820044_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: 4@romp iance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: J Arrival Time: Departure Time: County• O__ Region:
Farm Name:` pJ -- Owner Email:
Owner Name: �-�t Phone:
Mailing Address:
Physical Address:
Facility Contact: G T>Title: Phone:
Onsite Representative: Integrator: rjj_
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry CapacityCattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
W n to Feeder
on -Layer
airy Calf
eeder to Finish
DI Poul Ca aci P,o ,
Dairy Heifer
lDrvCow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E3'No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[i/o
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Page I of 3 21412015 Continued A

Facility Number: jDate of Inspection: c7-
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 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �—
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ea<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 [T N ❑ 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 eNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �lo ❑ 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 NNoo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 21<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
C C),-
G
i
13. Soil Type(s): )(Jo f 7co� fl� — — —
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 Q'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes El"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes dNo
❑ Yes []'**No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
D Yes
[ter No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cj 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
[a 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
[r No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
dNo
[] NA
❑ NE
Page 2 of 3 21412015 Continued

• Fa ill Number: - Date of Inspection: -- �-0
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ "No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes 13 0
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [D'� o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [.]I&O
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 CA WM P?
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 E j No
❑ Yes 2rNo
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Z�<o ❑ NA ❑ NE
❑ Yes E5-No ❑ NA ❑ NE
❑ Yes 2<0
❑ Yes C2,1<0
❑ Yes 2 No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: - Z2-2%-fl
Date:
21412015

(Type of Visit: OTompliance Inspection Q Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: CrRioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — 6; Arrival Time: 1.; 31) Departure Time: County: Region: 6
Farm Name: vt' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: h Y' Phone:
Onsite Representative: ! f1 Integrator:
Certified Operator: SDK f Certification Number: 9-:3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C! tit
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capaciity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oul
Ca aci
P.o P.
Non -Dairy
Beef Stocker
Farrow to Finish Layers
Beef Feeder
Gilts
Non -Layers
Beef Brood Cow
Boars
Pullets
Turkeys
Other
TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
[] NE
Page I of 3 21412015 Continued

acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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
�Z 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
Callo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VIA,
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind %Drift ❑ Application Outside of A proved Area
12. Crop Type(s): �C�I�L�` /Oyr�S�--�J y'W / Gv�� 1 a7�Y.�.-3 C A clo,
13. Soil Type(s): D /
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes JKLNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
jo_No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
211�.�D""oes record keeping need improvement? If yes, check the appropriate box below_
aYes
[:]No
❑ NA
❑ NE
��
2twaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
(2 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

acili Number: - Date of Inspection: -L r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? C] Yes [�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes (. No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 12 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C-No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0,No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency9
❑ Yes
®No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional: recommendations or any other comments.
Use drawings of facUity to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signattu
Page 3 of 3
l,j rrt cL s Gb­,,ff c-i &-k r
LT` d----- hone:l`a
21412015

E
isit: ompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
r Visit: outine O Complaint 0 Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: D Departure Time: 0,'3 vCounty
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: �y a . Title: Seyn e`er Phone:
Al
Onsite Representative: Integrator:
Certified Operator: S Certification Number -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine {'
Wean to Finish
Capacity Pop.
Wet Poultry
JLayer
@apacity
Pop.
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
,64Feeder
to Finish
VE>
. :`_ - "- _
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oul . ,
Layers
Ca aci
$o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-- :1, 1�
-
Other _
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes fflNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
[aNo
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�3_No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili ]Number: - 1 Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ�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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -5 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®No
DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 771 No
❑ NA
❑ NE
maintenance or improvement?
I I. 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 l0 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): (,!J /S'9*4~+ f
- / k�� ;/ �Uc✓`4�rsst
13. Soil Type(s): �j pr-14a/ fe
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[EL No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[No
Nk
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
%Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [Z Crop Yield DI20 Minute inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
54 No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: g;,g_ - e Date of Inspection: 3 -,.39//,
24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes ®. No ❑ NA ❑ NE
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5 No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
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 ® No ❑ NA ❑ NE
❑ Yes [E No ❑ NA ❑ NE
[:]Yes [&No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes EKNo
❑ Yes 4 No
❑ Yes 2!�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
yDUr L r-17r +/e )°D v I—
r,
��►irn- �v `, I i /�� G B i cJ c� I-J D DF ► l �j r r'r b � >� =jO�L. .
A7w 7-o1 j-umr
P4/ C'k mo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: l /y C97
Date:
21412014
Page 3 of 3

Type of Visit. UrComplisince Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outme p Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: J (7 : o v County: Region: O
Farm Name: Gt,�
Owner Name: t'
Mailing Address.
Owner Email:
Phone:
Physical Address:
Facility Contact: Title.- r��J Phone:
Onsite Representative: integrator: jJr�j
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: j%%' jt_ 3
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Pointry Capacity Pop.
Layer
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Nan -La er
Design Current
D . P,oultr Ca aci Ko .
La ers
Gilts
Boars
Non -La ers
Beef Feeder
Beef Brood Cow
jPullets
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EINo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Eg-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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 FRNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes � No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? []Yes 13,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J&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 �0 Application Outside of Approved Area
12. Crop Type(s): C'U/'f7 /�jSB�.fr_o ys �T'� -'�'.c �I�ri�✓S `d�
13. Soil Type(s): %
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2 No DNA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes [Z 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 r 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZLNo
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Faciliy Dumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ® No ❑ NA ❑ NE
❑ Yes .® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ N)
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 allo ❑ NA ❑ NE
Reviewer/inspector [dame:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %-/0-,�133 3300
Date: 77 /-57-
21412011

