820056_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: �'i:om (lance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 :3�01 Arrival Time: 0/ KS Departure Time: // ;' S County: C/OfP v I V Region: F:_! 7
Farm Name: M— vl ( �` 4V `"`5 Owner Email:
Owner Name: >" y O Stui Phone:
Mailing Address:
Physical Address:
Facility Contact: J' -I S jJ ato' GcJ(�-k Title:
Onsite Representative:
l(
Certified Operator: Q l/ �vt S V%A y 4t
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
ikr�—s
Certification Number: C �3
Certification Number:
Longitude:
Design Current Design Current- Design Current ,
city PopPoultrapaciPop. Cattle Cap cP
Finish
Z 00
OCR
La er
Non -La er
Dai Cow
Dai Calf11
Feeder
7pFaarrow
o Finish
Dai Heifer
Design Current D Cow
o Wean
o Feeder
Dr. P.outt , Ca aci Po Non -Da'
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Finish
LLI—Gilts
Boars
Pullets
Beef Brood Cow
Turke s
O#her
Turkey Puuets
Other
Other
��xwwrn�r�um"nw.re�,..r:nwwr-raa.+�nn.mw�w.
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 [❑ NA ❑ NE
❑ Yes
M No
[_F7C
❑ NE
❑ Yes
[D No
[]'IAA
❑ NE '.
❑ Yes
❑ No
❑' IAA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facilit Numl*r: - s Date of Inspection: r7 07-uwe-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rq-Xo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No A�D NE
Structure I 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
❑-MV-0 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
U��o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gj-"o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EEI<o 0 NA
D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[''g—o ❑ NA
❑ NE
maintenance or improvement'?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �!o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): G 5 — r"t s�
13. Soil Type(s): Wo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑Ko— ❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes [,�'l�o ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [D o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑Yes [�fo ❑NA ❑NE
❑ Yes 2--No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2-NIo
0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[f 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
[D'Ko-
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking 0 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
[D o
❑ NA ❑ NE
23. Irselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ef No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Numlfer: - Date of Insection: i�"�He
24. Did.the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [dtf ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-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? ❑ YesEl-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑, o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2'<o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
S/No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately,
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
U2rNo ❑ NA
D 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. ere any additional problems noted which cause non-compliance of the permit or CAWMP?T_yls_
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[g4o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ECo ❑ NA
❑ NE
Reviewer/Inspector Signatur
Page 3 of 3
21412015

S 1 _1
I S.1 1
LJ
Type of Visit: (JCom Hance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: %� Departure Time: County: Region:
Farm Name: ""--`�' �eLJvl4 c,
Owner Name: 3 Fa-- {,( S T.Y-,
Mailing Address:
Physical Address:
Facility Contact: C. Vtr'f "1_3 �c�✓'lu�ti✓ �{ Title:
Onsite Representative: q
Certified Operator: is t( adh
Bach -up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: JY 13 ` S
Certification Number:
Certification Number:
Longitude:
Mow
�Ef`e`��,
-_4aDesigCurr
Swine Capactty. Pop. Wet Poultry:. Capacity Pop Cattle Capacity' Pop
Wean to Finish La er DairyCow.
Wean to Feeder ),,�� �+� Non -Layer Dairy Calf
FeedAl
er t0 Finish
I a1 rU.- 4 ^', w r y i 1 a i c u h �
# , t 1 .s: Dairy}leifer
Farrow to Wean Des gn�'�Curreiit D Cow
Farrow to Feeder nr� P,o.ultr, Ea aci P,o Non -Dar
Farrow to Finish La ers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other I 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 tom""' ❑ NA ❑ NE
❑ Yes ❑ No Q-KA ❑ NE
❑ Yes ❑ No t335A ❑ NE
❑ Yes ❑ No
❑ Yes allo
❑ Yes ff No
C3 NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

J;'acili Number: - Date of Inspection: gt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q-biar❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [2'90 ❑ NA ❑ NE
❑ Yes 0�o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑- io ❑ 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 ❑'< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ETINo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu,Ln, etc.)
❑ PAN ❑ PAN > 10% or W lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
Evidence ofWind Drift
❑ Outside of Acceptable Crop Window''""
❑ Application Outside of Approved Area
DD❑
12. Crop Type(s): fvvu�td� J 6,y
13. Soil Type(s): (�� ku
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [—al-NV-
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes 71-No-_
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []-N_o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes [:3-go ❑ NA ❑ NE
19. Did the facility faii to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [D--Ko— ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑- o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E]rNo ❑ 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

f acil4 Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �lo ❑ 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 eNo ❑ 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:
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 E]�No ❑ NA ❑ NE
❑ Yes [�J<o ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes [31�
❑ Yes DIN' o
❑ Yes ETNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to; question #): Explain any YES answers.and/or any additional recommendations or any other comments.
Useldrarvings,.of facility to better;ex iaini;situations'(use_additional 'ages as.necessa ).
7
Cep
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: (J-- lr 3 `3'
Date:
2141A15

