820009_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q.C�mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O'Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: 3 Arrival Time: 1 7t c07F1 Departure Time: County: `�«�so-,
Farm Name: &71Y— (- Cay"-vk p rr-- F Owner Email:
Owner Name: OVA c if syo-gt 1`" Am, -i -,Lc, Phone:
Mailing Address:
Physical Address:
Facility Contact: (1,J 1`S &a=CV ly_k Title: Phone:
Onsite Representative: t t Integrator: lf'-e<f a?,e
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
t30
k�a
Farrow to Feeder
`
Farrow to Finish
Gilts
Boars
?'
m
-Other;.
Discharges and Stream Imuacts
1. Is any discharge observed from any part of tl
Discharge originated at: ❑ Structure
a. Was the conveyance man-made?
Latitude:
��s�x-cz-•a.�s
Region: I•1Z10
Certification Number: 16 b 8 6
Certification Number:
Longitude:
Inairy COW
Calf
Heifer
- ;ow
Stocker
Feeder
'Brood Cow
Yes ®'N—o ❑ NA ❑ NE
71 Yes ❑ No [] NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑Yes
❑ No
[! NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
E5 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 1Go
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[n"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: r07, - Date of Ins ection: At 48011
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9i`4
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
LLJ °'"'
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
r
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
®' T�o
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0'go
❑ 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
[:L>16-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
❑'l _oo
❑ NA
❑ NE
maintenance or improvement?
Waste ApRlication
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 �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 ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a tre & 6:(2 0 R Ef --
13. Soil Type(s): t& i.J t:L11
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes To ❑ NA ❑ NE
GDoes the receiving crop and/or land application site need improvement? Ej Yes ui 465 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] N ❑ 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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [TNo ❑ NA ❑ NE
[:]Yes D-No ❑ NA ❑ NE
❑ Yes [DNo ❑ NA ❑ NE
❑ Yes E31To ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [DI�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes [3'go ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 2-- - Date of Inspection: 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [3-go— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes []'I 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 Lim<o [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fo
❑ 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
[2 o
❑ 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
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
E],No
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
mere any additional problems noted which cause non-compliance of the permit or CAWMP?
es
D No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]"Iqo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]'FIo
❑ 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),
�07
'e�d Clio --@I -6�V
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone:'I [u _ l ,} �3�3
}} t g
Date:1 p Llir1
2/4 OI5

L
9 � �,
Type of Visit: (UCompliiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: U Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: l f Arrival Time: h`QT Departure Time: County: Region:
Farm Name:f� �j �'--q,V`�` "l Owner Email:
Owner Name: ��iSt�i l AA_X F;ttL41 Phone:
Mailing Address:
Physical Address:
Facility Contact: 13A-A'xl Title: Phone:
Onsite Representative: 1( Integrator: 1��d
Certified Operator: tr1(!-t q, NJ'_T Certification Number: a? L T 6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry C*apacity Pop. Cattle @apacity 14
Pop.
Layer DairyCow
Non -La er DairyCalf
DairyHeifer
Design Current D Cow
D , I;oultr. Ca aci P,o , Non -Dairy
Layers Beef Stocker
Wean to Feeder
Feeder to Finish
-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
t�0
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r—Tdther
Other
Turkeys
Turkey Poultr
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [�ICo ❑ NA ❑ NE
❑ Yes ❑ No �A ❑ NE
❑ Yes ❑ No [E'I';rA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) [—]Yes ❑ No M< ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C3"17o ❑ 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?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is heavy
Yes
NE
storage capacity (structural plus storm storage plus rainfall) less than adequate?
❑
[g3Qo
❑ NA
❑
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
QfiTA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[, 4 a
❑ 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
�o
❑ 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 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3"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
fMo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
G2'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1�44'0 ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Applicaattiion Outside of Approved Area
12. Crop Type(s): 9 �J�lilue� S,
G d /`Tidy e
❑ NE
13. Soil Type(s): Qr Q W C1_ `
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ErNo ❑ 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 Q 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 [2 No ❑ NA ❑ NE
❑ Yes [:2-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes [?rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes [2-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 [2-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E!rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes C: N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
a ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: djJi
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑.3Go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D 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 ©'moo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�-�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes D10 ❑ 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
[:�lvo
❑ 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
[/]`Flo
❑ 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
[!rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2`1�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[10
❑ 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).
co 746
P, 3 - 7 P,
Reviewer/Inspector Name: G 11I - V o x64
Reviewer/Inspector Signature:
Page 3 of 3
0,9( Al0-:3og-Rsr
Phonelco- T'f 3 3
Date: - t1 [
l/4 M

