820007_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Quai

d°QMivision of Water Resources
Facility Number - �IUia O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliauce Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: n Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: P Departure Time: /, 3 a County: 1,49�e�AI
Farm Name: P �; � , !�, � ,� � Owner Email:
Owner Name: 3, Farb e— &rb 1 11�p5` Phone:
Mailing Address:
Physical Address: C0'4 5 j 'x_V- i[
Facility Contact: Ic Title: Phone:
Onsite Representative: 1 ro7V L5 -4 rVb�yx Integrator:
Certified Operator: ft
Back-up Operator:
Location of Farm:
Latitude:
Region: PLO
Certification Number: loo —( I yy
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish p Zt>d Oo
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ei , ❑ NA ❑ NE
❑ Yes
❑ No
❑'NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [RIA ❑ NE
❑ Yes VNo
4[DNA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: R 4 - " 7 jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ NV--E] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q-N*-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
pp qqq
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6D_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
EJ Ko
❑ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-7o
❑ 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
[DND
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑11To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ 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 Windofw� ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C � IT
13. Soil Type(s): Lsjcc
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes FE; o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes l.i I No' ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [) o' ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ 010 ❑ NA ❑ NE
❑ Yes Ea Xb ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;—NLo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[UXo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
[:]Yes
[2,Nm
❑ 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
[g No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 7 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: M - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'N-o— ❑ 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 j oo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes `�tB o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g-lo ❑ NA ❑ NE
[-]Yes �lo ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes [2�1Qo ❑ NA ❑ NE
[] Yes �o
❑ Yes [5 No
❑ Yes ®No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments °(refer to question"#): Explain any YES answers and/or any additional', recommendations or any other comments. "
Use drawings of facility -to better explain situations (use additional pages as necessary).
a7-�e VIIAOy _ C/ -9 7 `I7
t �t�i3 60
7 o
� La vOtli l�G{ 1L�� � 5tu�i r5C "L � �''ci S CC7 UG ✓ octet �o�4s�
Ctio- 30-f- 6 FS(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'3 J( D u
Phonelfo-q,33` 33 }
Date: 21 'Mov1 8
21412011

j'7 50
ivision of Wa#er Resources
Facility Number ®- [� ®Division of Soil and Water Conservation
®Other Agency
Type of Visit: 7Routine
Hance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: S w` Departure Time: County:, Region:
Farm Name: Iq 4�, — Owner Email:
Owner Name:t owl Phone:
Mailing Address:
Physical Address:
Facility Contact: &a40Vf'( Title: Phone:
Onsite Representative: �� Integrator:1J
Certified Operator: �`� �elx Certification Number: 1 '7 ��►f
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
al 111,
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
'11Non-La
er
I
Dairy Calf
Feeder to Finish
p=Z
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . l;nul
Ca acity
P,o ,
Non -Dairy
Farrow to Finish
layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
T urke s
Other
Turkey Poults
Other
Other
Discharues and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[,❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E3-�<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
l� A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[34A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IlNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I 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
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[; .l
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
nn
Observed Freeboard (in): � 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No
❑ 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
[TNo
❑ 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?
D Yes
[a 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
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes `J 1No ❑ 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): Sed' &
13. Soil Type(s): _ WA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ �rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes dNo ❑ 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 W0 ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes (a No ❑ NA ❑ NE
[] Yes [ErNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [yNo ❑ 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 Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FfT—No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: n
241Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7] 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 RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
[H 01No
❑ NA
❑ NE
❑ Yes
E3/No
❑ NA
❑ NE
❑ Yes
FJONo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes zNo
❑ Yes RNo
❑ Yes VNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any; additional, recommeudations_or any�other comments :, F
Use drawings of facility to better explain situations (use additional pages as;necessary)
�C SCA 6
3,7 t(ef
3 3,), 3-7
cal quo- $og- Usf,
Reviewer/Inspector Name:
ReviewerlInspector Signatuc
Page 3 of 3
PhoncSO- 33 3 26t_
Date: kr,rl 1
21412015