. "
S
Mr
7 —1;7-3— )
Type of Visit: IMCompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: routine 0 Complaint Q Follow -tip O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: ;pp Departure Time: 1 : 3� Couaty:
jV
Farm Name: &'q ez a 6 -S -0 Owner Email:
Owner Name: A ZU f Phone:
.01
Mailing Address:
Region: F�'Ll
Physical Address:
Facility Contact: %�f �� _ Title: f}wyi•.. ✓` Phone:
Onsite Representative: Integrator:
Certified Operator: G...�� Certification Number: f �3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current .� DesrgnCurrent
Design CIIrrent
Swine Capacity Pop. Wet Poultry y Capaty, Pop.
Cattle Capacity Pop.
Wean to Finish Layer
Dai Cow _
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
�°
,��,,�„�.�� � .''
Dai Heifer
Farrow to Wean
At esign ,Current
Dry Cow
Farrow to Feeder
Dry P,oultrly:- C aci . ty ,. Po T
La
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
ers]
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other ";
Turkey Poults
Other
Other
Discha�es and Stream Impacts
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 W No ❑ NA ❑ NE
0 Yes [:]No
❑ Yes ❑ No
❑ Yes [:)No
[:]Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facitiy Number: - Date of Inspection:
;2-
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): L_� 19
Observed Freeboard (in): {r 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ram ❑ 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) : eltn ul / Gflen
13. Soil Type(s): �pl713/A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 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

Facility Number: ir- Date of Inspection: _.��—�pr
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 C-7 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to property 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)
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
®No
[:]NA
❑ NE
❑ Yes
Ca No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �Zj No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes L4 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C23-No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments.(refer,:to question ft Explain any YES answers and/or any additional recommendations -or anyother comments.
Use drawings "of facility to better explain situations (use additional pages as necessary).
it -en tvvrk 7 AW-t—_ t7oz,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 411-/
21412011

-, - Di�is�on�pf Water'Q� �ej
Facility Number $ - I Division of Soil and Water Conservation
© Other Agency
Type of Visit: -0 Compliance Inspection C5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q; Departure Time: S- County: SQ,n� Region: F4
Farm Name (mayj-— Sp/7
Owner Name: fl^ a
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: 8Q Title: Ownlor Phone:
Onsite Representative: Integrator: K—a
Certified Operator: Certification Number: 19399 _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Destgnp Current Design CuHe
Swine '� Capacity Pop. Wet Poultry Capacrty Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
I
11-ayer
at Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Farrow to Wean
tZli
- r ..
- Design Current
I) P,o_alt .3; Ca a P,o „
Layers
Da' Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
❑ No
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
® NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
CK NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - pate 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: DVS
Cot fft t7+ 10 aSIl3�
Spillway)- !
�Q
Designed Freeboard (in�`.,��
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
No
❑ NA
❑ NE
S. 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
[0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3 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 ❑ Application Outside of Approved Area
,Drift
12. Crop TYpe(s): an , Small ala � &DV . Hill)1& J
1.
13. Soil Type(s): N()
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JZ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check
® Yes
❑ No
❑ NA
[D NE
the appropriate box.
X]WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21, Does record keeping need improvement? if yes, check the appropriate box below.
Yes
Eg No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ® Soi�Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
KNA
❑ NE
Page 2 of 3
21412011 Continued

acili 'Number: -99Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
[DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
CR No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
KNo
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
toNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
N No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®, No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
KI No
❑ NA
❑ NE
t , n K,
0.1NeAe 6) hor o- +ernPff Q 0dMeA Ttr rn (10 WV_ +AD
&f'� ems) bot i- wos n� ma f
c�e� eIr,n�k~ sad buns
Zoo,4o track dCW - f$ luvi)
Exree a f noi-k a bovi� Pa fe mya '7,gccd ,shi fe,
So l 14 si ooJ $Y ao la, W is befyf`ewik, fir 6011, oxo p -%or MI-1,
MCf,COP yA or11 9 l'� (I �QrRtc—
tP va%k f'icm pe ) ci,c _ k)oMk ,50o
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 90 33-33o0 /c6y)
Date: l 1.3
21412011

Facility No. _Farm Name CoDate 1 11 l
Permit COC C ✓ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
L—C
Lagoon Name, S forspillway
1
12
3
4
5
6
7
Design Freeboard I Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
a
,
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
Ring Size (in)
. - • Flow / •
-----
Soil Test Date VI-*16 Crop Yield Transfer Sheets
pH Fields Wettable Acres ,� + ��UGE
Lime Needed WUP ���Q � f ead or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu-I Zn-I 1 in Inspections Check Lists
Needs E (S-1<25) 120 min Insp. Storm Water
Needs P Weather Codes
RKM
133
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records altr�3sD
Date last WUP at farm Lagoon # I
App. Hardware Top Dike St -
Stop Pump 511
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 ib/ac
Mdfiie (C
melm -Aoltu roc:na�;liret:il,
CI1HO, IBC CD its Wa o
MIIfa (s
pn�as �� d ve'�o la�'�ess a�P

$laI11)"
`. Division of Wa'te QuaEity �i
Facility NUm il and Water Conservation
� Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 1j Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: i Arrival Time: Departure Time: ;gyp County Region: f7kT
Farm Namei�pp�� Q
Owner Name: ffiw:a fy PV02& -
Mailing Address:
Owner Email:
Phone:
Physical Address: 0 y 4 F-4 Mi II K& .
Facility Contact: AA"Title: Own'Pr Phone:
Onsite Representative: -ttIntegrator: H D
Certified Operator: Hamer (p , kw�& � Certification Number: 11349 _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current"i `
Design
Current Design Current
Swine
Capacity Pop Wet Poultry @apacity Pop.
w;.
Caitle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
O � '�,
DairyHeifer
Farrow to Wean
"
Design
Current
D Cow
Farrow to Feeder
`.'D..1 1'uW
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
iPullets
113eef Brood Co-,
Turke s
Other
Turkey Poults
NJ Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [g No ❑ NA E] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
J'No
❑ NA
[a NE
[:]Yes
[RNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: Ig
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): @5- �Lf 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NJ 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
ja No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? 11-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 Ibs_ ❑ 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): 11, h'haz� �9s 2r11 I n,ll %1� : lXl f OIV (L'aq"SP�C
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CA WMP? ❑ Yes fij No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Callo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes & No ❑ NA ❑ NE
❑ Yes C"No ❑ NA ❑ NE
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
CK Yes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis E] Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ®,Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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