i ype or visit: tsmompuance inspection v uperatron xeview V nrrucrure c vaination v i ecnmcai PusisLauce
Reason for Visit: C ecoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: c o Departure Time: a County: �.41
Farm Name: [� �`� Owner Email:
Owner Name: 15r9%<91 S^fl-[ Phone:
Mailing Address:
Physical Address:
Facility Contact:
1 ""e, "Title:
Onsite Representative:
Certified Operator: f'te.K,/, Ufx ws
Region: �l '�
Phone:
Integrator: F ,SF
Certification Number: �7 C ` ,
Back-up Operator: /I Certification Number:
Location of Farm: Latitude: Longitude:
Desigu
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Design
Capacity
Current Design
Pop. Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
J=N
er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oul ,
Layers
Design
Ca aci
Da' Heifer
Current Cow
P,o Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
OthPouets
Other
H"urkey
urke s
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[jio
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
QI!RA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[�lA
❑ 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
g�rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[JNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - (fib U Date of Inspection: IN
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
�M-bicr—
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[r]-IAA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes[].
'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
QXo
❑ 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
Q o
❑ 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
[2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2,oNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. [—]Yes [ o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift/ ❑ Application Outside of Approved Area
12. Crop Type(s): e�'y'��✓'�t� L�
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [g lqo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []]ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]4o
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[1 io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[;JoNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
['I�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 [2�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes L?fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaeiliNumber: - d Date of Inspection;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [E-I�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 to provide documentation of an actively certified operator in charge? ❑ Yes g�'<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes [ffNo ❑ NA ❑ NE
❑ Yes Q1Io ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [RNo ❑ 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 [ErNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other.comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ,`ZL34;)Phone: �]J
Reviewer/Inspector Signature: 1}-''I aAj Date: 3
Page 3 of 3 21412011

i M s
5 g rJ
Type of Visit: e'Compliance Inspection U Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: GrI outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: rival Time: $ 0 Departure Time: S County: 15 4 " Region:
Farm Name: Is �__c'�,4ylx Owner Email:
Owner Name: *rhyy+ -SV q-�.P Phone:
Mailing Address:
Physical Address:
Facility Contact: 1t4L-``^' 7 Title:
Lt
Onsite Representative:
Certified Operator: IG oh A oo-ey
Phone:
Integrator: 1 ,!5 {
Certification Number: r2 ? LN W
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Ponitry Capacity Pop.
La er
C►attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
MEDesign -ff
Dr. P,ouI Ca aci PLOP.
Layers
Dairy Heifer
Dry Cow
Non-Dai
113eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees 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
B<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
[�' T1�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 ❑
E A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes L_I
No
D A
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes E�'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection;n,2%r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3'11To_
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
❑ No
[a]'i�A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed
Freeboard (in): d�J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z'1Qo
❑ 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
Eq o
❑ 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
QNtf
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ITV u
❑ 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
R-<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B<O
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [A�<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. D❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �i'IM l'� C)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EjNo ❑ NA ❑ NE
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes O-1To ❑ NA ❑ NE
❑ Yes [S-Ko ❑ NA 0 NE
❑ Yes ❑-KoT ❑ NA ❑ NE
❑ Yes ER -Nu ❑ NA ❑ NE
❑Yes �o ❑NA ❑NE
❑ Yes [5'lq-o ❑ NA ❑ NE
❑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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3No [DNA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CJ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

rJ
Facili Number: X2 - Date of Inspection: S17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [tea ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3-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 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 [3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3<o ❑ 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
[DNA ❑ 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo
❑ 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
[ffNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E rNo
[] NA ❑ NE
Comments {refer toiquestiou #): Explain an YES:.answers'and/or an additional recommendations or,an bther,comm.ents'
y y y
Use drawurgs of facilityto betterezplarn sltuatinons (use:addihonal pages as necessary.)"u: ma .•
'r
ue
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33 A�
/,
Date: f + A %S
21412014

Type of Visit: UCompliance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 42(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regio
Farm Name:n,-,- Owner Email:
Owner Name: �( �` Phone:
Mailing Address:
Physical Address:
Facility Contact: _ G`� V s 1 C itle: Phone:
Onsite Representative: if Integrator:
Certified Operator: fin PL No iry if Certification Number: :27 7 0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
DairL Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dry P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
I Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes B'NO ❑ NA ❑ NE
❑ Yes
❑ No
❑'9A
❑ NE
[:]Yes
❑ No
[I ] -NA
❑ NE
❑ Yes
❑ No
[�VA
❑ NE
[:]Yes
[glfllo
❑ NA
❑ NE
[:]Yes
[D No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

f�
Facili Number: - Date of Inspection:
VV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
E]'No ❑ NA ❑ NE
❑ No QAA ❑ NE
Structure 6
❑ Yes "o ❑ NA ❑ NE
❑ Yes I 4o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑>6
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jg ljlo
❑ 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
62"&o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3' io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): E e-S "''�- 4, .56 Q
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
❑ Yes E3-N'o ❑ NA ❑ NE
❑ Yes Q - ❑ NA ❑ NE
❑ Yes Q Wo ❑ NA ❑ NE
❑ Yes E21Ao ❑ NA ❑ NE
❑ Yes [JjW6 ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z),Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes [J16 ❑ 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 G3"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes '[�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