ICI eMS '436
6 t' W
W'Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QFUoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D Departure Time: County- R—
Farm Name:Z
2, Owner Email:
Owner Name: a 5 •J J_ Att- `"g J Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: Integrator:
1�
Phone:
'049
Certified Operator: Certification Number
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
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?
Longitude:
Region: r
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [l"No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0140
❑ Yes
[ErNo
G-NA [] NE
0—NA ❑ NE
[�'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ErNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): VQ 'Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QXo ❑ 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 tNo ❑ 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? cs dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes D No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5"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 ❑nApplication Outside of Approved Area
12. Crop Type(s): ,i]�Q.—. 5h o 4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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.
[:]Yes
�o
❑ NA
❑ NE
❑ Yes
[TIZo
❑ NA
❑ NE
0 Yes
[�To
❑ NA
❑ NE
❑ Yes [�<o [] NA ❑ NE
[:]Yes [RIo ❑ NA ❑ NE
[-]Yes [2-Ro ❑ NA ❑ NE
[:]Yes Q'No ❑ NA ❑ NE
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q'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 [ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Cantinued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[( No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[;�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
VNo
❑ 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
0 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
[;[Ao
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
O No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
g�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
[TNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ONo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers andlor any additional recommendations or any other comments. ,.
Use drawings of facility to better explain situations (use additional pages as necessary).
(4AAt 2 T,
4-
4-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ij
Ou
Date:' 0- _V± ( t6
21412014

type of visit: k--i-uompuance inspecuon v vperanon xeview V structure r.vamanon V Iecnnicat Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name_-pj
Lt
ai_.0 or ( ;: � ? Owner Email:
aOwner Name: I> Cc�/CGI Phone:
/,—
Mailing Address:
Physical Address:
Facility Contact: �err�!z q-_C04_Aj Title:
Onsite Representative: l
Certified Operator:
Back-up Operator:
t(
Phone:
Region:
Integrator: 4113
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current Design
Current Design Current
Swine C►apacity
Pop. Wet Poultry Capacity
Pap. Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Da' Heifer
Feeder to Finish p�c�o
r 0D
Farrow to Wean
Design
Current D Cow
Farrow to Feeder
1) . Poultr. C•_a acity
P,o .. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other 10ther
Discharges and Stream Iinnacts
I. Is any discharge observed from any part of the operation? ❑ Yes D�� ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No L_I KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No [3-GA ❑ 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)
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 '
[—]Yes No
[AiA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - ©ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5"o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[J-#M
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
L-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E>o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
MKoo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C11Z ❑ 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 �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C]�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes t[ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
[:]Yes
Ea -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
E2['90
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]'&o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O-No ❑ NA ❑ NE
❑ Waste Application El 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 EdNo ❑ 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 3 21412011 Continued

Facility Number: - 6Q Date of Inspection: ITX
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes K] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Duo ❑ 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 EJNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes 001�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Q Ko ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
[-]Yes 0 No ❑ NA ❑ NE
❑ Yes �2rNo ❑ NA ❑ NE
[—]Yes �No ❑ NA ❑ NE
[:]Yes Ef No ❑ NA ❑ NE
lUseCmeets (refer.
lions or any other comments. f Comments re er:to question Explainy y I an answers and/or an additional recommendations
g' ,of facility to.better. eapWn situations (use-additional.,pages: iI npossary).'_
4( 0-3•I, P-2,�
*2- 6 - 3-k
Reviewer/Inspector Name: U
Reviewer/Inspector Signature:
Page 3 of 3
try s
t
57 ;;�
Phone: 333
Date:
214 014

