes
M No
ElNA
ElNE
❑ Yes
VNo
❑ NA
❑ NE
Page 3 of 3 12128104

(Hl g1x(eq
Facility Number 3 a00
Division of Water Quality
0 Division',of Soil and Water Conservation
0 Other Agency
Type of Visit -eCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit I2KIZoutine 0 Complaint 0 Follow up 1 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 10',0D Departure Time: County: we- Region:
Farm Name:` �-K_l__ _QI�hS - Owner Email:
Owner Name: N& pvrvl"r Phone:
Mailing Address:
Physical Address:
Facility Contact: TON, Heve Title:
Onsite Representative: _�*, 'ff
Certified Operator: ^c
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: e)qT'7(P757
Integrator: C9 ' M qr-. �/1+1
Operator Certification Number -
Back -up Certification Number:
Latitude: = 0 = i Longitude: 0 0 0 1❑"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouits
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
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 'R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
5KNo
❑ NA
❑ NE
❑ Yes
[Nqqo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 13 00q
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 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
VNo
❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�R 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
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ 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
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[,ijNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C`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 AcceptableCrop ❑ Evidence off}Wind ❑ Application Outside
of Area
/Windrow `Drift
12. Crop type(s) CUM l7Cf/h �Q l ,l I 1 A t fljQ f )
13. Soil type(s) 6tojyde y11 '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Di -No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
jffYes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[—] Yes
ER 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):
ReviewerAnspector Name JbZK S` Phone: 9I0-433-3300 X3333
Reviewer/inspector Signature: Date: H&rh 3Q aOO
V 12128104 Continued

i
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes allo ❑ 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. Cgffes ;@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking NlCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
. ❑ No
J"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?
`[WT es
ErNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LE`No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
U NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CffNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ERNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�RNo
❑ 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
RrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R[No
❑ NA
❑ NE
Additlonul Comments and/or Drawings:
!.S Q IiMe_ im e_ JM IS f—W . a00$ f D,9^
y
ti 51' .
in oLl
�J, P1e4e, Volt re Corot' yvhemver cLA
as. No t- 3 urve done a oo $ ► r•iI (check pj� yvh�� >n� ��'lred £�a►
�
w oe if -
Goa 100LMJ crop,Pv141.4
Page 3 of 3 12129104

91 /td olCz- W/#e ", �e_
Facility No.�P-33 Farm Name
Permit V/COC ? AI
Pop,Type Design Current
dive- Date 3 ()0 { 0
OIC_0� V&!ye-- NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
Soil Test Date �5�06 Crop Yield 120 min Inspections
pH Fields Wettable Acres Cr Weather Codes �-
Lime Needed -kY144. WUP . 11-� Transfer Sheets
Lime Applied ND Weekly Freeboard RAIN GAUGE
Cu z;— Zn ✓ Rainfall >1" ✓ Dead Wx or incinerator
Needs P 1 in Inspections
ME "t-IM-P71 MIN
.1 r.
.1 �.
•
Pull/Field
Sail
Crop
RYE
PAN
Window
Max Rate
Max Amt
a
�3'
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump

ea?r , ti.ti
u4
Division of Water Quality3 �.I
Facility Number ..0 Division of.Soil and Water Conservation
Q Other Agency
(Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: d Arrival Time: Departure Time: County:
Farm Name:, __l_X tQf'mS Owner Email:
Owner Name: Y� Par +`5 i'T,! +` rns [ r1C� Phone: _
Mailing Address:
Region • XI*zd
Physical Address::--
Facility Contact: + rYi_ Moo t ��] oQ r r. Title: Phone No: 1/0
Onsite Representative: r Moo ir °e, Integrator:. __ — _ f V 15 _
Certified Operator: or � e Operator Certification Number: 1 r
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean 0(0
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ c =' 0 " Longitude: ❑ o ❑ t = 11
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
DesignCurrent.,._,,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No
�JNA
❑ NE
❑ Yes
❑ No
�aNA
❑ NE
❑ Yes
❑ No )K[;TiA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
f,No
❑ NA
❑ NE
12128104
Continued

Facility Number_ to3 — 0-5 1 Date of inspection
T�
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):
p
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JB:�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
hZNo
❑ 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
�U'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
0 Yes
� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) e.OV(1r_ y ;
14. Do the receiving crops diff(Arom those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
tR 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
IX No
[I NA
El 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):
f
Reviewer/inspector Name GN P-1 ✓5rJ K& 6 Q9 AJTQJA + 112 1 Phoneq 'rJ3 33co
Reviewer/Inspector Signature: Date: — (
12128104 Continued