M �=
Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EKo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L Ko' ❑ 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 L.Z' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E31<o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes Ql<o ❑ NA ❑ NE
❑ Yes E2 o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes Q No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ej/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:..
Use.drawings of facility to better explain situations (use. additional pages as.necessary).,
t' I I f,
Reviewer/Inspector Name:
a3= 1
r u.s
Reviewer/Inspector Signature:
Page 3 of 3
Date:

�iype or visit: kyt_:ompuance inspection V operation xeview V nrructure r.vaivanon V iecnmcai Assistance I
Reason for Visit: QRoutine p Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: �i�la f Arrival Time: Departure Time: 3r County:T
Farm Name: Q �iR £ CRv.m�j P_R �AiZ.n Owner Email:
Owner Name: AKE�s �h �gitr� Tnc _ Phone:
Mailing Address:
Physical Address:
Region: /go^
Facility Contact: Cum Title: `r�h��t+ �fpµ�F- Phone:
OnsiteRepresentative: G1ts'r Wes, Q'a Integrator: kRHLsT oSM49i _
Certified Operator: a%exk'n Atlt<rn t%OM3:5 Certification Number: wl4.gi1
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine CaUcm Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
C+atfle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
EE-
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
14oO
MQSign Current
Dt. P.oul Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [;] No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes []"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: $ a - a Qz,9 jDate of Inspection: 9a'
a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I R
Observed Freeboard (in): are _
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
�No[_]
❑ 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 ff 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 R!'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes QrNo ❑ 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 [dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [gNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [ /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (ZOR3'z A\ aF�rr•.► _ A 1 �t�Ii�TL'-y. Q. ._ _ ,.
13. Soil Type(s): p C'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo
❑ NA
❑ NE
acres deter nination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;['�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[yf 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 VNo [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 4No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�(No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -oajoy Date of Inspection. l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0"'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes M"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 ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3'*No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [ o ❑ NA ❑ NE
[:]Yes E3"'No ❑ NA ❑ NE
❑ Yes [3Ao ❑ NA ❑ NE
[:]Yes [(No
❑ Yes dNo
[:]Yes ff No
[:]Yes [ "'N' o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 3 j-
Page 3 of 3 21412011

Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: R Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -4-t� Arrival Time: Departure Time: County: -56KPC&
Farm Name:% 4^ Caw 6L R(� 81-4 C- E Owner Email:
Owner Name:,QPhone:
Mailing Address:
Region: 9W
Physical Address: 1730 00 117 , Rojeb"
Facility Contact: 6I-en tiTitle: LAJ H&,A r Phone:
Onsite Representative: �je SPA -No 'r I's Integrator: C1 /ltoj`t 31n I±�
Certified Operator: k-ky Ay4y oA Bw Certification Number: �lal�g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C++specify Pop. Cattle
Layer Dairy Cow
iNon-Layer I Dairy Calf
EE]
Design Current
Capacity op.
Wean to Feeder I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current D Cow
Dr, Poultry C•_a acity I;o Non -Dairy
Layers Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes 5a No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 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
®'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15j[ 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
C5�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?
IS Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR 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
n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of 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?
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
[X No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. N Yes [:]No
03 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �C] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes U No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
-P 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 jo No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any -other comments."
Use drawngs.affacility to betterexplaen situations (uvse additional pages asneressary .. m
❑ Yes CKNo ❑ NA [3 NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
Er Yes ❑ No ❑ NA ❑ NE
Mgwor )9ackrloye of ( ,,as-�� ����1'�f- -Few fokebei�, CDC..
II �.
1S, egtr % — P e, CU_i & - s "V
la 3 � ��
4a-4-S � � �uue -ex�ell�r�ro�r,
� {?�"Q(� b�� g ra��d , D�i� s ��a�►-�`etG�.r
s � record)
.On le v,,, �.�rr�l+ N Ual� -&an yvaOe Ala yse ai
PA ►vs not c-eed ed .
ad rPco
a now a6t ►JT rf� r s�ia��
) �-st
4O'A , Dro137s in� `
[holf `for tolvs), C�" ftc6cer]
w "'S
Reviewer/Inspector Name: U
Reviewer/Inspector Signature: k"— 4CAMN.4
l ow srf 1 n riots bv� n
0
Date: Arva ;Q, a 0
1412011
Page 3 of 3