Type of Visit: 4f Co
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint 0 Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: yev"_ Region: t'
Farm Name: Perg,Lei 2 `J Owner Email:
Owner Name: ev--s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Lt
Certified Operator: It
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: R B 60 L r
Certification Number: q7- j-7
Certification Number:
Longitude:
Swine
Weinish
Design Current
Fapacity Pop.
Wet Poultry
La er
Design
Capacity
C*urrent
Pop.
esign Current
Cattle Capacity Pop.
Dai Cow
eeder
Non -La er
Da' Calf
inish
6O
Dai Heifer
Wean
Feeder
Finish
D . $o_ul
La ers
Design
Ca act
Curren#
P,o
D Cow
Non -Da'
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
E&(, _ ❑ 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 [g-,K-A
❑ 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
C.'�io ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Efj'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

41�F�cili Number: - Date of Ins ection: h -L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NSA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [B'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in),���p
5. Are there any immediate threats to the integrity of any of the structures observed?
y
❑ 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 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
❑ 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
r 12. Crop Type(s): igey c"K J G-o
rr_�De�
13. Soil Type(s): Gr, ll'�1�'��
V
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
QI� o
[] NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CDXo DNA ❑ 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 Ea No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F2"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[D,14'o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E? o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? [—]Yes Q o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ffNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�No ❑ NA ❑ NE
❑ Yes R]-Iqo ❑ NA ❑ NE
❑ Yes E'FTo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments.;
Use .drawings of facility to better ez lain situations use additional pa es.as._necessa '
L(
ill
�c 0'7
O
s�A� _ t6 ---V
=fl-2 0 � 3.
Reviewer/Inspector Name:
Reviewer/Inspector Signature: 1 I Date: �i1`JurA�
Page 3 of 3 21412011

- I K4, © C
Type of Visit: QjCom ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Times j� L = County�Lt C6 Region:
Farm Name: 3 YC Pc-q Le7% Owner Email:�—Owner Name:Phone:
Mailing Address:
Physical Address: cc
J �y�
Facility Contact: �llv�y � Title: r Phone:
Onsite Representative: Integrator:,
Certified Operator: �l Certification Number: --9,7 L
Back-up
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
C*attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
MWeNsign Gur e
D . P,oult . Ca acit P,a ,
La ers
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Co —
Boars
Other
Other
Turkeys
Turkey Poults
Other
_=J1
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
2 A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
2r<A
❑ 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
[jk<
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[D-ido
❑ NA
❑ NE
3. Were there any observable adverse impacts_ or potential adverse impacts to the waters
❑ Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
N
Page I of 3 s$ -5 'ems w @ t
S
2142011
Continued

Facility01
Number: - Date of in ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 2� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):lfl
5. Are there any immediate threats to
the integrity of any of the structures observed?
❑ Yes
[E�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
[!TNo
❑ 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
[;K4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑r 1l o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[DIVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
<o
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3N"'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G � G - 'i " ?kt" S r'.
13. Soil Type(s): A A/�Ct.✓L
14. Do the receiving crops differ f4 those designated in the CAWMP?
❑ Yes
[Ep'&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[;�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Rio
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[1),No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ONo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[ff"(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j3No
❑ 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
[; '&o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
4]1�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[jg' Jo
❑ 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 ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes ❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes [:]No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments:,
Use,,drawings,of facility,to.better, xPlain situations (use additional pages.as necessary).
1 1,(ilA-
S L�ft EICX'C"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Mou 4�'60�'4 ZZIZ-',
�(—ll—Jo�3
3� P _ 2,
r
D r r Lt
3,1 397
Phonq L 0
Date:sa
21412011