Facility Number: Date of Inspection ICf"t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes '�allo ❑ NA ❑ NE
the appropirate 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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JR 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
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
b!�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
i dNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
191 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
ONo
❑ 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
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�allo
❑ NA
❑ NE
Additional Comments and/or Drawings:
F o- f I
- & S U�fl4 `�'° J1 �q� n'1 S I,� S'E' °,m C�. Q Ck-A . Q 'f' ew I f a" A rc ll
iilti'�r,l rnUn, li me 0. rn6n4 . 1 wit Cal i4."ra.( I fec red,
12128104

Date
L
Facility No. ` Time In Time Out
Farm Name V i iLi N Cum
Owner Q }emu'{ �t� ✓ �� C�
Operator
Back-up
Integrator Pu '( V I s f y�
Site Rep _ T�,�
No. .1
M
COC Circle: Genera or NPDES
Design
Current
Design
Current
Wean -- Feed
Farrow -- Feed
Wean -- Finish
Farrow — Finish
—Finish
Gilts 1 Boars
Farrow -- a
Others .
F
Siudge
Crop Yield ! v
Rain Gauge /W t�lr
Soil Test PLAT
1
Observed 1 g11g /
6P
Calibration/GPM Mtn 1 2
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspection
Spray/Freeboard Drop��
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
61
g
Date Nitrogen (N)
1.
3
s1��
cl�a
Pull/Field Soil Crop Pan Window
1
,_

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 0-7 Arrival Time: Departure Time: © County: Region:
Farm Name: i `C, _in S _ _ Owner Email:
` Owner Name: C`� U r VPhone:
Mailing Address:
Physical Address:
Facility Contact: Ion" P Iwo— Title:
Onsite Representative: �on u
Certified Operator: n �-
Back-up Operator:
Location of Farm:
;J &CLLI UW LU FC;UUGI
] Farrow to Finish
] Gilts
] Boars
other;-
Phone No:
—PA
1
Integrator: Ul li � S
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =' = " Longitude: = ° =' = '.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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)?
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 I of 3
❑ Yes Na No ❑ NA ❑ NE
❑ Yes
❑ NoN'�JNA
❑ NE
❑ Yes
❑ No
'NNA
❑ NE
❑ NA
❑ NE
❑ Yes
N No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
E/No
❑ NA
❑ NE
12128104 Continued

Facility Number:LQ
—�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): i-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 Structure 6
❑ Yes &No ❑ NA ❑ NE
❑ Yes J9No ❑ 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 allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes VNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IVo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) &
13.
Soil type(s) Ge—
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�o ❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
ONo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
J�3 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
0 No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
(ANo ❑ NA
❑ NE
Comments (refer to question ##): Explain any YES. answers and/or an y,recommendations or any. other.comments a
Use drawings of facility to better explain situations. (use additional pages as necessary):
�
r�
Reviewer/Inspector Name I v-zj m ; W-Th 1 Phone: Q `{ 3 3
Reviewer/Inspector Signature:f.1kLDate: �r R e'n -1
Page 2 of"3 12128104 Continued

A.
)Facility Number. 3 —C Date of Inspection I�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ///o ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes RNo ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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
-KNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
kNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
1PYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
%No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§;�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
bgNo
❑ 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
kNo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
to
ElNA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes
❑ NA
❑ NE
Additional Comments and/or Drawings:
0-7 _
U
3 4o -- ocrrm (a P AP &-ail 46
AL
Page 3 of 3 12128104

FaciQ,�4.00 Time In 5_0 Time Out Date
Farm Name 4� )I , _ Integrator
Owner
Site Rep
Operator No.
Back-up No.
COC Circle: eneraI or NPDES
Design
Current
Design
. Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts 1 Boars
LFeff6w--_W—ean-,-jOthers
EB Design 4 Observed �g I
ey Calibration/GPM L/ 1 Q�
Crop Yield Waste Transfe - _
Rain Gauge Rain Breaker
! �,
Soil Test PL ,.• Wettable Acres
Weekly Freeboard Daily Rainfall �-� 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Poi A Waste Analysis:
N Date Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Sm v�
o