)Vu s 9-d-1-13Q
QMlvision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: om ante Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S Region:
Farm Name: ar Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 9 r" i5 � ���� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification N ber: > ` 4'T-6)
Certification Number:
Design Current Design Current
Capacity Pop. et Poultry Capacity Pop.
Layer
�a 0 Non -Layer
Dry Pounry
Layers
Non -Layers
Pullets
Turku.
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
Page I of 3
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
DaiEZ Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[119—A'❑NE
(3-'g ❑ NE
[]Yes ❑ No 2#A ❑ NE
❑ Yes ❑ NA CDNE
❑ Yes g5No ❑ NA ❑ NE
21412011 Continued

1% Z A
Facility Number: - Date of Ins ection:
U to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eno ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No e-I1A ❑ 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❑ 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
[5 9-o ❑ NA
❑ NE
waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
Q-Nta❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-<� ❑ 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
[: "'o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LJ 1"o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind lDrift ❑ Application Outside of Approved Area
12. Crop Type(s): EV` CC) ]C J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eg>e— ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E'f o_ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 137 '4o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Q-�o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes EyNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [:J o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 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 [ o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crap 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 ENo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility umber: - Date of Ins ectloni
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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 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:
ED!Lo— ❑ NA ❑ NE
[3-N ❑ NA ❑ NE
❑ Yes [E3-No ❑ NA ❑ NE
❑ Yes E:LNa- ❑ NA ❑ NE
❑ Yes ❑`NO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EJNV ❑ NA ❑ NE
❑ Yes ❑-No-T ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E 'hio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes � ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ga lqo [DNA ❑ NE
Cominents_(refer to question,#): E.xpiain any YES answers and/or any additional recommendations or any other comments.
Used raWings- of. facilityto better eiplahi situations (use additional pages as.necessary).
Stu"), Q,"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: AW' S3 Q
Date: A
2/4/2014

13 I KS
4'n. jMvision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
' 0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Vislt� / Arrival TimeDeparture Time: / ( o County Region
Farm Name: rFr fL�t. jv
y d�`f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
SA � Phone:
Facility Contact: Title:
Onsite Representative:
Certified Operator: J0 B✓t
Phone:
Integrator: M 17 L
Certification Number: f %G [ ,7
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I I ::::]
Non -Layer
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dischames 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?
.Design Current
Cattle Capacity Pop.
D iry Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes Rio _ ❑ NA [] NE
❑ Yes
❑ No
O-NA
FINE
❑ Yes
❑ No
E3-IqX
❑ NE
[]Yes
[]No
E3 A
❑ NE
[—]Yes
E5nNo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page 1 of 21412011 Continued

Facility Number: - Date of Ins ectio
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 E3-NA` ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): iy
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-N
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[] Yes
L> '"U
❑ 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
Cg�N°
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑.W
❑ 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
E31
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
51,M5�_t NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
��IQo ❑ 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): (J9 'e'A2L4LAS (�
13. Soil Type(s): S j 4��_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
lJ"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
lam�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Leo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
[�Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3-ITo-
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑.Nu
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q'TTo
❑ 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 E3No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: IDate of Inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes
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 properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
LINa- ❑ NA ❑ NE
[34dtf ❑ NA ❑ NE
❑ Yes
l3-'vU
❑ NA
❑ NE
❑ Yes
6
❑ NA
❑ NE
❑ Yes E.Aie- [DNA ❑ NE
❑ Yes []-fl-o ❑ NA ❑ NE
❑ Yes [].No ❑ NA ❑ NE
❑ Yes [3-< ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes rL_'".J-19-0" ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [Do o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2-110 ❑ 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).
qu;y S � ((- 15 -)4_7
ReviewerAnspector Name: V t _Y An_1V
Reviewer/inspector Signature:
Page 3 of 3
P_5('16
Phone:
Dater
2/4/20I1

