630012_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Water Resottrcea
FacElity Number %, - 9ivision of Sail and Water Conservation
Q Other Agency
Type of Visit: 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 91 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r"j ; Departure Time: County: M00AZ"5_r
Farm Name: Rl t IzI bbtn SL✓r�p Owner Email:
Owner Name: 1/� `& -V1 S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
er
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: 117-
Phone:
Integrator: A''( /�vY✓+S
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop,
Wean to Finish
Wet Poultry
La er
Design
Capacity
Design
Current
Pop.
Current
Design Current
Cattle Capacity P.
Dairy Cow
Dairy Calf
Dairy Heifer
Dg Cow
Non-Dai
Wean to Feeder
oD
Feeder to Finish
ll'Layer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Othcr
Turkeys
Turkey Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, 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 [j] No ❑ NA ❑ NE
❑ Yes ❑ No EDNA ❑ NE
[—]Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No CgNA ❑ NE
Structure 1 Structure 2' Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
y
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes jrO'oj' 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 j�No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes TO 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 �g No
❑ NA
❑ NE
maintenance or improvement?
Waste AgWication
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): _ / 1/I065GiQ "n n a —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [VNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes No ❑ NA ❑ NE
acres determination? IF
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No
❑ Yes No
[] NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1;0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili ,Number: pate of Inspection: F77 ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ep 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector rail to discuss review/inspection with an on -site representative`?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 'A
No
❑ Yes No
❑ Yes NhNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [ ] No ❑ NA ❑ NE
❑ Yes 1�No
❑ Yes No
❑ Yes �] No
❑ NA ON E
❑NA ❑NE
❑ NA ❑ NE
Camments(refe`raktaigiii tion #)"Eirpluln anyYES answerssand/or anyaddltional'recommendAtions:or:any other comments.
IV,.+ r V S�1 00.11 �v llw W � ti 4f a"n�� ^a �4:l r'� ,,, t . �,;+�gy�'�h�4
Use drawings orsfaciEity�to.better.explain situations°{use additldnal_=pages-as necessary).'
Reviewer/Inspector Name: J�0 rA �— tt4nv ✓T
Reviewer/Inspector Signature: 464 _111t14
Page 3 of 3
Phone:r72,Ct�
Date: s' /
21412015

type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: lwleL
Farm Name: Owner Email:
Owner Name: 6� �Gt-tiylf�h SCE Phone:
Mailing Address:
Physical Address:
Facility Contact: " r O c" i'Y`o�� Title: Phone:
Onsite Representative: Integrator: AZL ©'411
Certified Operator: F Certification Number:
Hack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
pesign Current
Design
Current
Design Current
Capaclty Pap.
Wet Poultry
Capacity
PnP.
Cattle
Capacity Pop.
Finish
rVF-eedert
La er
DairyCow
Feeder
Q� 2
Nan -La er
DairyCalf
Finish
Design.
Current
Dairy Heifer
D Cow
row to Wean
row to Feeder'
D . , P,oult .
Ca aci
P.o
Non -Dairy`
row to Finish
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
g
Beef Feeder
Beef Brood Cow
kGilts
rs
Turke Poultser
Other,�y,ys
1
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑Yes MNo ❑NA ❑NE
rj
❑ Yes
❑ No
� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No 95 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

Facili Number: - ,Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(gNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ANA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 70 y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ANo
❑ 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?
1 1. 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 Windop5; 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
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes q No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [y 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?
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 [% No
❑ Yes [�] No
❑ Yes No
❑ Yes No
❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
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 Tr21fe r s ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faell Ity Number: - Date of inspection:
w
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 ❑ Yes [ No
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
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 qN0
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA NE
❑ NA ❑ NE
[]NA ❑NE
Phone:
Date:
21412015