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 147; -915-1 County: AYAWC-
Farm Name: j,se ii'm ate► I Owner Email:
Owner Name: , Pury` ! S _ar�xs Phone:
Mailing Address:
Physical Address:
Facility Contact: 7-A—nx N rTitle:
Onsite Representative:�re-t__
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: FX?
9.
Latitude: = o = 1 ❑ N Longitude: = ° = 6 = {1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischaMcs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: FTI
b, Did the discharge reach waters of the State? (I1'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 Z No ❑ NA ❑ NE
❑ Yes
ZLNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
allo
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
I&NO
❑ NA
❑ NE
12128104 Continued

Facility Number: -- p 3
Date of Inspection V eR -V
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 I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I "v J'
Spillway?: ,F
Designed Freeboard (in): %�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
[3 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
Q9 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
19 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
allo
❑ 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) 15,rofado- Z
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C5kNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
r7l 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
R No
❑ NA ❑ NE
a:r X�., rumen nn♦e /rninrAfn n:inefln..'�11 a G',v..l'raie.,n...r. UTi C n.. a.a n . .; . J....n.............i..F3........., .......r...«....Ln
Reviewertinspector Name "jj;j� p-r,. , ' { ��" ;� ; s r� z `t� Phone: 00 /�/ -
Reviewer/Inspector Signature: Date:
12a8/04 Continued

Facility Number: 6 —0 Date of Inspection -0fv
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 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 [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 5jCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
00 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
Co No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5d 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
C.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
Z 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
G&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
KNo
❑ 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
R No
❑ NA
❑ NE
33.
Does facility require a foilow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
12128104

Facility Number date of Visit: In��gl Time:
Q Not O erational Q Below Threshold
UPermitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Tbreshold: ..................
Farm Name: ............ .......24..►..:e.►.'!�..1............................................................. County:........ vVtF
�.................................,
Owner Name: .......... &...a, ........................ ..'06rdryi j........Fat.m..1................. Phone No: ...........7i..z::.... 9.y �.'... � ..�R. %...............
Mailing Address: ...... u2X .......,A45::..... ....... P.!. .. ......... �Pt..,t�.....C� � o l; K[...................a�..7.�?tS
FacilityContact: ........................................................................ Title:................................................................
Phone No:...................................................
Onsite Representative:
.......... AlYAle..............?e;y.t..................................... Integrator: .............
?+t ie("j .................
Certified Operator: ................................................... .......................... . ................................. Operator Certification Number:
Location of Farm:
0Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 44 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ............... /................. ................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoalication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
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?
(icl WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, 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
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
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
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
E 'I"Ij - .€€�€,i 9 & '�.:�. , i" I 'a F - -, - ,'Q. IV§ "€€ } 8° i' I:iS-ia A, 5,.5 € F - £4 �i - � E t l i - h' 1 ': ti;..., ra
(referstp question) Explain Yariy €1'ES'unswers and/ar any recatnmendatiana tr,anv atiter�commenu:
1Co £contents
Use drawings of facility to better explain`situAio6s . (use additional a es as necessa ) 1 ' Fl
�� € ti Field CAPV ❑ Final
s'�'O r wa a4dON G 4t C[..�s,
1� � �� ! � � €P �E %€ € � %� � � � •qn � dtt -+� ^n pf^p� Y r m h 3h ...;�. y, � ! _, � �., € R•.� i :. y, .. �,. . ,�,.,.M
Reviewer/Inspector Name
_.�lt}
II 3 1
Reviewer/Inspector Signature: Date:
05103101 Continued

��`` °�!"� .,RF�� .son � �„ a;a N �. 7F�'' � DlyiSi0n10l;Wii#@!' Qttnlit�su. *R'a e r� n rE,i h'�E ae �� �a^ M y��y " L � r" 4'4 f •1 "Will
i • •�r
� �, wir�axN�i,.�,�,rkl�j�,,�'�,� � ���j''�0 Division olSoil and.Ws#er Conscrvatian:�r. F° z �j` �yz�1, ,� '�,„� °r ;� � •ti
(Type of Visit 0 Compliance Inspection 0 Operation Review ' 0 Lagoon Evaluation
Reason for Visit ®Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility- Number �y Date of Visit: 3 0 Time:
EZIZI
ID Not O era 'onal 0 Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified f] Registered Date Last Operated or Above Threshold:
Farm Name: —_l)t y,C County": Moore, orb_ _
Owner Name: Aj. �i, Asym'r Fan,T Phone No:
]~failing Address: .2 S 040 .Sly"lft__ YCoi %ln �n S _ A/, C,
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: ri7 +� C �'1s�d _. _ Operator Certification Number: G T�
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 04 0" Longitude I ii
Design Current
Design Current Design Current
Swine Ca acity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
I
JE1 Laver
❑ Dairy
El Feeder to FinishEE]
❑ Non -La er
I
I
I ❑ Non -Dairy
L.
Farrow to Wean
p
other
El Farrow to Feeder1
El Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons i 3 cart Subsurface Drains Present 1j❑ Lagoon Area, j❑ Spra} Field Area '
;Holding Ponds I Solid Traps r , ❑ No Liquid Waste Management System ,Z: fir`
,4.
DAscharges R St. _pam Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is obsenved, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes Mio
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P No
❑ Yes IN No
❑ Yes �No
Structure 6
Continued