431 w1r 14 -zin, P-j t- l b
ivislon of Water Resources
t '
Facility Number - Division of Soil and Water Conservation
� Other Agency
Type of Visit: ommp�pliance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: Gr1 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: sh-4
Farm Name: 4�d(/r�*��y.�ctti. Owner Email:
Owner Name:/4,! �,�.� G(�, S'► Phone:
Mailing Address:
Physical Address:
Facility Contact: 6,d1.j�[j_itJ f !� Title:
Onsite Representative:
Certified Operator: &r404,4- IqMA
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone: Integrator: ■ rt g—_�
Certification Number: 126 Q36
Certification Number:
Longitude:
Design Cttrrent
Swine Capacity., Pop.
Weslgn Current
Wet Pouitr, Capacity Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
ob
a er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr. P.oulti, Ca aci P,o P.
D Cow
Farrow to Feeder.
Non-Dal
Farrow to Finish
Layers
Beef Stocker
J!j
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
0, ler
keys
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes PTo ❑ NA ❑ NE
❑ Yes [:]No �A [] NE
❑ Yes ❑ No [!rI ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes
❑ No
�IA
❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes
[g-IQo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes
[] o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

JjFacilltNumber: - Date of lns ection:
Waste Collection & Treatment ,--,��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? �] Yes I�'"'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No TA ❑ 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 to ❑ 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 1 _f<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E''lo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ' Flo ❑ 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 EJOONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EEl"Ro
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C3 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): C - S 6-0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�l
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ff*?No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EjN`o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ca�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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
�]NA ❑NE
Page 2 of 3 21412014 Continued

FaSility INumber: jDate of Inspection: ` .s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-11ro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Rio ❑ 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 [ !o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�'IVo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�o ❑ NA ❑ NE
and report mortality rates that were higher than normal? '
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes eo ❑ 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 Y�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 [ZrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ZNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [" ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency`? ❑ Yes l No ❑ NA ❑ NE
Comments (refer:. to. question #): Explain_any YES answers and/or any additional recommendations or any other comments.
lJse.draWings.,offacil ,to;betteir explain,situations,(use additional' ag6 as necessary).;,
Cab
s� �.sUI7R0
Reviewer/inspector Name: V) t L_L4H)0�� „ Phone:
Reviewer/Inspector Signature; V LZ Date:
Page 3 of 3 21412011

4FBivision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CWoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,9 0 1 Departure Time: CountyRegion:
Farm Name: jj Owner Email:
Owner Name: Zr 4pm 17F' ep yyr, Phone:
Mailing Address:
Physical Address:
Facility Contact: (;f, Bf�!/7`/� Title: 2-,—G�+ Jf � . Phone:
Onsite Representative: y Integrator: 01W & fl y
Of
Certified Operator: 72,C42' !:5� ; Certification Number:
f
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
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
I aid Non-Layer__I I
Non-L�
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No [3 NA ❑NE
❑ Yes ❑ No
[:]Yes ® No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
'1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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): 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Co 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
JZ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
ELNo
❑ 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
M No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �rpiti[de� ! Br/rrS�r�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R 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 EK No ❑ NA ❑ NE
❑ Yes ,No ❑ NA ❑ NE
Rewired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes 1K 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 [Z 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 allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - jDate of Inspection: —72--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Z No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r111 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to. question #): Explain any YES. answers and/or any additional recommendations or any other comments.
Use driiwings of facility to better explain situations (use additional paces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /Q-'317D
Date: ,S—" %7 —,,20/3
21412011

DIMS, \-YvS gSaoIli
10 Division of Water Quality
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: GLCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: §) Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 106)1f)l IZI
Arrival Time: 8;
Departure Time:
County:
�
Farm Name: N-e
Fo/hi
l� ow
Owner Email:
Owner Name:
Phone:
Mailing Address:
Region: E&
Physical Address: y �T SM i'r D F�/ryr Laa!e T
Facility Contact: BTsm rTh Title: �h' Phone:
I r
Onsite Representative: fi 14 �/� } Integrator: �1f�
Certified Operator: �irXa^ &A I�—�'i) Certification Number: gg6q3�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Design Current Design Current
Swine Capacity Pop, Wet Poultry Capacity Pop,
Wean to Finish
Wean to Feeder 5a
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
rou
Non-L,
Pullets
Poults
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes ja No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes 2f 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
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®-No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ER No ❑ NA ❑ NE
maintenance or improvement? f Lvt
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes j o ❑ NA ❑ NE
❑ Excessive Ponding R Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN tRPAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ol'Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
]2.Crop Type(s): COj g1 8�/fia2_
13. Soil Type(s): Caib hip, ,szal j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
G�NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
❑ Yes
to No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? Ifyes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
® Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis OlSoil 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
E-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