(Type of Visit: ® Compliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Awveg
Farm Name:IUl Rjl�Pot�} Owner Email:
Owner Name: Lu- PU-{'J1 s Phone:
Mailing Address:
Physical Address:
Facility Contact: _ M4qf Title:
Onsite Representative:
Certified Operator: M
Back-up Operator:
Location of Farm:
Latitude:
Region: 09212
Phone:
Integrator: Ptwvt3
Certification Number: 174 4
Certification Number:
Longitude:
Is
Design urrent
C
Swine Capacity Pop,
Wet Poultry
Design @urrent
Capacity. '1?op. i'
q
@attle.
arm
Design Current.'
Capacity .Pop. `.
Wean to Finish
Layer I
I INon-Layer I
Design Eurrent
D�, P,oult , C.a aci P,o
La ers
Non -La ers
Pullets
Turke s
Turkey Poults _
Other
3uIElIWY.Yp.IPJfYlfl1{ePYgILNmi,sM.aauaela'MYi.i'�cxiu['.Mtu..Ilspi6L',YPaL�F. P
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Yaewv,l��.w.
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [] Ycs ❑ No CA 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)
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
❑ Yes 0 No
[]Yes ® No
NA
❑ NE
❑NA
[]NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

` Facili Number: A 5- DateInspection:
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 4a NA ❑ NE
tu
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structur`e' 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Yfl
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 N4 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 P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j g 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
Ea 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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 E� 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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes EP No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes [)� No ❑ NA ❑ NE
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
Phone: f o:" 3 3-330D
Date: gLl
21412014

� lfligl�jr
• Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ID Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:, Departure Time: I DT"Ca7DCounty: Moom Region: Plav
r--
) arm Name: 1?I1.,A 91 0r" f't "'-s"� Owner Email:
Owner Name: /l) Pt- KVt3 Phone:
Mailing Address:
Physical Address:
Facility Contact: ��'"P Title: Phone:
Onsite Representative: �� Integrator: tl)c,-�' PU. v13
Certified Operator: Certification Number: 1 7 6 11t8'
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: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
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 DWR)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C�jNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[� NA
❑ NE
❑ Yes ❑ No
❑ Yes [Pn�No
❑ Yes 0 No
® NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Condnued

Facili Number: - Z _ 1 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
Q NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
�r q
Observed Freeboard
(in);
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r/5TNo
❑ 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
[S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop.Window /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Pt C"'� �'? ) , SrM • - ovz sad
r �
13. Sail Type(s):
J1�,p6$
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
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
[P 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 K] 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 21412014 Continued

acili Humber: jDate of Inspection: $
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ��` No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes `P No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

• Division of Water Quality
11 Facility Number ®- Q Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine () Complaint Q Follow-up ( Referral Q Emergency t) Other Q Denied Access
rr�r�
Date of Visit: Z9 Arrival Time: ICE e. Departure Time: " ��. County: MOO Region:
Farm Name: eB U'L-TzLkw' sgw L�,p Owner Email:
Owner Name: rV G— PC.Lit,� V nn.� ���Li Phone:
Mailing Address:
Physical Address:
Facility Contact: ] 0y4 14awf Title: Phone:
Onsite Representative: A Integrator: N 6— ea'yy'��
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 221M Z
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Laver
Ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
4 NA
❑ NE
❑Yes
❑No
[PNA
❑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 [P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes JE� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

, 5
Facility Number: - Z Date of Inspection: W L`i 1
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: �-up�R/L tee
RNo ❑ NA ❑ NE
❑] No NA ❑ 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ENo
❑ NA
❑ NE
waste management or closure plan? TT
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [P No
❑ NA
❑ NE
8, Do any of the structures lack adequate markers as required by the permit? ❑ Yes 10 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!V 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): ��" ifA")
i
13. Soil Type(s): M"6�q
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 5 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
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rW 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and l" 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 21417011 Continued