Facility No. Farm Name i Date
Permit _ - COC c.I
Pop.
Type
Desigh
Current
01C NPDES- -Cert
� �-
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
Actual Flow
a
Design Width
Actual Width
Soil Test Date a Wettable Acres UGE
pH Fields WUP ad bo or incinerator
Lime Needed 2 c �) Weekly Freeboard Q Morta ity Records
Lime Applied d3 1 in Inspections
Cu-t Zn-I 5 ��� 120 min Insp.
Needs P PO �Cvi Weather Codes
('rnn Yielri . / o7lTQ Transfer Sheet��
Waste Analysis Date
! • � � -
____________
it
Puffield
..
. .
M zff
,1
J ►
iIW�
1
�-
r�ij�
�-
Verify PHONE NUMB RS and affiliations Off)
Date last WUP FRO��C3 Date last WUP at farm Hardware
FRO or Farm Records'
Lagoon #
Top Dike
Stop Pump
Start Pu p
Conversjbn- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
� 1

3�d31ro —i41�
oll4i oq--art
a a�� Dq -�

s 6-11-2-010
ivision of water Quality..
�' DYvision of ate Sod=`and Wr.0anservairvn"
FaCi ty Number 82 } Dd 9
QA O ergency,
th -
type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
2eason for Visit
outine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: eio -23 /Q Arrival Time: Departure Time: ' �� County: Region: 6?
Farm Name: C ryas Owner Email:
Owner Name: GYive S.-W ff4� G • Phone:
Mailing Address:
Physical Address:
Facility Contact: Ole-"J'd ND rrJ 5 Title: Aw-.•. Phone No:
Onsite Representative: Integrator: aG4&Aa3� F r~_ Ste,
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o E:3 0 u Longitude: = o = t = «
Design Current
Swine ` Capes tyPopulatiun, WetPopltry 1
❑ Wean to Finish
El Layer
❑ Wean to Feeder
❑ Non -Layer
❑ Fe der to Finish f"
arrow to Wean 7.4DDDry Poultry
❑ Farrow to Feeder
El Farrow to Finish ❑ Layers
❑ Gilts 1 ❑ Non -Layers
❑ Boars ❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑Other
,ID Other
777--777-77
esign Current ;--
ipacityPopulatic►n l Cattie¢ ,
_l ❑ Dairy Cowl
o-
LJ Daia Heifer
❑ DEZ Cow
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes [--]No N
:NA
ElNE
❑ Yes ❑ No
❑ NE
El Yes No L9NA
❑ NE
❑ Yes �Zo
<El NA [I NE
El Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: : i9
6-0y /0
Date of Inspection -Z 3 /0
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:
❑ Yes 7No
[3❑ NA NE
El Yes❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑11 Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�. a.��._ J . Si4l ¢ �� �o ►-� i iv t1CP..s._)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
o El NA ❑ NE
7Ld N ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
L�Co ❑ NA ❑ NE
Comments (refer to question t#): Explain any YES answers and/or yany'recommendations or any. otr"er comments:
Use drawings of facility, to better explain situations.:.(useadditional pages as.necessary)
R
eviewer/Inspector Name Phone: 910. y��3,33OC�
Signature: Date: fp -Z3 - Z,0,40
Page 2 of 3 12128104 Continued

+ Facility Number: 82 -Dv9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ 117T Tp ❑ Ch kli ❑ D ' ❑ M ❑ Oth
❑ Yes YJ No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA El NE
ec sts esgn aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspectionss El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
BINo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
:�.N ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[IYes
❑ 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
/No,❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes�N/o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ONo ❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Xdditional�Comments,and/ortDra ngs q.
�... �.�-`tea. �: �...:�✓:,.,���.
qV
Page 3 of 3 12.128104