Facili Number: ig IDate of Inspection: ]S
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 C@ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
MNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ff No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
a 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). =
7e ketef wog �C! C , b6re- s� o, )u�� , Some- 3rav k0i SePc16t oft ho► 4f 1 J#7
iof
d o v,& ry e v-e 4 o dr s �e I Lf, gal kJ � *4 -r&-ve
r
"eC�. - a ©� ►'1
��%� gas also �0�
hf�
code- Yv Y'
1-.0�0� 4 t�s� r � rj
Qc'e� i
Fume
1�
*W�
1, 4 r,Cc j
A �+ Mail rl �QC�Cur01c,
�oo?� � F � ✓ r a � r1 nc� o>�zl � be c�c�,e r� ao 13
� j � bra%q�, �S � � ale �3 � s i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Doll.
Phone:
Date: Ayo i S. aQ i �
r Ili
21412011

Facility No $a__qq Farm Name 6lf Date
Permit COC OIL; NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
I
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date (p 41
Sludge Depth ft
Liquid Trt_ Zone ft
5.
la
.a
Ratio Sludge to Treatment Volume if> 0.45
a']
.30
qEj
Date out of compliance/ POA?
I
-Design Diwm
Actual Diam.
Soil Test Date 1-1 t'�tall(r/ Crop Yield Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed WUP ✓ Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu-1 ✓ Zn-I 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Insp. SStorm Water
Needs PQ ,Weather Codes 4 �"`'
Wei
Vol' I MI=
• r /
r 'r ft
Verify PHONE NUMBERS and affiliations
Date last WUP FRO i!!a 1bP FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac-, Zn-1 3000= 213 lb/ac

ype or visit: td c.ompuance inspection U Vperation Review V Ntructure Evaluation U 1 ectinical Assistance
Reason for Visit: WRoutine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit:
-1;Arrival Time: Departure Time: County:
Farm Name: TTot Son Owner Email:
Owner Name: "CoPlu DQQQ Phone:
Mailing Address:
Physical Address:
Region: FRO
1
Facility Contact: Title: 5y f Phone:
Onsite Representative: Integrator: M R
l
Certified Operator: %M-p- BOaae# Certification Number: $34It
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
_
Del
Current
R Design Current
SwineCCapacity Pop.
Wet Poultry ,:
Cap ity = Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
"° �_
``
DairyHeifer
Farrow to Wean
D`e'sign
Current
Cow
Farrow to Feeder
D 3 P,o_uItry_,.Ca aCi
Po ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther -
Turkey Poults
Other
Other
Discharges and Stream lmoacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 [RNo ❑ NA ❑ NE
[:]Yes [:]No
[—]Yes [:]No
❑ Yes [:)No
❑ Yes a No
❑ Yes P 'No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ 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). 261 t,
Observed Freeboard (in): X_ L _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
tN 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?
%Q Yes
❑ No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
64 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 ❑ Evidencje of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Types) I/1�A 17C/MUlf a 14Q�( . Smal oy-e s'r - Ckn,
bLht± sorb
f, f
13. Soil Type(s): N 1 N
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 C& No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Cg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes �jNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 'J�3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CR No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
�2 oes record keeping need improvement? If yes, check the appropriate box below. 'W Yes []No
aste Application ❑ Weekly Freeboard OWaste 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 EffNo
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
WA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - LIJ
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
'R No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N No
❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[�j NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes M No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? []Yes (3 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
gNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UNo
❑ 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
gNo
❑ NA
❑ NE
F a r���-'S 4n [ )001 . San e y OJ4 Wos rj/�f� eJ �, Dw� ih v�'�P �D"q h ruS2
S Cif V hot g! ci d yl i
Yv��e � set act - J a Is,dW-
w col16f4et
a ` � - 4o ��e p (R � t-s
Yo c sI , fields ove rr� shy e-
reto�(r��r� j f
ow"Jerr� JrOL
Reviewer/Inspector Name: —Sc h /)''ei
t\
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: of a Do
412011

Facility No. `�` _y Farm Name Date
Permit COC OIC_ I NPDES (Rainbreaker PLAT Annual Cert }
LIOF -,In;
r ie.ur7a �rii�sZ
:w►'iz��r`i��i�� IlCllll�ri,'!'1��
AI;11Z7i�''y t�"�-
...n
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Surve Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Wes,
Calibration bate
Actual
Design1'-------
r�---�---
Soil Test Date c) I-L Qnettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed { Z0-7T/ Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections 3tvib!n
Cu-I L 2, Zn1 120 min Insp. Needs P _ Weather Codes `'U a ��,� ]a vy
Crop Yield ,Transfer Sbeets G�l3r
NUMM
.,
.
ME
• ,
- .
,�
[ltalME]
Verify PHONE NUMBERS and affiliations
Date last WUP FRO ;i la Iop Date h�aasj WUP at farm
17fa
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conver$ion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