Facility Number: - 2-- 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 compiete 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
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
D Yes
No ❑ NA [D 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/]nspector 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 drawings offacility,.to! better, explain-situationsluse additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / l0 33 -330v
Date:
21412011

qh'
Division of Water Quality
Facility Number ®- 12 O Division. of Soil and Water Conservation
Q Other Agency
type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
lesson for Visit: 0 Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: '< County: �4(q
Farm Name: �j l,c,� o h SL+� Owner Email:
Owner Name: i1G �irv.�( Phone:
Mailing Address:
Physical Address:
Facility Contact: �_Fo � pp Title: Phone:
c,
Onsite Representative: Integrator: ��r p113,
tl
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
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
4LayerDt) �1bo Non -Layer
Discharees and Stream Imnacts
Non-L
Pullets
Other
Poults
Design Current
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry. -Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. is any discharge observed from any part of the operation?
❑ Yes
No
TT''
❑ 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
[!p No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IV No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: IDate of Inspection: 1-4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 02 It
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes q 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? T
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 M No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes N 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 C] Yes No ❑ NA ❑ NE
maintenance or improvement? r
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 ® 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): C`►e l 4 /l„„....,.
13. Soil Type(s): 004'a
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 TT�/ No ❑ NA ❑ NE
acres determination? `P
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1P 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 E� 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 1 ' No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

facility 'Number: - 2 Date of Ins ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6No ❑ 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
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
Ep No
❑ NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
1� No
❑ 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 No ❑ NA ❑ NE
Comments (refer to question #) Explain ttnyYES answers and/or any additional recommendations. or any other comments
Use.drawines df facility to beiter. exnlain.situations fuse additional naQes as necessarvl.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 6�2y�
21412011

hype of Visit: W Compliance Inspection V operation Review U Structure Lvaivation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I S ►�►1'J_ I Arrival Time: r ;SQ.,. Departure Time: M w County: � Region:
Farm Name, RiUbr Sw i�, Owner Email:
Owner Name: PU, j C Phone -
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: A� ? ,r ,,oj
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current Current
Swine Capacity Pap.
SUes
Wet Poultry' Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer Dairy Cow
INon-Layer IDairy Calf
Wean to FeederI
Feeder to Finish
Dairy Heifer
Farrow to Wean
SDesign Current '' Dry Cow
Farrow to Feeder
D . E;oult . Ca ac-1 P Non -Dairy
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feedcr
Gilts
Boars
Pullets Beef Brood Cow
Turke s
Other
Turke Poults
Other
L1221icr
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
�p
I NA
❑ NE
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
❑ Yes
❑ No
{ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
T
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
9NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
❑ 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 Num er: Date of Inspection: l3
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 Fg NA ❑ NE
Structure l
Identifier: —Lq?—k
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
H
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 L55 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ftNo ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 4 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): �95 CLIP V"%f
13. Soil Type(s): %i 6054a /A_L.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [n No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1�1No ❑ 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?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 2/4/2011 Continued

Facility Number: - 2 Date of Inspection: 2.2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below. 1P
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes �Q] No
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 ❑ Yes No
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? [] Yes [)9 No
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 �0 No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes � No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?] Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑NA ❑NE
[]NA ❑NE
❑NA []NE
MNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
M10
Reviewer/Inspector Signature: Date: s 3 2
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: County: GYI/q Region:
Farm Name: f3i U-a- R b b 0" 'Sw1 t o Owner Email:
Owner Name: N Ptt,.�LAS �-...4 Phone:
Mailing Address:
Physical Address:
Facility Contact: D n y / f 60 +r' P Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: W!�L
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
�� Design- Gurrent Design Current
Swine
Capacity Pop.
P 0134 3
Wet.Pou�ltry Cap i Q.
lic le_ Capacity Pop.
Finish
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
Dairy Heifer
o Wean
�.
Design Current-
D Caw
rFarrowo Feeder
o Finish
Dr P,oult . Ca acity P,o .
La ers
Non -La ers
Pullets
Turkeys
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes PNo ❑NA ❑NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
q3 NA
❑ NE
❑ Yes ❑ No
❑ Yes �] No
❑ Yes No
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: '� Date Inspection: 'fl If
b- of
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes (P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
M NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
L68
Observed Freeboard (in): + t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 4gNo
❑ 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 V No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes [J5 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 P9 No
❑ NA
❑ NE
maintenance or improvement'?
Waste Analicatinn
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [gNo
❑ 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 Win ow ❑ Evidence of Wind Drift [] Application
Outside of Approved Area
12. Crop Type(s):
i
13. Soil Type(s) to 5 42 ngA=
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 n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [0 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes No ❑ NA
❑ Yes ® No ❑ NA
❑ Yes M No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
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 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 No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

. Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tjNo ❑ 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 RLNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [� No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes $2n No ❑ NA ❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EA 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? ❑ Ycs ®No ❑ NA ❑ NE
Ciimments (refer to question ft Explain. any YES answers and/or any additional recommendations or any: other. comments.
Use"dr'irvings pf.faeility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
ro
Phone:
Date: (A
21412011

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:r Arrival Time: Departure Time: dq; County: Region:
Farm Name: IUD 1 �UOn __�SWr11� Owner Email:
Owner Name: IV & !' lif6t s IP / Phone:
Mailing Address:
Physical Address:
Facility Contact: _i7v1 /1100!y 'Title:
U
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = Longitude: = ° = 4 0 1[
Design Current
Design Current
Design Current
Swine
Capacity Population Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑
Daia Cow
Wean to Feeder
00
1 2Y0
on -Layer
❑
Dairy Calf
Feeder to Finish
�,
❑ Dairy Heifer
5Larr—ow to
Dry Poultry
4
x' € r n
P �,� �
, ❑ Dry Cow
❑ Farrow to Feeder
"'
El Non -Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
El Beef Brood Cow
U
Turkey
Foults
Discharges & Stream ImAacts
1, Is any discharge observed from any part of the operation'? El Yes ' No ❑ NA El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? El Yes ❑ No �NA El NE
b. Did the discharge reach waters of the State`? (If ycs, notify DWQ) ❑ Yes ❑ No [P NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ) ❑ Yes [:]NO 5aNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes �No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes ?No El NA ❑ NE
other than from a discharge'?
Page 1 of 3 12128104 Continued

r
7
Facility Number: Date of Inspection 8 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P5 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No P NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ` U d✓ 2— Lowe,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Lruo
p 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 CpNo ❑ 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 V�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)1,,,2 Q,., )
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? []Yes FSLN0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettahle acre determination? ❑ Yes t No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [R�No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
C m ts(refer�ta question #) ExplamNany YES answers and/or any recommendations or any other commek is "4
[7sc drawmgs�;of facility�to better explain situations} (us e�`addittonul pa ges as necessary):
Reviewer/Inspector Name i �' Y Yv
Phone:
Reviewer/Inspector Signature:
Date: 10
Page 2 of 3 12128104 Continued

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

Division of Water Quality
Facility Number ` O.Division of Soil and Water Conservation
b.ther.•Ageney
Type of Visit t!FCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit § Routine 0 Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �y, Arrival Time: �; Q H Departure Time: (,Z3.0((1 County: Region: FRO
Farm Name: P -U Owner Email:
Owner Name: Wo RMx P(Irinf �i►r'_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Iritle:
Onsite Representative: OhT�(0 (el
Certified Operator: Moore -
Back -up Operator:
Location of Farm:
Swine
Phone No:
Integrator:. N[,) &yh- Rivns
Operator Certification Number: __170 VE
Back-up Certification Number:
Latitude: = o = j ❑ {6 Longitude: 0 o =1
Design Current Design Current
Capacity Population Wet.Poultry Capacity Population
[Ell aver
o'? ��l0 ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers_
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 'rurke Poults
❑ Other
Dischar¢es & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field [I Other
a. Was the conveyance man-made'?
Design . Current
Cattle Capacity Population
❑
a
Dai Cow
El
Dairy Calf
❑
Dai I-leifei
El
Dry Cow
El
Non-Dairy
El
Beef Stockei
El
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f 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
❑Ycs
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of InspectionMOM
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �- 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Jallo
❑ 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
10 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes tKNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10%or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
5
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes
CkNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR 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):
Reviewer/Inspector Name Z_nm Phone: 916 t{3l—,_ 30QK 33
Rev iewerllnspector Signature: Date: NATA103100
12128104 Continued

Facility Number: —tl Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f "No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IR-No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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
5kNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JSNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ayes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNc,
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
t'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
brNo
❑ 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
[3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
GJ/No
❑ NA
❑ NE
as-, UA SIE'd S.Xvt� c(o,,� aoo $
we -a( ept,4M oj�e_-hal abo,
Page 3 of 3 12128.104