'Elul _S /1-C 7
Type of Visit Q Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !D-lS�-B �% Arrival Time: Departure Time: County: Sa�^� Region• E!�
Farm Name: AlGy �` (f �%Y Owner Email:
Owner Name: ___ _ _ __..._ . __.__ Phone:
Mailing Address:
Physical Address: /j�
Facility Contact: �GAOW ' " a rrr S Title: ram` J � ' Phone No:
Onsite Representative: �� ^� �����.5 Integrator: �%�����/ol �"` S"W ll
Certified Operator: lGitrN A10r.175 Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 ' = " Longitude: = o = ' = "
Design Current Design C•nrrent
Design Current
Swine Capacity Population Wet Poultry Capacity Population
C•attie
Capacity Population
❑ Wean to Finish 10 Layer
❑ Dairy Cow
❑ Wean to Feeder IEJ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean Zq%b I 2.44aa Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Broad Cowl
❑ Turke s
Other ❑ Turkey Poutts
❑ Other ❑ Other
Number of Structures:
Discharues & 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 to ❑ NA ❑ NE
❑ Yes ❑ No 2 A ❑ NE
❑ Yes ❑ No LJ'NA
❑ NE
ElYes ❑ No NA
❑ NE
❑ Yes BIZ_ ❑ NA
❑ NE
❑ B Yes lao ❑ NA
❑ NE
12128104 Continued

facility Number: 82 — 009 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
i No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ETNo ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: Q5 %
Spillway?: ^10
Designed Freeboard (in): / 91
Observed Freeboard (in): 2-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
_,�
UK' ❑ 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
l _ < ❑ NA
❑ NE
8. Do any of the stuctures 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
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ETNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) , 3-e 14do-- lfVA; •�a I ej S7.wA�� �j Awr iV
10• 5•
13. Soil type(s) lUa_ tj d.-g
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,�,
0<0 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L4'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
ETNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
:0>-10:1
NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any o, ther�commenIINI
Use drawings of facility.to.tietter explain situations. (use additional pages as necessary)4",,'u�?
w
Reviewer/Inspector Name �iG2L�
G
S E x Phone /��• %13-3 ��®�
Reviewer/Inspector Signature:
Date:
1228104 Continued

Facility Number: t?Z —009 Date of Inspection
Reguired Records &_Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Imo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0190�0 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 C❑ NA ❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Oyes
❑NA
ONE
El Yes
,L.3,1V�o
LTN�o
❑ NA
❑ NE
❑ Yes
[J 5oo
El NA
El NE
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0'go
❑ NA
❑ NE
❑ Yes
e qlo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes GRgo ❑ NA ❑ NE
12128104

3.ilKs e.A44­4 9-iz zooB R.2
Type of Visit t9,-, mmppliance 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: 9-09 O $ Arrival Time: Departure Time: : QO County: SQ 5"CAJ Region:
Farm Name: &u flcr 4 CVU Owner Email:
Owner Name: ir"l 701 S' W, i Phone:
Mailing Address:
Physical Address:
Facility Contact: a9 le -At ✓ �On'/ S Title: rAl /M*r Phone No:
Onsite Representative: 11gk'1-r"i -r Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =] o E--] ' =" Longitude: = ° 0 t = u
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle DoneilM1
pulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non-Lalyer
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
® Farrow to Wean Z960
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Putlets
❑Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
,�,j
1. Is any discharge observed from any part of the operation?
El Yes
L� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
�
ET No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
4No
[:3NA
❑ 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-
N�o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
3 N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: V2 — O g I Date of Inspection
Waste Collection & Treatment
dNo
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
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E3No
❑ 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 thre notify DWQ
7. Do an of the structures need maintenance or improvement? ❑ Yes No El NA ElN
Y P
E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E 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 9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
�,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes LJ No
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1
epansm—) sPsi411 Cr-VIA./
12. Crop type(s) e4r 4_&LJcA— � s
13. Soil type(s)A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
iJNNoo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[�: N
[I NA
❑ NE
Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]L
�, N/o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/o
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
eNo
❑ NA
❑ NE
Go -a � 2.G6ora�,5' f,
Reviewer/InspectorName �{�i C ��a.d Phone: 117, 933.3330
Reviewer/Inspector Signature: Date: ZOO 0
Page 2 of 3 121181U4 Continued

Facility Number: SZ — 09 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box.
❑ Yes L' I No ❑ NA ❑ NE
❑ Yes Lf No ❑ NA ❑ NE
❑ 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 1"
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NNo
❑ NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,EI,(/NNo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�BNo
L/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
[3 o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,/
[3 NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZN
❑ 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?
Cl Yes
ErNo
❑ 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
io
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
.,�
[JNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
a<0"'_0
NA
❑ NE
Additional Comniiedti;androri�Drawni s .. ' w. ._., =f .. � a
gAL
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