jo
qldI/,a 0
Type of Visit: QrCompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Q(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: Departure Time: [; County: Uln Region:
Farm Name: CZ Q C a rig 3 Owner Email:
�r
Owner Name: ��� ��l�th9 eta ��2 1crLnpg LIC Phone:
Mailing Address:
Physical Address:
Facility Contact: D P U AN q_ Title: Phone:
Onsite Representative: &?P1W Integrator:
Certified Operator: ,1 [� Lp(� Certification Number: qg 8 40
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pog.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Da' Cow
Non -La er Da' Calf
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish 101500
18
Da' Heifer
Design Current Cow
D , Pmoult . C•_a aci P,o Non -Da'
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ff NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
dNA
❑ 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
U No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[:yNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facility Number: a - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No
❑ NA ❑ NE
[]1VA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 p
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in): sa a+
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 02""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 [L�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C�(No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes [ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [- "No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �lo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZNo ❑ 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):
a. Ge'a'bs 1 '14A
13. Soil Type(s): �,,�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [j]4Jo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Cg-l�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 514o ❑ NA ❑ NE
❑ Yes [qlo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes CTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C3"'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 [DAo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [EfNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: sz_-i jDate of Inspection: `7 o'n
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [yNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [S]rNo ❑ 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 2/No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [E�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[4FNo
❑ 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[-]Yes
[�fNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E;(No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: 1
'7
Page 3 of 3 21412011

Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region:
Farm Name: F—`1� Owner Email:
Owner Name: 3 t✓1 0 ��/t LAC Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: u
q
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator.
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
nt
DesignMile
Cattle Capacity.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Q%
Design Current
Dry P,ou_ltry C•_a achy P,o
Layers
Non -Layers
Da' Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turke Poutts
er
Discharges and -Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes [ No
❑ Yes [ No
M NA ❑ NE
[Z] NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

~ Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes � No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2 3-
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 53._
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �g No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ pplication Outside of Approved Area
C 12. Crop Type(s): DC6Q � r [_"'Pss ��,{.lot
13. Soil Type(s): W yl,,— W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�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 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
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
t@ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1,�jj No
❑ NA
❑ NE
Page 2 of 3
21417011 Continued

Facili Number: 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 provide documentation of an actively certified operator in charge? ❑ Yes �] No
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
F] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
4] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any:.additio.nal reOrnmendattons.or an other comments:.
y rt
Use draw,inns.offacilitv.to.better,explain-situations�fuseaaddtttonalaiaes;as<necessarvl';�.;..,:,_,.z;
�.a ­o
, i sa,� te -7
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone: ' 3
Date: 3 ��
21412011

livii,i# of Water Qpahty ,: bR „
le
�0 DivLsitin of_Soil and Water Conservation _
O.Other-Agency M. .,
Fac�ty Number
i
Type of Visit G Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: d b Arrival Time: 024 4 /1, Departure Time: d l County: POOA) Region:d—r`U
t
Farm Name: 9 Owner Email:
Owner Name:mi�LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: c�p Integrator:
Certified Operator: G ©� `` S Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 � 0 Longitude: � ° 0 A 0
D�esign �x�Des�gn� « Current, Des�gnCurrent
s�rrent�
SRwe CapacityPo
ulation Wet foul Ca act Po ulatton Cattle 'Ca ac Po ulahon
❑ Da' Cow
h ❑ Da' Calf
., �,:
❑ Da' Heifer
-
Dry Po:tltry� A 1
Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
J.
❑Beef Brood Co
M Other:
°'
X.,' •a
-
,«
i ❑ Other
t ¢r
uml] ru N roof S c#ure
54,;Jr
U,:-77777777-7777777
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
fSZ�
�iCJ
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ La er ,
[E]Non-Layer
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No [� NA
❑ NE
❑ Yes ❑ No 1 NA
❑ NE
❑ Yes ❑ No � NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12/18/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
F NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
?
Identifier: J 3 2?6 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ff�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?
An
ElYes LjpNo
❑ 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)
1
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
Ir
ElNA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (,�, No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ A lication Outside of Area
12. Crop type(s) t�'S �`^^ SS ® rA
13. Soil type(s) OA
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 acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Wo ❑ NA ❑ NE
Comments (refer, to question #): Explain any YES answers andlor; any recommendations or any other comments
Use'draw-ings of facility to better. explain situations. ,(use additional pages as riece5sary} p hh. I
Reviewer/ins ector Name
p A Phone: Q 10
Reviewer/inspector Signature:
Date: i
Page 2 of 3 1212810 Continued