Type of Visit ®rCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason forjVisit & Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Iq� Arrival Time: Departure Time: log `iS County Region:
Farm Name: Owner Email:
� f+
Owner Name: `� Phone:
Mailing Address:
Physical Address: /
Facility Contact: Title: _ owga - Phone No: 3S5 Sga3
Onsite Representative: V Bcwa& Integrator: I�—
Certified Operator: �' _ �� Operator Certification Number: 1:T3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = I 0 Longitude: = e = d = {f
Design Current
Design Current Design Current
Swine Caparity Population
Wet Poultry
Capacity ` P,op anon Cat#le Capacity Population
❑ Wean to Finish
10 Layer
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
$
Poultry
-_ ❑ Daia Heifer
El Dry Cow
ElFarrow to Wean
IDry
ElFarrow to Feeder
ElNon-Dairy
El Beef Stocker
El Beef Feeder
ElFarrow to Finish
❑ La ers
❑ Gilts
❑ Non -Layers
❑ Boars
❑ Fullets
❑ Beef Brood Co
❑ Turkeys
Other,
❑ Other
❑Turke Points
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IQNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IgNo
❑ NA
❑ NE`
❑ Yes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility number: 4 Date of Inspection RUPW
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:
Spillway?:
Designed Freeboard (in): D&V Q&H
Observed Freeboard (in): Oa(p �31
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure b
El Yes CRNo ❑NA ❑NE
❑ Yes RNo ❑ 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? ayes ❑ No ❑ NA ❑ NF
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ISNo ❑ 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1 f yes, check the appropriate box below. ❑ Yes IR No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ('t)A-fa 1 Jba;,L/n ibv ' 3mall (ra)r OS
3.
N { s) Is , _ '
+ rL f
Soil type '
�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
@ No
❑ NA
[:]-NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Eallo
❑ NA
❑ NE
I&
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
87No
❑ NA
❑ NE
Comments (refer to question #): Explain an YES"ansKei sandlor any recommendations or an3 other comments
Use drawrngs of facility to better ex lain situations use additional a es as necessa
IReviewer/Inspector Name I N Phone: I0 ) I
Reviewer/Inspector Signature: Date:
12128104 Ckw iirued

acility Number: $� — fr Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box. WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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
tR No
❑ NA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
R[No
❑ NA
❑ NE
❑ Yes
PK No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes ❑ No aNA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes INNo ❑ NA ❑ NE
❑ Yes t@ No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
El Yes
P5No
El NA
❑NE
q" PfA 7i let 4jo
`7, tee w o,- m bere s PIS a� s o V-fn' ac innje, s l© _f1 9`F i dye o� , N sew
Ors �, of l 4 ha m v(ch
. Ea+%w� faer bt) are rn� !gym �o✓P�
@I, lPleo e- IDca+e sa�� aldl s s . Will n�Q c��-(6r 'Zola sow rna�,t
aooq wie,
y, pet t wu s ea ( j bg44 in @ot d. Nea�e, Ca I f 6,a#e hahfy WureVf a eacs,
ast St vdye,Svrve d vie- berme end cC- I t:w,
�600d-caor ad rf(o rdl.
Page 3 of 3 12128104

Facility No. Name
Permit //COC -�
Date '1011 qj 10
olciz," NPDES (Rainbreaker PLAT A nual Cert
Dr 140
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
3
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
,
Ratio Sludge to Treatment Volume
..Design Flow
hatual Flow
Design Width
Actual Width
�cogo�aao ,��
Soil Test Date
Wettable Acres -/ RAIN GAUGE
pH Fields
WUP ✓ Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-1 Zn-I
120 min Insp.
Needs P
Weather Codes
Crop Yield
Transfer Sheets
MA
..
..
Sl'�iil .511
it
- � �
►►
�1J
!.�
i
i OA
i
f F
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm 1�
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 lb/ac
App. Hardware

IType of Visit -Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S Q Arrival Time: - Departure Time: / L County: Region:
Farm Name: 6,a-y 8a4ad I So Owner Email:
Owner Name: flc�,. '' ?o 150,0Qd— sr Phone:
Mailing Address:
Physical Address:
Facility Contact: yL#-4 ��.74 _Sr. Title: -"r Phone No: 333r5t "All
4�3 l C�
OnsiteRepresentative: LO"> BaA `t Integrator: ►Mua 1-�1�I-n
Certified Operator:$" G' Nell
!!++ Sr Operator Certification Number• Awi 193 ��I}c�
Back-up Operator: N wit- � Back-up Certification Number: -A"
Location of Farm: Latitude: = o Longitude: ° u
Design Current Design Current Design
Swine Capacity Population Wet Poultr Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
I
I
JE] Layer
❑ Dairy Cow
❑ Wean to Feeder
I
1
10 Non -Layer
❑ Daia Calf
® Feeder to Finish
I 5sao❑
Dry Poultry
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Pullets
❑ Boars
Other
❑ Other
❑Beef Brood Co
El Turkeys
❑ Turkey Poults
10Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes P No
❑ Yes RNo
❑NA ❑NE
❑ NA ❑ NE
12128104
Continued

Facility Number — Date of Inspection
NVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
❑ Yes DKNo ❑ NA ❑ NE
a. 1f yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure l Stn[Cture 2 Structure 3 Structure 4
SiruCturC ? Slructur,� 6
Identifier:
Spillway?:
Designed Freeboard (in): _ �q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes C: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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes CgNo El 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 [5kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
&f No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) c2h-b I urm'.do- ivh GI-nrh Can G(Qi>) S,Yh t
Dabho 6-zw
--
13. Soil type(s) N[
I k Ag-
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
5kNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
t5kNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
52 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�R`No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages. as necessary):
Reviewer/inspector Name s Phone:
Reviewer/Inspector Signature: Date: Aw.
V 1.a81114' (.onanuea