Facility No. "b. Farm Name O-� Date 3130
Permit I" JCOC OIC_/ NPDES {Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
r.,
Zen -
Soil Test Date al l CYb
pH Fields
Lime Needed
Lime Applied
Cu Zn ✓
Needs P
` Crop Yield
Wettable Acres
WUP
Weekly Freeboard s�
Rainfall >1" ✓
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
-M
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware
Soil Test Date al l CYb
pH Fields
Lime Needed
Lime Applied
Cu Zn ✓
Needs P
` Crop Yield
Wettable Acres
WUP
Weekly Freeboard s�
Rainfall >1" ✓
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
-M
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

aIMS' UV5 141a loq
0-01vision of Water Quality
Facility Number 6,� Q Division of Soil and Water Conservation
Q Other;Agency
(Type of Visit C�Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit NRoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L�J�[L1�7 P rrival Time: rf�� Departure Time: Q3.00 N County: Region: D
Farm Name: :�vfM IS FA0%, . Owner Email:
Owner Name: Nino A,Ni'r 1'"u m r � rtC_ Phone:
Mailing Address:
Physical Address:
f� Title: Phone No: Q] 105-
Facility Contact; o�
Onsite Representative1:- ' W Integrator: �J& 11W.11's-
Certified Operator: __wQYna Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-1,a et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =O=t �s
Design Current
Cattle Capacity Population
❑
Dair Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 5B No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
5'No
❑ NA
❑ NE
12128104 Continued

Facilit Number:&3 -001)$ Date of Inspection 1313 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JjjNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NI-
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 10 a�
Observed Freeboard (in): �a
5. Are there any immediate threats to the integrity of any of the structures observed`? ❑ Yes 21 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 15kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? • �@ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ 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 IS No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDHCation
10. Are there any required buffers, setbacks, or compliance alternatives that need [--]Yes &No ❑ NA ❑ NF
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �kNo ❑ NA ❑ NF
❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
r
e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
0. Does the receiving crop and/or land application site need improvement`?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[]
Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NI
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):
J
T
Reviewerllnspector Name : Qj
Ve PhoneO WO —MO kaW_
Reviewer/inspector Signature: Date:
U 12128104 Continued

FacilWy Number:(03 Date of inspection 30
Required, Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J�; No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [,%No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. CRYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking [Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
15JNo
❑ NA
❑ NE
23.
if selected, (lid the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
15INA
❑ 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'?
ESYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
f 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
BTlo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector rail to discuss review/inspection with an on -site representative?
❑ Yes
N`No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5ZNo
❑ NA
❑ NE
t'a i K r a-
Additi. onal Comments and16i', Drawings
i
-7, r4af e- dirt at crovaw of p 4- mean .
H vit Ilme.`f'his ypA,' J p 4 FS worab&,j- 5.7-5-9 1A+ year.
o�3 �slv e St fw- no�c�bt e ii) aoo� , M� 6e t�q� ann�al�
a I. ad, Of h A. 7C_ yv$ nOf` to
Cow of nn ` h�r1�1�'ffr. �11p SO'��r ��s do,f, Pr-ej s ha r
Page 3 of 3 12128104

.Facility No. G70C$ Farm Name, r� I � l � Date 31lob
Permit CIZCOC OIC �l q-eF, NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
k -T,- L
Soil Test Date 05 (
Crop Yield N0*1er+—
120 min Inspections
pH Fields '1-
Wettable Acres
Weather Codes
Lime Needed
1^6-1 •
WUP
Transfer Sheets
Lime Applied
PA- l�
Weekly Freeboard ✓
RAIN GAUGE
Cu ✓ Zn � "
')<ib �
Rainfall >1"
Dead box or incinerator
Needs P Jo
1 in Inspections
y It
e,T
all
PulllField
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
a
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