-Facility Number: 9— Date of Inspection t O D
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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:)Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JP No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
J� NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�1 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
?No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�,No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
qjNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�jNo
❑ 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
I .No
❑ NA
❑ NE
Page 3 of 3 12128104

I
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `r 7 Q Arrival Time: h Departure Time: County: Region: Pft
Farm Name: r 3 Owner Email:
Owner Name: h Phone:
Mailing Address:
Physical Address:
� 4
Facility Contact: T LOY2_2S Title:
Onsite Representative: N
Certified Operator: lu l--
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Ne-
Operator Certification Number: ,7
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° E__1 =
Design Current
111111111
Design Current
Design Current
Swine C•apaeity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
1
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
1
❑ DaiEZ Calf
Feeder to Finish I IV
❑ Dairy Heifer
El Farrow to Wean
Dry Ponitry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes PNo El NA El NE
❑ Yes
❑ No
O NA
❑ NE
[I Yes
❑ No
r] NA
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes 6 No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection 7�
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes T No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
w
Observed Freeboard (in): u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ` h No
❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
[INA
ElNE
through a waste management or closure plan?
1
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) I
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [% No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evide of Wind Drift El Application Outside of Area
12. Crop type(s) Cm &oaWr 6;* 4r i Acltiv), .4A- �Q�In owe c- /
13. Soil e s)
type(s) (W�
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 acre determination ?
❑ Yes
1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
$] No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
`- No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or "any other comments
Use drawings of facility to better explain situations.. (use additional pages as necessary): f
A6
T
Reviewer/Inspector Name Phone:
ReviewerAnspector Signature: Date: Q
12128104 Continued

Facility Number: Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes OrNo ❑ 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. ❑ WTJp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
)n No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&I 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
01 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JU No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
i9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �ffNo ❑ 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
ElNA
ElNE
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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[)TNo
❑ NA
❑ NE
12128104

ry . I
0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 01 Arrival Time: /0 S 3 Departure Time: r ` County: �I Jr' s[�
Farm Name: N4 L4?q Owner Email:
Owner Name: lrotJh Phone:
Mailing Address:
Physical Address: {�
Facility Contact: � 000 W n Title:
Onsite Representative:
Certified Operator: � t It06
Back-up Operator:
Location of Farm:
Latitude: E—D o
Region: fizo
Phone No:
Integrator: Atx.V'R�_ DVDtjy\
Operator Certification Number: ;L714
Back-up Certification Number:
Longitude: 0 ° =1 ' = u
Design, Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish JA2DO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ on —Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ DaiEZ Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No E f NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ElNA ElNE
ElYesgNo
No ❑ NA ❑ NE
12128104 Continued

Facility Number: 01
07 Date of Inspection rl D
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 El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Po ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &o ❑ 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 IgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fFNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) bQy-jMtAL 6Yi 66
13.
Soil type(s) WQgr a'WN—
14.
Do the receiving crops differ from those designated in the CA WMP?
❑ 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 acre determination?❑ Yes
MNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft 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):
AL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 9 �
12128104 Continued

Facility Number: — Date of inspection 7 Or)
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 ElNA ❑ NE
the appropirate box. ElWUP ElChecklists ElDesign El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �LNo ❑ 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
IRNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
g_No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
[INA
❑ 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
�To
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
ll
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
t�'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4D Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 2 " Departure Time:
Farm Name: PEA LfA Own
Owner Name:L�7 n u� Ph
Mailing Address:
Physical Address:
County: P-SO Region• F�
er Email:
one:
Facility Contact: _J_ h i . /d oY(-3 Title: Phone No: --
Onsite Representative: Integrator: U C l Jam_AML.1*\ „
Certified Operator: M t QLVJ t' fDb tlnL4 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = [ ---- 1
66 Longitude: = o
Design Current .
Design Current
Design Current
Swine
Capcityty Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ DaiH Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
I 0,R00
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ I urkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
'may No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
IP No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
In No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/18104
Continued