• Facility Number: $ a — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &'No ❑ NA ❑ NE
the appropirate box. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ 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 RWeather Code
22.
Did the facility fail to install and maintain a rain gauge`?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
❑ No
[ffNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
�'No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
21No
❑ 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
bd-No
❑ NA
❑ NF
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Additional Comments and/or Drawirigsi x i
7 +(f�� i'f tr'+ dtr}�a LY► �ie s of � o h 1 AS i L�f e ! a I, 'Va Wed Ja ff ,Q 1 l SePd 0, �
l - vP-� � �� . Is s r�� , ��G)Me l� a sari
M� bc�� s ob Ore U 1-�wr?e�T C K t�
SIt, fes �
` Qrr d'!rr S' a -7 eT
tk r o
IS Corn dr r4 u p I /
Code1ns'crS�r1
11�
a aj p��A � s�c,�
r Nell -M01hfa )h4 4
` �� ` yec i��� frr J �
1 � , llTPf117lY4'�d
Page 3 of 3 12128104

Facility No. 3)—y`/ _ Farm Name (t' Gp Date
Permit `� COC ✓ OIC NPDES (Rainbreaker
FLU iaj Bead td,
r
3IoA 11
PLAT Annual Cert)
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
J
,�
Sludge Depth ft& %
'j,
Liquid Trt. Zone ft
5.0,1
5 ' -191
L M L=0011
Design •
wb*
Design Wi.
---_---
Actual Width
Soil Test Date Crop field
pH Fields Wettable Acres_
Lime Needed_ WUP
Lime Applied Weekly Freeboard
Cu _� Zn�` Rainfall >1"
Needs P L, - rc'rj Jd 1 in Inspections
120 min Inspections X}^�-
Weather Codes
Transfer Sheets h ai
RAIN GAUGE Alcicr
6ad box or incinerator77
nut cA ec -eit
Waste Analysis Date
G4�•'�l�lt7if��i��?11r1-frT►
• .fi 6��
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
W0 I 'Wr
COA471 4j,a
-sP
a 5,t.
S
-Q�6
In
3
`b
-JLn
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm,�,�f App. Hardware
FRO or Farm Records F� �D�p - C � I J r u � r Q +C bad
Lagoon # tN i7 tivekt) er �cd
Top Dike �� "�
Stop Pump t
Start Pump 3
),-)

Division of Water Quality
Facility Number1. - O Division of Soil and Water Conservation
O Other Agency f�
Type of Visit Q Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency Other ❑ Denied Access
Date of Visit: l7 Arrival Time: LYLIy, Departure Time: ,` O[7 County: tom- Region:
dor
Farm Name: (o-src_c��ct 258n� _ _ Owner Email:
Owner Name: __ 61 e'L' rT Q e Gfi`� 1 - Phone:
(�, l !
Mailing Address: F �`� �OS� fjon) N C ����'
Physical Address:
Facility Contact: _(�_ A. g_4. �� 1 Title:.UGUrt',_ Phone No: 2/0— 3,U-7f7 �3
Onsite Representative: S'� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Operator Certification Number:
Back-up Certification Number:
❑ « Longitude: = ° = ` 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_T. ❑ La er
1 1' ❑ Non -La et
Dry Poultry
Pullets
LI Turkey Poults
❑ Other
Discharces & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
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 R1 No ❑ NA ❑ NE
❑Yes
❑No
[1 NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection R�-42 do —
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): _ �,�- N
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA SNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA J9 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA 2.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 RYes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA N 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift D3 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ No
❑ NA
Z NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?19 Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ERNE
18. Is there a lack of properly operating waste application equipment?
® Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
WO a i5i 7 a k k'r a c �rN' Ovr✓�
Reviewer/inspector Name r Phone:
Reviewer/inspector Signature: Date: s —aDCDC?
1212 /04 Gonanuea

Facility Humber: — Date of Inspection`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [9 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 1,9 NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [9NE
❑ 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
[K NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ No
❑ NA
NNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
(I NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
A NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
aNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
P1 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
;9[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
0 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
S No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ No
❑ NA
❑ NE
kdditional=Comments and/or Drawings:
"
pn • % O -V �` -� Wli5 61,91 /-_4_4 40 a
/4�sr
J vim- �." /as : /�fi+ -�
'14 Al
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Q[Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date o1 Visit: Arrival Time: Departure Time: County: Region:
Farm Name:a�'� �S Ii/1 Owner Email:
Owner Name: , �^ G. Balm a Sim Phone:
Mailing Address: reedm i U U JP 6ern a s
Physical Address:
12
Facility Contact: Title: ���' Phone No:
Onsite Representative: x &"lI' Integrator: "— F
Certified Operator: 2M& % iT Operator Certification Number: -A" I g3 q y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] o [=] ' = u Longitude: = ° = ' a «
�Design Current
j D6iin ur #
Design Current
Swine Capacity Population
Wet Poult O
Fapac�Po tilahan
C
Cattle
Capacity Population
Wp:.
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
Eg Feeder to Finish
'"'''
❑ DairyHeifer
❑ Farrow to Wean
Dry Env+4
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La erg
❑ Beef Stocker
. ❑ Gilts
on -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
_ ❑ Turkeys
Other n TurkeyPouets
-
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
ElNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
FNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CR71Vo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued
.a- -

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): 37 33
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
RNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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?
taYes
[:]No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CRNo ❑ 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
KNo ❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
DR 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) C,0 #jla 1 $Pfrn V d Q L J+) ' S CO 0 S
13.
Soil type(s) �O A- l S
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
&No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
CRNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
19No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/Inspector Name S c&eie1Z .:` Phone: r —�
Reviewer/inspector Signature: A Date: 71340$