Division of Water Quality
Facility Number G Division of Soil. -and Water Conservation
0D: ther,;Agency
IType of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �ff Arrival Time: Departure Time: County:
Farm Name: Z%1 rIOwner Email:
Owner Name: I l� Pr�r Ire 5 /&IM6 Ili c Phone: _
Mailing Address:
��- Region: t e-0
Physical Address: �--
Facility Contact: 00 e- Title: Phone No: IQ ra c �] 7 5__
Onsite Representative: Chi? Mot) got) r Integrator: PLky-V /f S
Certified Operator: o I t I�l �-- Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
dVean to Feeder
Feeder to Finish
'Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 = i Longitude: = o =1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beet' Brood Cow
Number of Structures:
b. Did the discharge reach waters ofthe State'' (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gal Ions)?
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 [XNo ❑ NA ❑ NE
❑ Yes
❑ No
[9 NA
❑ NE
❑ Yes
❑ No
N�NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
El Yes
;kNo
El NA
[I NE
❑ Yes
)0 No
❑ NA
❑ NE
12128104 Continued

F
_Facilitl_Number: F
3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
�Wo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Wo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aZO
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
(�No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
'"'
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
WNo
❑ 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?
8. Do any of the atuctures lack adequate markers as required by the permit'?
(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
maintenance or improvement?
Waste Apylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes 9,No ❑ NA ❑ NE
❑ Yes gNo
❑ Yes PNo
❑ Yes XNo
❑ Yes V, No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[I NA ❑NE
El NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) )5eC 1,1 e -- P
13.
Soil type(s) /, 1QUS/7C L4%9fe
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
19No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
Wo
❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
tgNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i�7�_ CP/6,4 W VCK O)l (A & .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
QJ STl iNIE
Phone: `1 fV 1f•J_� a
Date: EtZ�5 !,5 Zgo
12/28/04 Continued

Facility Number: (p -017- Date of Inspection Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KVo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes AkNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
h 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
t,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
DONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
tf1A
❑ 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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
�)^% � '>I �AN 'r tk"4 0-1, r+ 07 ',,\ ta�y� /
12128104

Facility No. w Time p �J 0 Time Out
Farm Name L( C� 2 b �JOK �b)4 V Q Integrator
Date
00 I,Y v ) ,r
Owner f Site Rep
Operator 1 DYt A No. -
Back -up No.
COC Circle; 6Ge or NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Fee - Fi
Gilts I Boars
Farrow -Wean
Others
fiBDA�B. sign
Sludge Survey
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Daily Rainfall
120 min Inspections
Observed
Calibration/GPM d I b
Waste Transfers �
Rain Breaker I
PLAT— -"-
1-in Inspection
Waste Analysis:
Date Nitrogen
Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Q'tl Y .Q SQ+ I

i
Type of Visit �jCompliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit %Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: `j� Arrival Time: F-;'T-';.M Departure Time. County: I I
Farm Name: I��i jU,C.. � � � Owner Email:
Owner Name: / `�' G Pu,(V I _� �a 1" iYl Phone:
Mailing Address:
Physical Address:
Facility Contact: b h
Title: �hJ
Onsite Representative: oril
V,�
Certified Operator:
Mtnf--'-_.
Back-up Operator:
)l
Phone No: 5 Q s2 a 2S-
I n grator: �'�-i 3 ' ]
Operator Certification Numher: !
Back-up Certification Number:
Location of Farm: Latitude: =0 01 =ll Longitude: [=o =6
Design Current
Swine Capacity Population Wet Poultry
Design @urretit
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
I ❑ La er
❑ Dairy Cow
❑ Wean to Feeder
I ❑ Non -Layer
❑ Dairy Call
❑ Feeder to 1: inish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑Non -La ers
❑ Pllets
❑ Boars u
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed irom any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
�STIA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
NLIVA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
r—
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
CBzlA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RJo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
A'No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: — 7— 1 Date of Inspection i)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �WA ❑ NE
Struct re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes JN No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes /� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes oNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PTNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �lo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) —'e- SCIA'e_. C�
l 3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JE�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �6o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'RNo
❑ NA
❑ NE
_Eomments (refer to question#):Axplaln any YES answers and/or any recommendations or any other comments. T5
UseSdruwings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I�.w YYW�Y Phone: �f O q33 33W
Reviewer/Inspector Signature: Date:1r
Pape 2 of 12/2R/114