Date of Inspection
,
Facility Number:
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 IDNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
4
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JpNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
P No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)6 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 'i5*Lk WfteEa 04�g (nat, f45fU4_)j ' iW,
13. Soil type(s) Alajq rom
v
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
E� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name IJA&L M0144t Phone:
Reviewer/Inspector Signature: Date: po Lo
Page 2 of 3 I2128104 Continued

Facility Number: `�—'� Date of Inspection
Reauired Records & Documents d
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 09No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E?No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E§No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PoNo
❑ 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
$a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ki No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I 0r` -Go'. I Departure Time: p County: SAT*VS64 Region:
Farm Name: PcA�IAI , jta , 4-.3 Owner Email:
Owner Name: QQCLX- IW M Farms T,,C. Phone:
Mailing Address: Physical Address: �oYX �6� Erb ujv
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o =
DesiAn@urrent Design Current Design Currenulation
Wet Poultry Capacity Population Cattle Capacity Populatiau
❑ Wean to Finish ❑ Layer
ElDai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
KI Feeder to Finish 10,2M
90,WO ❑ Dai Heifer
❑ Farrow to Wean Dry Poultry El Dry Cow
ElFarrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
El Pullets
❑ Boars ❑ Beef Brood Cowl I
❑ Turke s
Other ❑Turke Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
[NA
rONA
[INE
ElYes
ElNo
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 1 O6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 3
Spillway?:
Designed Freeboard (in):
-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
E�NA ❑ NE
Structure 6
❑ Yes [INo ❑ NA ❑ NE
❑ Yes � No El NA [I 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 [2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P1 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 RNo ❑ NA TINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable `C-rop Window El Evidence of `Wind Drift ❑ Application Outside of Area !
12. Crop type(s) &,(Y IAA6 &-a 55 (l{G41 . �QS-�-�.-,c) , s �!� &-a,, ^ 00_.4r Semi
13. Soil type(s) Wd S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[K No ❑ NA ❑ NE
E9 No ❑ NA ❑ NE
SNo El NA El NE
`Z No ❑ NA ❑ NE
Comments (refer to question #i): 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):
NOR
ReviewertInspector Name �!+ —]Phone: /O 3 33Da
Reviewer/Inspector Signature: Date: io 2( p
Page 2 of 4 12128104 Continued

Facility Number: ea; — Date of Inspection LL', Oi]
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes pqNo ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J61 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E,No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IF No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
yu No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 14 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CD No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
f5jNo
❑ 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
Page 3 of 3 12128104

Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit dF Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (T�s D Arrival Time: Departure Time: County: Region:
Farm Name: `° �' #�� Owner Email:
Owner Name: _ VeS4t Jlli Phone:
Mailing Address: P8 qo_x _ 4_ r_µ_ a G 2_1}1f Y
Physical Address:
Facility Contact: M + A114 e, I t ri S— Title: Phone No:
Onsite Representative: _ r�.� [ N,o,�fr' S Integrator: JnC 4 rt� rc.��
Certified Operator: �i� aa✓� _ xly-e��.rIvt —Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ED 0 0 i = u Longitude: = ° = I = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
MO
Z 30
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-- - ---
-�
Other
❑ Other -- - -- - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
3
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
5d No
❑ NA
❑ NE
❑ Yes
❑ No
XNA
❑ NE
❑ Yes
❑ No
9NA
❑ NE
N NA
❑ NE
❑ Yes
❑ No
❑ Yes EkNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 2 — Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C3,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NNA ❑ NE
Structure 1 Structure 2' Structure 3� Structure 4
Structure
5 Structure 6
Identifier: C-4`
Spillway?: Q6 jZD T kin
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
95No ❑ 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
9LNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
25No ❑ 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
JKNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
(K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ of Wind Drift ❑ Application Outside of Area
(Evidence
12. Crop type(s) _�f-P.ry+�ttOst l i=� `�M _ 91 girt f�u�.�S�
9J e
1
-ax a
13. Soil type(s)�
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EQ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
@9No
❑ 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
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Reviewer/Inspector Name ¢'�" �" Phone:lift
Reviewer/Inspector Signature: Date: --f/Z'S/dss
12128104 Continued