Facility Number: 6.9—
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
9. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes [ XNo
❑ Yes qNo
❑ Yes ER[No
❑ Yes [allo
❑ Yes [N No
❑ Yes [2 No
❑ Yes No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15, Does the receiving crop need improvement?
❑ Yes
[@ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reouired Record
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? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q 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]
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
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
O] 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.
t r. ..Y ...-r',- J',�
Comments(referato question) Exp�IAlneany YES answers' and/or,any recommendations or, any'6ther comments :.l =F r
lJse'iErawings of�fQciiity to better 6plein'situations. (use�a ditian l:puges ns hecc'isary')" r
❑ Field Copy ❑Final Notes r
�� G!`m ,� L.Q. 1✓ � G �tr>� � 0 � c� ��
/
a
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 V Continued

Facility number: (o �� —3 Date of tnshcctinn
dor Issues
2b. 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 [Z No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 2 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 [9 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes m No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
ri<dditional Comments;and/or Drawings
05103101

Site Requires Immediate Attention:
Facility No. 0_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ?'' f , 1995
Time:
Farm Name/Owner:_A2 G e0k
Mailing Address: 7-5o j SP, e -5Yam' > fiR, o bb+ +.zs L0 Z77Z
County: Y/
Integrator: 7"o-m o t o Phone:
On Site Representative:' of Phc
Physical Address/Location: 5 L e
Type of Operation: Swine Poultry Cattle
Design Capacity: 9)Pp Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) s or No Actual Freeboard:_�Ft. Inches
Was any seepage observed from thePoon(s)? Yes or o�Was any erosion observed? Yes orE
Is adequate land available f r spra�? (es or No Is the cover crop adequate? 49or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? es i
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(o
No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oQjo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or l&o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o(S
Additional Comments: Ems" A1,0411AAf AAAA 1//S L., GA440
n!Kgo Aja �—
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: r' , 1995
Time:
Farm Name/Owner: Ili d D I xl a 1,krn
Mailing Add s: z50 j 5Pl e ,5 ran Q bb+ tos KY'_ z7745
County: Mop no'
Integrator• "Po-m o g s Phone: __ i o- Q $— z z_ 7 .
On Site Representative: o� apt s Phone: f(P - o, Div *0
Physical Address/Location:0�51l0 57 afu Le - •0.,+ =-e dep4d
Type of Operation: Swine -,k— Poultry Cattle
Design Capacity: 4eo _ e& -an Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)s r No Actual Freeboard:�Ft. Inches
Was any seepage observed from the Ia oon(s)? Yes o o as any erosion observed? Yes or o
Is adequate land available f r spray? (es or No Is the cover crop adequate? &or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells?or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(a
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes os90
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or&' If Yes, Please Explain.
Does the facility maintain adequate waste management records (vol mes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ox
Additional Comments:
cof
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: r' t , 1995
Time: o : Zjr p : $ 4, : 3A
Farm Name/Owner: U G' t:Q& 2L.1 tj±a5 I71x1,9
Mailing Add s:_ zSnT SP, ee s "Fn _&L6itog KNO z,73Z-g _
County:
integrator: 'PoR 01 Phone: 4 t o- 9 g-- Z Z f 7
On Site Representative: a.o t s Phone: f(O-OD-t04040
Physical Address/Location: OR 16 37, o Le4-
Type of Operation: Swine ­'�— Poultry ' Cattle
Design Capacity: 07,P oo�e - K -D Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° It Longitude• "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (s r No - Actual Freeboard: Z _Ft. inches
`Was any seepage observed from the laXr
(s)? Yes or To Was any erosion observed? Yes or(�b
Is adequate land available f r spray? No Is the cover crop adequate? &or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? c i es, or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�s
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oK�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& - If Yes, PIease Explain.
Does the facility maintain adequate waste management records (vol mes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o
Additional Comments: was
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.