Facility Number: — 2 Date of Inspection I �I
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'No El NA [3 NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 62 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
*o
[INA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
[:]No
kNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
Yes
�ZNo
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
� 1Y s
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
*o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
*A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes )kNo ❑ 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 PQ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes k] No ❑ NA ❑ NE
E
Page 3 of 3 12128104

Facility No. 22 iZ Time In Time Out Date
Farm Name _ �� I Lx P • '� f 1y)4.. Integrator 121.
Owner Site Rep
Operator _ �� ' i�lA No. P _-
Back-up No.
COG Circl Gene I or NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
F d -Fin'
Gilts / Boars
-Earrow - Wean
Others
FREEBOARD: Design— / � f f q Observed
*Sludge Survey AJcr- i Calibration/GPM
Crop Yield Waste /
�Wa Transfers Rain Gauge U Rain Breaker-010"�
Soil Test PLATS / Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections -�
Waste Analysis:
Date Nitrogen (N)
«
c,1 C7, - 1
Date Nitrogen (N)
1, !
Pull/Field Soil crop Pan Window

of Quality
Facility Number & � %� � Division of SWateroil and Water Conservation
Uther Agency
Type of Visit 0-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: —/2��
Arrival Time: fpO
Departure Time:
County:
Farm Name:
331-4e e 9i ���r�
L-�i rt
Owner Email:
Owner Name:
Ea , -J'aim_j
Phone:
Mailing Address:
Phvsical Address:
Facility Contact: 7� y /�z9e1r Title:
Onsite Representative:
Certified Operator: , fart r_
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /�
Operator Certification Number:
Back-up Certification Number:
Region: FRO
Do =' 0« g =o=i �
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
® Wean to Feeder DO Qtjp
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: [y].
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? (I1'yes, notify DWQ)
2. Is there evidence of past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
LK No
❑ Yes
ER No
❑ NA
❑ NE
El Yes
4No
❑NA
El NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes SNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Spillway?:
Designed Freeboard (in): / f t7
Observed Freeboard (in): ZL y19,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
QNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[21No
❑ 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
0 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below.
[]Yes
Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of
Area
12. Crop type(s)
' l
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
RjNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
R_No
❑ NA
❑ NE
y
Reviewer/Inspector Name ':� a Phone: /6
Reviewer/Inspector Signature: Date:
12128104 Continued

• e 4
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ® Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking C&Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " 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?
�PD Y) e-41, 67-3- �
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes [IINo 1KNA ❑ NE
❑Yes (ZNo ❑NA ❑NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
El Yes ®No El NA El NE
❑ Yes 0 No ❑ NA ❑ NE
12128104

t
r �
�� �,r� ;,T p"�'- y� ..i. ;�, . �'}{.!�;�i'�;e.���l+'�i��a� .'�i.��.��:��i�;� „t�� •"ilhir..�rtsr �f�. .... - . `+ l F ... .,
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 4± Routine Q Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access jI
Facility Number J ra Dale of Vicit: rT' 1p'o`4 Time:
•• •— ..10 Not O erational 0 Below Threshold
® Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Kamc: AlUe
rr,�+ Q: Ion y2 , 5 w'1 t^ ` Cauntv: rrnr,sti,r C
Owner Name: N . l� . �t..r %%\ S E'a r w. s Phone9No-, 1 0— 9 48 — S-7
Mailing Address: Sp',n s cR. QoL6o_,. 114 - C. ,)73�5
Facilih' Contact: Title: Phone
No:
Onsite Representative: Wa n 4_Integrator: il�� rVI_Sy Far m b Tm .
Certified Operator:
Location of Farm:
Operator Certification Number:
[X Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0• 06 0u Longitude C • 0• C�
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I I 1E] Laver I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver ❑ Non-Dain
® Faaow to Wean d
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity C�
❑ Gilts
❑ Boars Total SSLW
Number of Lagootis _ I I❑ Subsurface Drains Present J1❑ Lagoon Area 1[] Sprav Field Area j
Holding Ponds 1 Solid Traps JE1 No Li uid Waste Management System
Disgbarges S Stream Impacts
1. Is any discharge observed from any pats of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (If yes, notify' DWQ) El 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 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches)'. y
05103101 Continued