Facility Number: �.Z. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ 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. ❑ WUr ❑ ChecklistKE] Design ❑ Mape' ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Applicatio#'�' ❑ Weekly Freeboardf❑ Waste Analysis"❑ Soil AnalysiS""❑ Waste Transfers ❑ Annual Certificatiofr
❑ Rainfaw4 El Stocking/[] Crop Yiel&' ❑ 120 Minute Inspectioe ❑ Monthly and 1" Rain Inspection'" ❑ Weather CodC
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
igNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
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
UKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�.No
❑ NA
❑ NE
Additional`Comments and/or Drawings:
I2129104
I2129104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 7 Date of Visit: 1o� �o Tune: 9 ' �F O
O Not erational O Below Threshold
13Permitted UCertiSed [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........ .........
_.
Farm Name: ... �_. L j a _ _ _. 3 _—. County:
Owner Name:
Phone No:
Mailing Address: ___La........a "?y ��- --� _ ..__ � �s sx __ � � 11 V C...___.____ ..Q 8 69
Facility Contact: _ _ ._ .W .__ __ ___ ___Title: ____. _. _ _. Phone No:
Or►site Representative: Y c:�.4 � o Y r . -s ._ _ ._ , Integrator:
Certified Operator:._ -M. r ti.';,�SA W iY] � �, c _ Operator Certification Number:. _ .�2
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' t 0L4 Longitude • ' "
Cnrrreat I?essgn Cu>crent'= Design Current.—-
Swrne- C� `
Mahon Poultry r Po alatiion ; Population
.
:Po �.Caile as
Wean to Feeder
�.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [3 No
c. If discharge is observed, what is the estimated flow in gal/min'? IV) A
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 Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 99 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 7 •3 -7
12112103 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [3 No
c. If discharge is observed, what is the estimated flow in gal/min'? IV) A
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 Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 99 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 7 •3 -7
12112103 Continued

Facility Number: 32 — 0 7 1 Date of Inspection 0
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 maintenancelimprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance./improvement? ❑ Yes UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/fmprovement? ❑ 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 [I Copper and/or Zinc
12. Crop type Qe r rrr ttoQcL A c L4 / S rv. a i G ti-",% Pj ` � r ..-, ��� a ✓ Ckz co{
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑ Yes 5] No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ]R) No
b) Does the facility need a wettable acre determination? ❑ Yes [0 No
c) This facility is pended for a wettable acre determination? ❑ Yes 13 No
15_ Does the receiving crop need improvement? ❑ Yes W No
16. Is there a lack of adequate waste application equipment? ❑ Yes W No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Q 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 EANo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes qNo
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.
Commets (rider toiieshan il) Eap YES aYers and/or aiey of y other commesits.
�x
r
mike drawmi iaeiLiy to he#tr sitnautron.. ad dihonai pages as nary) Field Copy ❑ Final Notes
u
�....._. a®.s '�` �.3° � .H_?i:__".t.e._�..'i,....__. '3���-'G'. �.�:..;-5"�....�,...2._.e'?S'„^��.». .,... �:.:^^ � d._,• .: Y .... e.fc�� ... B'"pr-m,... .ti_.. v.-w.:.�00....
%- rSF�&rcc iG�aa►t bQzl�s.1
dv�"Ate'
co
1
4. � r2 a CGCz41C ,
�F�P� fs Grncj /�il.� fltTf4 ��G I�90,D&3 array+. T'�L 7`Du SCJ, L haS l5
IS
i/ S ( �+ h Q G t b b Y� �`O t" C �•
Y> o [" Q c�
Reviewer/Inspector Name:..@
n r
Reviewer/Inspector Signature: Date: �'7 1,5%2 A-5W
12112103 Continued