II 6'vision of Water Quality
Faeffity Number SZ O O Division of Soil and Water Conservation
-_ ... O Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: /Z-/g A% Arrival Time: 9��"_, Departure Time: y;'3a County: /� Region: f 5
Farm Name: [��1 f��Y �✓ 1 r� D�t-r� ,., _ Owner Email:
Owner Name: r�� li n . SQLPhone:
Mailing Address:
Physical Address:
Facility Contact: 61C,41 Alorvii s Title: 14AI4 tir Phone No:
Onsite Representative: t 9�,., /Vo! t-is Integrator: G12r!la�t� -wt Si��4_
Certified Operator: �/ 'Kd rr s Operator Certification Number: 77VV41
Back-up Operator:
Location of Farm:
�� .:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° 0 d = id
Design Current Design Current_...,,.
Capacity Population Wet Poultry Capacity Population
❑ Layer
-_� ❑ Non -Layer
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 I
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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 10 No ❑ NA ❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: $Z — Date of Inspection i2-18-07
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: ';r /
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): �3 J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
19 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi 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? [:1 Yes
4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,E] No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) B�YILjtIeJG� . { ��57� rGr 4 Sftal� �i'� �'�✓ �+�. $. J
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
jNo
❑ 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
JoNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use -drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 9/0• Y33,3300
Reviewer/Inspector Signature: Date: /Z — l8— -zoo %
Page 2 of 3 12128104 Continued

Facility Number: SZ — O % Date of Inspection 12 18 D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes ) No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
§] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
t[ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

L fl
Facility Number _ �Z, Q Gf
O Division of Water Quality
O Division of Soil and Water- Conservation
O.Other Agency. ✓✓✓
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 0 County: Ssrt Region:
Farm Name: g�r� C1 uwc0%may Owner Email:
Owner Name: A��'t�� Phone:
Mailing Address:
Physical Address:
Facility Contact: rri .5 Title: Y . Phone No:
Onsite Representative: G t N / 0 Integrator: 604-10w.. C/ Fvwt She �,
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 0is Longitude: = o = I = is
uesign t,urrepr uesign t.urrenr uesign
Swine_ r Capacity. Population Wet Eoultry, Capacity Population; Cattle. Capacity
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
%F;Zw to Wean
2Z100
Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
`Other
❑ Other
❑ LMe ❑ Dairy Cow
❑ Non -Layer El Dairy Calf
-- _ -- - ❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑N D
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- ary
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures ,-..I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes M No ❑ NA ❑ NE
❑ Yes E6 No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes [2 No ❑ NA
❑ NE
❑ Yes [% No ❑ NA
❑ NE
❑ Yes 51 No ❑ NA
❑ NE
12128104 Continued

1
Facility Number: 2?2— d Date of inspection S-o3�a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate? ❑ Yes [A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structurep Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: IUl7
Designed Freeboard (in):
�r
Observed Freeboard (in): Z %
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [I 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 DA 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 U No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5M 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 CA No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area j
12. Crop type(s) �u'►+ u dam. H� s 16v-cn e— �iY? � �yw"/l/ Lid01ri.r5', C-,Z][ -
13.
Soil type(s)�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
{j No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[A No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[$No
❑ NA
❑ NE
Comments refer to question Explain an YES answers and/or an recommendations or an other commentsI
( = gp y y y
Use drawings of facility to better explain situations. (use additional pages as necessary): �.. ,
Reviewer/Inspector Name r� e��s 4
P one: g/b .33 ~3330
Reviewer/Inspector Signature:
Date: g-03 _?,006r,
Page 2 of 3 12128104 Continued

Facility Number: '72— —d q Date of Inspection $�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes E� 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[4 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 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
[A 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
U No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
rwNo❑
NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12178104

Type of Visit 10 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: / S Arrival Time: Time: County: .►+ Region: FJ?Q
Farm Name: Lot 3 ___er icc"-b 10v r�+ i�C3_; e mow•► Owner Email:
Owner Name:. __Z-Z h fe it :44 p .o Phone: Q/lJ 5�29 9 �3
Mailing Address: r ✓r. (" v it/f d2�"'`✓'il�
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: z len /Ila r�'iJ
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: a !%/�
Back-up Certification Number:
Location of Farm: Latitude: = 0 =' [=] « Longitude: 0 0 =' = u
Design Current
Design UM -F-ent Design Current
Swine
Capacity Population. VVet Poultry
'Capacity Poo tilation Cattle. Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La et
❑ DairyCalf
❑ Feeder to Finish
❑ Dairy Heifer
[Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
yo a o_,qjq Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Dry Cow
Non-DaiTy
[] Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
Other
❑ Other
FOLTCurke Poults
ther
Number of Structures:
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[2No
❑ 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)?
71
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
E No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ED-*No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — pI
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[jYNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 4 `i
Observed Freeboard (in): a `J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]'No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2'&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
E'No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B*`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 Mi4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EDAo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Qr.a•ua�w f-�it., , `�er se AW j K,,. _.. r- 5i+-,s1 11 IV.* 111
13. Soil type(s)� e 40,342
^^
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
[+'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
[YNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[+`No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
D No
❑ NA
❑ NE
Comments (refer, to gaestz©n'#) Egplam any YES answeirs andoo' anyai"ecomme naguons o,r y other comments.
I3sedrawings :bf facility to better eapla situations; (use. addihanal pages ass�necessarv)
Reviewer/Inspector Name Phone: Rld04 ILf
Reviewer/Inspector Signature: Lkj Date: y -1 r-dso"-
12128104 Condnaed