Facility Number: a — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E27No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5JNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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
IRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
r5kNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
GrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
❑ Yes
❑ No
EqNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(McNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[27No
❑ 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
-
�o
❑ 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
CNo
❑ 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
WrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
12rNo
❑ NA
❑ NE
;�'� e
Additional Comments and/or Drawings.:`� �"��� .E � � _ s ),
7,'P1Pae, kfP
1� O k- &eSlos h l '� r-Oth. AkTL 401901 l and 1 +d ���
auL
4 bey ^�t�e h�f)� mwfl wtlldFe`6 CIA, #.�, . �r.•Pje� Qdk Cro left
'�a8 GYJ 6�h�08 O�c�
T`effWO& PAN ��? � Mtn•
[.imew6sA 1)PE_�-D 01W-6eg1� Feb,'The ohsd, no- an
I0V$a11,goa -` 41-M 1
Page 3 of 3
12128104

Date
'Facility No. Farm Name
Permit ✓ COC ✓
Pop.Type Design Current
OIC-V NPDFS (Rainbreaker PLAT Annual Cert )
FB Drops
Freeboard
1
2
3
4
5
6
7
Design
BIMS
Observed in
Sludge Survey Dateallft Perm Liquid ft
5,01#5*1
Sludge Depth ft
;1l,
rif q Tu
Calibration Date
r - •
Actual
i�Z�-------
Design Width
Actual Width
soil Test LO, arced M Fe6
pH FieldsH Lagoon`s
Lime Needed Wired i k N
Cu
Zn
Wettable Acres ',/
Crop Yield
Rain Gauge
Weekly Freeboard
W04 PI&, ✓
Rainfall >1"
1 in Inspections
120 min Inspections
Transfer Sheets
—Da t -
M, M. M
IM ` Q
Ia=?.5 3�rL(o 3,1--)i5 20-7.3 M-7,( IT— 7,(o
Pull/Field Soil Croa I Pan I Window
o- Sr tl 7 q� �"d,,3 .�„$�v .s�►ar�s�:7 /add a tf
Ole $ n �r� In'�1�5 d►e�
-}o �rar}a�r

Type of visit `Compliance Inspection ()Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: S Z 01 Arrival Time:
r► l
Farm Name: kDS:&X
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: _
Departure Time: � County: Region: �+-'�-f
Title:
Email:
Phone:
� l �.�riPL Phone Noc
Integrator• �Pam��
�C�+
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = 6 ❑ Longitude: = ° = 6 ❑
64
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
to Finish
❑ Non -La er Iry Calf
❑ Dairy Heifer
eeder
Farrow to Wean
., __.
©ry�Poultry
El Dry Cow
Farrow to Feeder
Layers
❑
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑
❑ Non -Layers
El Pullets
El Turkeys
❑ Turkey Points
❑ Other
Discharees &Stream Impacts
1. is any discharge observed from any part ofthe operation?
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
Owner
b. Did the discharge reach waters of the State? {If yes, notify DWQ}
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes *No ❑ NA ❑ NE
❑ Yes
❑
❑ Non -Layers
El Pullets
El Turkeys
❑ Turkey Points
❑ Other
Discharees &Stream Impacts
1. is any discharge observed from any part ofthe operation?
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
Owner
b. Did the discharge reach waters of the State? {If yes, notify DWQ}
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes *No ❑ NA ❑ NE
❑ Yes
Discharees &Stream Impacts
1. is any discharge observed from any part ofthe operation?
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
Owner
b. Did the discharge reach waters of the State? {If yes, notify DWQ}
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes *No ❑ NA ❑ NE
❑ Yes
b No
A
❑ NE
❑ Yes
❑ No
A
❑ NE
;kNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ N E
12/18/04 Continued

Facility Number
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ;&No ❑ NA ❑ NE
Structure I Srre 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 `gNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes �yo ❑ NA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) k V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ 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 V No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 1ZNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or an y.recommendations or any other comments* W
Use drawings of facility to better explain situations. (use additional pages. as necessary):
T
P i (,u►P 1 FYI KV-7 & pNTnr�] - G { O 3� 3360
Reviewer/Ins ector Name i phone:
Reviewer/inspector Signature:
Date:
!1
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 2, O
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
)KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
)KNo
❑ 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
J�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;9 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
N4No
❑ 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
F9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
1PNo
❑ NA
❑ NE
Additional Comifie :and/or Drawings: I
Cov, 4,. rN u�_ Lcz)f kr; rm bz�L.-v-e- Q44?uS vr\L 91�
1 n5,A
-
hk ed 4Q !j�i_ Vt n 14 rn e v ; C a r t. s k I LS �o r S o /S -7�PS-Z co
S �� C� Sv..rVe�3A sd-t6U_r-� o ve-Y 5 1 r eoAnun .-t- vo Iu km
`T Yei>rCp ►' e- '�bp� ram' C.t Y?LGC �dul Yl ` 1
an Y-uZY 5 ,
Page 3 of 3 12128104

Facility No. Time In 9 30 Time Out
Farm Name C O -f tA f -t� I SOS Integrator
Owner Site Rep.
Operator C.5,
No.
Back-up No_
COC _ _ �/ Circle: enera�or NPDES
Design
Current
Design
Current
Wean = Feed
Farrow - Feed
Wean -
Farrow - Finish
eed, Finish
Gilts / Boars
Farrow -
Td
Others
FREEBOARD: Design Ql^
S;uugc Survey
Crop Yield
Rain Gauge I ..
Soil Test PLAT �W
Observed
Calibration/GPM ✓ ! ()
Waste Transfers
Rain Breaker-�
Wettable Acres
/S2
Weekly Freeboard Daily Rainfall 1-in Inspections f r
Spray/Freeboard Drop ��'S '�� 1 IO _ �1 a6 � 1 !0 �! 1s Z I^ °k-ev
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
-7 z3 z.
q 3 3 :.0 3
2. , 23
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
IIc q 50 4Ef-- MA
rS
r g 1
a
3•� d� j a