Facility Somber: S ;L _ p-7 I Date of inspection 7 bz
Required Records & Document~
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ❑ Yes No
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
l] No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
91 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑
O
(ie/ discharge, freeboard problems, over application)
Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Ep No
28. Does facility require a follow-up visit by same agency?
❑ Yes
a No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
10 No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [ja No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention: N
Facility No. % 2--1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1� w , 1995
Time: S
Farm Name/Owner: �-� J
—
MailingAddress: (6zW
color : AalS a
Integrator: kji2- v A (L o b
On Site Representative: VQ*- � C C��d4
Physical Address/Location: Qv, - lW 5', c�s
)ne: 1- I,U G ~ 61-1 ~---
Phone: C-[ t a
N f "zz it n R n� V
Type of Operation: Swine Poultry Cattle
Design Capacity: you Number of Animals on Site: 3
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• Longitude• 0`
Circle Yes or No
Does the Animal Waste Lagoon haw sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No A teal Freeboard:._Ft. _Inches
Was any seepage observed from the la n(s)? Yes No as any erosion ob ed? Yes o Nod
Is adequate land available fopray? Y or No Is the cover crop adequate? es r No
Crop(s) being utilized: 4 S �.L.
Does the facility meet SCS minimum setback criteria? 2 eet from Dwelli Y or No
TOO Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a U5GS Map Blue e: Yes ooNoo
Is animal waste discharged into water o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management (volumes of manure, land applied,
spray irrigated on specificg�Meqe wi cover crop)? Yor No
Additional Comments:r A4, d _-
a
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Ll Au\A 1995
Tune:
Farm Name/Owner: Z VV_ SA
Mailing Adds m
COMM
Integrator: Phone: 0 --
On Site Representative: E Phone: q! c_ — 53Z—
Physical Address/Location: 5_'% . tk jilL-1 S A .
r-A ykt � vet
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: , 3 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0•
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No T-Wfoal Freeboard:�_Ft. Inches
Was any seepage observed from the (s)? Yes o N Was any erosion observed? Yes or o
r N a cover crop u? Y Is adequate land available f or ray. o o Is the op adequate? es or No
Craps) being utilized: L—)
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli��I a or No
100 Feet from Wells? �.csJor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or i0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes No La
Is animal waste discharged into water ofAlke, state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes No
Additional Comments: _
-Inspector Name '
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. Z H'i
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: VI�� v�� , 1995
Time: t CO
Farm Name/Owner:
Mailing Address: 0- Al
County: S v
Integrator:
On Site Representative: oil► i d
Physical Address/Location: - 'Sj
o-: tv�t iso "
4Z
ou
Phone:
Phone: 1:�%Z — S3Z.— Z�S
Type of Operation: Swine Poultry Cattle
Design Capacity: 3`to Number of Animals on Site: 3�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
{approximately l Foot + 7 inches Ye or No Freeboard: Ft. r Inches
Was any seepage observed from theF(s)n? Yes o N Was any erosion served? Yes Or
Is adequate land available fo ray. or No Is the ver crop adequate?r No
Crops) being utilised: s
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli Yes r No
100 Feet from Wells? Y 0 0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes No
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS Map Blue e: Yes oCNo
Is animal waste discharged into water of�state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management (volumes of manure, land applied,
spray irrigated on c acreage cover crap)? Y r No
Additional Comments:�()v�V_sr ,cam _ _ VIAS, 4 �I, _ ►4
cp,
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.