Facility Number: Date of Inspection
Required Records & Documents ,,_!!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9- o ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9To ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[j'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑f4o
❑ NA
❑ NE
29. Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
52"No
[I 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
[5No
❑ 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
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,❑'No
UTNo
❑ NA
❑ NE
Additional . ornments and/or Draw ii5 x r " � � 4 �c r
-� -.. �,Q-•c.s:� `. �:.i'f"."w w'e .°..i-V y..r
12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit • Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 2 �� of Visits / O Tune: s O0
O Not Operational Q Below Threshold
F1 Permitted 13 Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ?WU fff- 4 �.c- � 1-°Lrw. al G F�r...> County: &IM6
Owner Name: €fit ,Svr► �'S"E^ �Re v� _ �..a� . Phone No:
� a7;ng Address: P 0 - 99,X
Facility Contact: Tide:
a
Onsite Representative: f { Jam► d �r� S
Certified Operator:. � -%
Location of Farm:
Phone No:
Integrator.
Operator Certification Number. 2 �- y Y_ (c,„ _
9swine ❑ Pouttry ❑ Cattle ❑ horse Made • " Longitude •
twine fp -�� Y :on. p
-
•on.
9x' J
-P0
Wean to Feeder
Layer
Dairy
Feeder to Finish
r Nan -Layer
Non -Davy
Farrow to Wean
Farrow to Feeder
Other
x ; ti
Farrow to Finish
--.. T
Z
Gilts
Boars
'y - r
;i i
9 Total S9LW
_ -
Discharges & Stream Impacts
1. Is any discharge observed fi-om any part of the operation? ❑ Yes ;9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes IgNo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 51No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) ten than adequate? ❑ Spillway ❑ Yes KNo
Strrrr I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ..... ..._.-..�.�.........._......�.. „_
Freeboard (inches): ?% s
12112103 CumYnued

Facili 'Nrimber: 8 Z I Date of Inspection l�
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes R No
seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed through a waste management or
closure per? ❑Yes �(No
(If any of questions 4-6 was answered yes, and the sitoation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [:]Yes J.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 1'l No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes �No
Waste Aanlication
10_ Are there any buffers that need maintenance/improvement? ❑ Yes LN No
11. Is there evidence of over application? If yes, check the appropriate box below. AYes ❑ No
❑ Excessive Pounding 61 PAN ❑ Hydraulic Overload 0 Frozen Ground ❑ Copper and/or Zinc
12. Crop type 9 e-cw,, LL , q e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVAAP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P9 No
b) Does the facility need a wettable acre determination? ❑ Yes IgNo
c) This facility is pended for a wettable acre determination? ❑ Yes j$(No
15. Does the receiving crop need improvement? ❑ Yes ;ff No
16. Is there a lack of adequate waste application equipment? ❑ Yes P'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes I&No
19. Is there any evidence of wind drift during, land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IR No
roads, building strucmire, 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.

FanZ Number: 15 Z— Date of Inspection O Y e
R . aired Records & Documents
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?
(id WUP, checklists, design, maps, etc.) ❑ Yes KNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J$ No
❑ Waste Applicatio] firceboai4--b Waste Analysib'O'O Soil Samplinj-"'
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes §g No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes ®,No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application) ❑ Yes KNo
27_ Did Reviewerfinspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
28. Does facility require a follow-up visit by same agency? ❑ Yes KNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,LNo
NPDES Permitted FacHMes
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes P(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 ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ 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-6 Inspection After l" Raik�
❑ 120 Minute inspections ❑ Annual Certification Form
10 No violations or deficiendes were noted daring this visit You will receive no further correspondence about this visit-
u
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12/12(03