Facility Number: 43 — J,� Date of Inspection
A ti
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Am )lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
0 Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.

s
� <��( i�t� ��`�i�,} • �}%i�� Ei"M&�'�,.,�i�ci3f'�s 6�?...�'. »!�����'��.,:�.� �:�;1���� � a�w,fl„�.•'i.: , ,w..<.,�., , .. � .. � - � , - 3? , ... _.
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up O Emergency Notification Q Other ❑ Denied Access
FaciGt.• Number (a 3 Date of Vkit: . Time: : D G
Not O eratinnal 0 Below Threshold
® Permitted ® Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: R I to tin. %h 6.1 �S Uj.* t. County: _I'A e3 I f e. 1 1�Zi�
Owner Name: . ii G . P'ryL's -arn, Phone No: `�i-� LO 19 4 k - _1 Zzq 7-
Mailing Address: 2.5 D•4 Sn, rA ke- -2-34S
Facility Contact: I d tz Titie: Phone No:
Onsite Representative: I 0.-!le Integrator:
Certified Operator:. ja I o d rr Operator Certification Number: T 414r
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' � �" Longitude • i �•
Design Current Design Current Design Current
Swine Ca acitF Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laver I I IE] Dairy
❑ Feeder to Finish ❑ Non -Laver I I Non -Dairy
® Farrow to Wean O
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ La oon Area 113 5 rav Field Area
Holding Ponds 1 Solid Traps FED —No Liquid Waste Management System
Discharges 8 Stream impacts
1. is any discharge observed from any part of the operation?
Discharce oridnated at: ❑ Lagoon ❑ Spray' Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach fluter of the State? (If yes, notiA. DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑Yes [UNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes @ No
❑ Yes rS No
❑ Yes ❑,;No
Structure b
0"3/01
Continued

Facility Number: 3 — la Date of Inspection
5, Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes M No
(If any of questions 4-6 was answered yes, and the situation poses an ty
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement'? ❑ Yes [ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes (%No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes ❑"No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type f -eke + LPA-
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 Z,No
16. Is there a lack of adequate waste application equipment? ❑ Yes [Q No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[59 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
01No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EbNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
BNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cotrim 'ts { feto question °#)� Explain AnrY swe <w L L yewr pf I'
• rs Mnand/or an `recnmmendatlons�tir an atherkcamments.
y,_d=
y
-- 4 Zia L9 k4._.✓:#yL L.
Use drawings ofEfacitity to. better�explain situations (use aaditiono3 pages�as necessary)
❑ Field Copy ❑Final Notes - - - - " '��..u'r?
Reviewer/Inspector Name
Reviewer/Inspector Signature: L Date:
05103101 Continued

Facility Number: 3 — Date of Inspection 3 p4
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts. missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover?
nal Comments and/or
05103101
❑ Yes ❑ No
❑ )'es ® No
❑ Yes © No
❑ Yes [Z No
❑ 1'es ® No
❑ Yes Q No
❑ Yes ❑ No
J

Site Requires Immediate Attention:
Facility No. (e3 —1L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9'~ , 1995
Time: 4!1-�s3
Farm NamelOwner:
Mailing
County:
Integrati
On Site
Physical
Type of Operation: Swine c Poultry Cattle
Design Capacity:.S'Lbsvw � -jew Number of Animals on Site: �`S'cc Sew
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 +
Was any seepage observed
Is adequate land available
Crop(s) being utilized:___�
Does the facility meet SCS
7 inches) to or No
from the lagoon(s)?
for spray? Qe or No
Actual Freeboard: Ft. -:�Zv Inches
8Rck3� ��s
Yes or 1)Was any erosion observed? Yes o is W0r ell"014azz
Is the cover crop adequate? Yes or( o
minimum setback criteria? 200 Feet from Dwellin s? � or No
100 Feet from Wells? ie or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or®
Is animal waste discharged into water o
f he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o 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 o
Additional Comments: ✓. f , cad
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Inspector Name
A/
Z__A-01
Signa ure
cc: Facility Assessment Unit Use Attachments if Needed.

Alt.

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