Type of Visit ;7outine
pl� ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g Z Arrival Time: Udy-29 I Departure Time: LPL G?—�l County:
Farm Name: -3zkq Owner Email:
Owner Name- \-10L I -Lk ��4 �]Jt Phnnr!
Mailing Address:
Physical Address: c ,,
Facility Contact.Q QUO— Title: Q Wr
Onsite Representative: 1 t t +
Certified Operator: - -- --
Back-up Operator: _
133
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: [
Back-up Certification Number: t ` —?ci3
Latitude: [= o = , ❑ « Longitude: ❑ ° ❑ g = u
DesignJill-
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity ula Cattle Capacity Population
❑ Wean to Finish
10 Layer ❑ Dairy Cow
❑ Non -Layer 1 ❑ Dairy Calf
� � � �.� � El Dairy Heifer
�, :w El D Cow
D PoulIN
' ~ �' '`
❑ Wean to Feeder
der to Finish
El Farrow to Wean
❑
Farrow to Feeder'
❑ Non-Dikiry
❑ La ers
El Beef Stocker
❑ Non -La ers - ❑Beef Feeder
❑ Pullets ❑ Beef Brood Co
-.. ❑ Turkeys
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Turke ❑Poults e r; .,
El Other ;Number of Structures:
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *No ❑ NA ❑ NE
❑ Yes
❑ No
*A
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No '`[�NA
[INE
❑ Yes
OoNo
El NA
❑ NE
❑ Yes
5ONo
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: — 04Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ).PqA ❑ NE
S cture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: ! f
Designed Freeboard (in): ! i
Observed Freeboard (in):
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 ❑ 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? *es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �No ❑ NA [3 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 El
maintenance or improvement? lk
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
maintenance/improvement'? 1)4
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) v
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside of Acceptable Crop Window _ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �_ QNJ rl-C1c�[O.. n WV- eQ-f-010.1
❑ NA ❑ NE
[I NA El NE
lR�n
13.
Soil type(s) � f - 0 I _ _.._
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 19No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ElYes No
El NA
El 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 ,),'*N' o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
tm �, ( �, , m � -
p)15CuXSr1& s
Sect? _ ►'Z �'go I / S D W►'7=-r lu 11 rcS5
Vojl,
ro 6lcrrt
JJ
Reviewer/Inspector Name 7
Phone: Ci /V "' 33 u-0
Reviewer/inspector Signature:
Date: 4 u6i Z z�
Page 2 of 3 12128104 Continued

Facility Number: —q# Date of Inspection (S(i
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes _Io
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes"�Wo
❑ 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 gNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ElNA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYeso
Xo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes NJONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Wo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes *o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ElNA ElNE
and report the mortality rates that were higher than normal?�PNo
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes o ElNA ElNE
If yes, contact a regional Air Quality representative immediately F)q
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA Cl NE
General Permit? (ie/ discharge, freeboard problems, over application) ((��JJ
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes RNo ❑ NA ❑ NE
Page 3 of 3 12128104

Facility No. O� ' Time In Time Out Date a
Farm Name C-VSSoo, Integrator T
Owner SY Site Rep S f
Operator S No. 1 !�34 cit
Back-up No. I -7 T� d
COC Circle: General or et�
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Farrow - Finish
eed - Finish
VFarrd-w`-
$
Gilts I Boars
Others
FREEBOARD: Design L /11q Observed 33 0 /
Sludge Survey a Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge Rain Breaker /
Soil Test b,-5 PLAT Wettable Acres V
Weekly Freeboard �r Daily Rainfall 1-in Inspections
Spray/Freeboard Drop bLq::x
Weather Codes 120 min Inspections
Waste Analysis: bI ! a Z--
Date Nitrogen (N)
3,z_ 3. o
3l Z,.(.o 2
r zrl � i✓ . b
Date Nitrogen (N)
.
WK
�0
,;
....VA
r
L

Type of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : dS Departure Time: County: Region: E 6
t
Farm Name: C C.- _+ s o v S Owner Email:
Owner Name: Ga./Phone: / _ se. `fy��
Mailing Address: /lj C
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: �'Y1 t Gen +e t� Integrator: -
Certified Operator: ga�_�-�- Operator Certification Number: IS 3 Sl'4
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = , 0if Longitude: = o = , 0 Il
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
SS'8 0
YA Gb
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
Non-L
Pullets
IJ Turkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
i
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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? (i.f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑Yes MNo El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
12128104 Continued

Facilit$ Number: $'a, — Date of Inspection 13/a /AE
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
q _ f Z - �'Ydentifier: _ . _
Spillway?:
Designed Freeboard (in): 20, Y -2 G . f
rJ
Observed Freeboard (in): 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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes © No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes @ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require to 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 [:IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into $are Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,��r r,=I -- S.7+n / I 6 ro ,'.�. CIO.-., G,)/r e j< &4 Joe --A, s
13. Soil type(s) _ /V ar'ea a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qd No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes ® No ❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑Yes
QNo
❑NA
❑NE
❑ Yes
P0 No
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of faciRtyto better explain situations. (use additional pages as necessary):
r o
�' - �..�a.� �-a* .lrr,•�C�ip�, hLyol�ra,vf 1-f�...a Id9oo.vt, /YID.
GCF "i- W I �� O� G: ICSS T' ff i 4' O o Y e v c ,-& fnJri S 'T C �YO r.1 o,% o V 1 n7 f a
�L� w0 A,2. _ Wi�J'iG 1..� i if �� d 1 r e_e_+coX b-c-L i —♦a �Lt { )� no.v� Car,nec,+ f-
r
� C_ kl �'`�� pr'tSSic�[ r4��C� A.''
S-�::+ ;,, �....- r v .-• l 1YS r GAS lt.. C.. �
Reviewer/inspector Name �� Q 25cje le- Phone: 2/40
Reviewer/Inspector Signature: Date: o
12128104 Continued