1
Site Requires Immediate Attention:
Facility No. 8 z - q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '- , 1995
Time:
Farm Name/Owner: e EsT ty t t# �� 3 — �✓ r� E,� b CR0MP1_E*_
Mailing Address: 7 j�2 G.Q.a L4A4 n IOC T 4461 -
'County: 5;�tmnsa.✓
Integrator: &. 3.ieT* , •memo Phone:_ 5 X9— S73/ On Site Revresentative: ?rc.cv 4tle A ✓ Phone:
Physical Address/Location:e,�) w
u.r --of - 1-1.) qll , s R
Type of Operation: Swine )c_ Poultry
Design Capacity: _ 9G 30 Number of
DEM Certification Number: ACE
Latitude: Longitude:
Cattle
Animals on Site:
DEM Certification Number: ACNEW
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �r No Actual Freeboard:_:_!Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or o Was any erosion observed? Yes or�
Is adequate land available for spray? es or No Is the cover crop adequate? (15�br No
Crop(s) being utilized: L r.z 0 (- —
Does the facility meet SCS ' minimum setback criteria? 200 Feet from Dwellings? for No
100 Feet from Wells? <:& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map -Blue Line: Yes or®
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(jo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
vim!
:Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

u
Type of Visit (WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 040-utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 2 G Date of Visit: `f /S o+T Tune: O
O Not Operational O Mow Threshold
Ql�e'rmitted GrCertified © Conditionally Certified Q Registered Date Last Operated or Above
�eR _._........._� _ . _Threshold:
ld•
Farm Name:.....q [�W�kt�.-_.LtCSo✓County: ...- .. -..
Owner Name: Phone No: 9 /D — Sr.? `t - 7 31
Mailing Address- P Q
Facility Contact: -_ 4'- 'ut �it�Y ...... - -Title. s - ..._ --- Phone No-
Onsite Representative:._!lMc� ski ---------------- Integrator. hze.
Certified Operator. !+r1 W IVo r11�, . _ _ _ , _ _ _- Operator Certification Number: T.. ....._ ... ___.
Location of Farm:
Qlls ine ❑ poultry ❑ Cattle ❑ Horse Latitude ' 44 Longitude • 9 44
i�ign a F.11rrPiit is;Clirrent'
' - a" "�eSiii r r l.niieiit'
, _
»z . .. ;
Swine - _�Ca rst :7P;; alat,on_Poul _ p i =Catde -g
_ Wean to
El
-
Other
-
Total D�gII Cap6dt s µ00
x
= Tota1
-er a Lagoons -
° Numb
it
N
- r
w
kt� C
Feeder
Feeder to Finish
arrow to Wean
jt y'p0
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I)]I5Cii3rges BC Stream Itnp CLS
1. Is any discharge observed from any pare of the operation? ❑Yes o
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/nun?
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 To
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes Leo
Waste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway El Yes [►fNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...-__._...----._...... ...........................___ _.......�......_......�.......
.31
Freeboard (inches):
12/I2/03 Continued

raclity Number: $g — 01
Date of Inspection 13 nc j.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance./improvement?
1 I . Is there evidence of over application? If yes, check the appropriate box below_
❑ Excessive Ponding [IPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
r�S-�
12. Crop type Cor.Ill j (4w w r1l-a u� 1 s> 11 �iv� Ourrsird
Jl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 1240
❑ Yes E?/No
❑ Yes !JNNo
❑ Yes M40
❑ Yes M40
❑ Yes R<)
❑ Yes L1d�o
❑ Yes [j"No
❑ Yes VNo
❑ Yes B/No
❑ Yes [3/No
❑ Yes dNo
❑ Yes WINO
❑ Yes 2 Igo
❑ Yes Slfio
❑ Yes ONO
❑ Yes Q No
Comte {refer to gnestsafr#) Eiplarn any YES aaswers and/or a� rei&fi dabons onan ,Titer _ 4
'Use dra of fa to better ituations. use additronal as•aecessa ) F
�►>' -� E 1� �' Field Copy 0 Final Notes
f�rGor'es aK :n 1po� SLc all arr. `rn r�zc.
r.bls �� So; j saw. 6vr bay & Mrs4*k �� ` �c
L (1s 1 s' � dakV'V11 Ito r�s/N J.,4-j..0 fir ., 1 °� /k/,q.
1
o&A Yl� 6r-1
P-46---- w 1h, S " lora,, &rrt-,1W w. % d.,ri 4 cv�4 weI-K.
w
Reviewer/Inspector Name s x _ _ _ "� _ L_
ReviewerAnspector Signature: Date: 13 0
111/1vn3 r_.,rif ntraa

Fa Rty Number: j� Date of Inspection 3 0
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes p'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 ff NNo
❑ 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
['No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ErNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
[jj1No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
eNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E►`No
NPDES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
E5'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
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ 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 I" Rain
1.10 120 Minute Inspections ❑ Annual Certification Form
(� No violations or deficiencies were noted during this visit_ You will receive no further correspondence about this visit.
12112103

f9

e 0 ..R
Ij�'� .«.