Facility Number: g— 1 f Y Date of Inspection 3
Required Records & Documents
19. Did the facility tail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA FINE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0fl No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N 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
2T
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
❑ 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
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional oll'ice of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments andlo-Drawings:
^n r f2s M L a
iy1 r.
[ 7 u Giu G1 VG r", e p i' C a+c h! .S G d w+.• f] i cx:ti C. C o r r� c $�Q
* 4' G i Y-\ V . R C. 117-A4 1 6 w"T 6 -' N C L3 A
a C 3 ii -t LL j . � V%. a'j P r a &U.4- L4� 1 0 -.-\ . k 1
12128104

Type of Visit (KComp�ance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit GMoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
hate of Visit: /S O Tune: /p : O D
Facility Number ,i
ro—NO—Toperational O Below Threshold
01FIeQtted ErCertified © ConditiionaAy Certified [3 Registered Date Last Operated or Above Threshold: ------- .- ..
Farm Name: W . .._.
-- ��---------SAS,.....------•-•---... -.... -.... --------..._ County:..w� °��.?._.__.�.....
Owner Name: PhoneNo:
MaJ.hng Address: ........K
Facility Contact: . Title:........ °!�'!�... . _. Phone No:
Onsite Representative: .. el++ Integrator:_ ��r^ �w^ S-�,,d.•-d
... n . ... _----...-._._......-.-._._....-_.._.------------ In tor: ._. - _ .... ...------
Certified Operator., ,- � ._ rlj �`>� Operator Certification Number:._ A. � ' .. .
Location of Farm: �._.......
at,wine ❑ Poultry ❑ Cattle ❑ Horse Latitude " Longitude `
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M'1Vo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2 o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B l�o
Waste Collection & Treatment �/
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1240
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............1................... ............. ............ _...
Freeboard (inches): 31dZ�
12112103 Continued

Faty Number: 8.2 --44 Date of Inspection iS o4
S. 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 maintenancelimprovement?
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?
WasteApplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ,!a I "u -L r w" r1
13. Do the receiving crops differ with those desigLted 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 110 NO
❑ Yes 2"NNo
❑ Yes YNo
❑ Yes 121NO
❑ Yes
❑ Yes 1Q'<o
❑ Yes [] No
❑ Yes [.+"' No
ElYes ,L,�r�NTo
_+�,
❑ Yes o
❑ Yes [j(No
❑ Yes [(No
❑ Yes YNo
❑ Yes �10
❑ Yes dNNo
❑ Yes YNo
❑ Yes Q No
r
Comments (rdI to question#} ;Eiblai n:aay YFS answers and/or any recammeudanons or any other ibbin&ents.
':Use drawwg5 of facstity to better egla�a sRtaatroas. {u a additional pages a5 aecc�ary} �; �Ft le d CopY ❑ Final Notes � �-,
qv e'1�i0[�+1 it�flj5 O�') I [MnNI.
coo �S live k 7vj
-A it
T
Reviewer/luspector Name Ri_ 4r
G_"
Reviewer/Inspector Signature: Date: `f //5 ID�

Facility Number: ;r.2_ —If4L Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 0 Yes [T<O
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ NVUP, checklists, design, maps, ctc.) 0 Yes [dNO
23. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [B"No
[:] Waste Application [] Freeboard [I Waste Analysis [I Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? E] Yes [B'No
25� Did the facility fail to have a actively certified operator in charge? [:1 Yes ErNo
26, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) Yes 03'f4o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes O"Ro
28. Does facility requirr a follow-up visit by same agency? Yes 3'�o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? 0 Yes GKo
NIMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 2"Yes [:] No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [I yes G?1qO
32, Did the facility fail to install and maintain a rain gauge? [I Yes B'N'O
33, Did the facility fail to conduct an annual sludge survey? El Yes M'Ro
34. Did the facility fail to calibrate waste application equipment? El Yes HTqo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. El Yes 2T40
[]StockingForm E]CropYieldForm []Rainfall [I Inspection After I" Rain
[3 120 Minute Inspections 0 Annual Certification Form
12112103

Site Requires immediate Attention: _A10
Facility No. 92-**
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: GiX
Mailing Address:- Rt, Z
County: -S-2rn Q;go^l
Integrator: Pr;sLafjr
On Site Representative":
Physical Address/Location:—
DATE: 1995
Time: I U 4-1
BoLameAk- � So,
5
RZ
Phone: e'910
14 Phone:
'f"V- 4Z/
e_-ek
-57-7
-4171,
Type of Operation: Swine Poultry Cattle
Design Capacity:. 5870 Number of Animals on Site: -5,900
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 36 * 09 ' ZS Longitude: -7 8 0 2 9 ' ZS
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (�or No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? or No
Crop(s) being utilized: Age�-Mckjo,, _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin! ')
Y!, P;e r No
es
100 Feet from Wells? (Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes olo
Is animal waste discharged into water of h state by man-made ditch, flushing system, or other
similar man-made devices? Yes on If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
.Additional Comments: MI-i _�� 1;4�4
%_j
Jnspector Name
Actual Freeboard: li Ft. 0 Inches
Yes orS Was any erosion observed? Yes o&
Is the cover crop adequate? (yi�or No
R�e� Re,,,z,�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.