Coriovdec aW hrp;t�h)')
Facilit .Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? M Yes ®No [DNA ❑ 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 �p,, ti
�[ Non -compliant sludge levels in any lagoon ���r `�fMs�
List structure(s) and date of first survey indicating non-compliance: L& J -- a0 j 4
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes [0 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
[,RNo
❑ 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
t' 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
CR 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
5� 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
�2 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ej No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #):Explain any YES ans►vets and/or AlhyadditionAl recommendations or any other comments
Use drawings of facility to better explain situations (use addltionul pages as necessary).
7, pi .AP_ CCXI�1�+ue Yv&a.) bo-e .rem 0ri Id, bat k.(, Mulch 1 i9htl y yvl`� r+0% )od. f Ar-
Vo hot r n '� s r1 �� , �56me S �� r h�-
QvgJ�abl�, YV�h� is y�' ow � ,�9 �s ar
c�Ore ry Cen i' �, Add
-�o orb } ava�la6P , O�f�c�,e s e
R?Pr41�is 4k - issanm
�P .
r ny,,e
yfr+ujl $t}� QCc.rna9t T C��1 ��U��`7 Ong n P { PQ��
Ir do �� //
0�011. Lodi �1 ,b n ��ie rel" &+4* of
t� �� �01 I t INOT ii0`�' op47f' r� C�I,o�calt b!tx'� +�, hvr
v►baxhadanote fro•,aol�-Hur#��waJda�
��i� � I n aolb Corc�lalf�'y�f''-b�tno'�c� Qw�t injl�tio�J,
�'1�d �srfv � aoll ho f- f0L441 Yv{ It nsur�7
,51 e Is c,l �,ed o�.� ��.� �� slyd�esv w a e i 0 9
h ar W r' Yi L� slid e s vt v ` _71 sP�� a
© -ye , yb
N0u boisryd, `fir- PAN oU$wn 1J'ecr�, dl9Cuml�Cn rerA"o�s
qwV-'3014-PC-04- 77,E 4- 4 not r;oF a, ea*4e Co f ,aCso � #a 4.
od o s i �cP�y�svlrt�y I n s©l f. y
FC1M W0j-*� 0V9-'Q6C1Q1yr,In DMeaoll.
G �rojreu in Seth Ij ec&d-r vF 40 cPa�e
1. Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
VVVai
_._...,...._._...,_._...
Phone: QIO-l{k00-10C(1[�° J
Date:
21412011

Facility No. $ -5�P Farm Name &4 RW b Date TI f
Permit � COC / OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
I1f it "RUEZ.F31
Calibration Date
t�
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres 7.
RAIN GAUGE
Lime Needed
WUP ✓
Dead box or incinerator
Lime Applied
Weekly Freeboard ✓
Mortality Records
Cu-I Zn-I
1 in Inspections ✓
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
11 C�1iK��ii � ; r �`1,�r �•,�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike 49
Stop Pump
Start Pump `f"7
1,
Conversion- Cu-1 3000= 108 lb/ac; Zn-1 3000= 213 Iblac

I. 1
� t` M1_uvs � riYrl�
u'IToMivision of Water Quality
Fogility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation tWTechnical Assistance
Reason for Visit: S 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency GCOther 0 Denied Access
Date of Visit:
Arrival Time: a.
Departure Time:
County:
Farm Name:Fr
rnS
Owner Email:
Y
Owner Name: n
m r+A
Phone:
Mailing Address:
Physical Address:
Facility Contact: B Qfm s„t 1± 6 Title: ID Phone:
Onsite Representative: gryan 4 Yn 6d a Integrator: � R
Certified Operator: y An stn Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
RIon-Layer a er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Canneity Pon.
Layers
—.Non-Layers
Pullets
Turkeys
Turkey Pouits
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure' ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA YNE
❑ Yes
❑ No
[] NA
❑ NE.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA NE
❑ NA NE
Page 1 of 3 21412011 Continued

acili -Number: 50k Date of Inspection: a
Waste. Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
[>_�NE
a. 1f 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. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
q 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
[RNE
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
E5� NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
[R 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
5a NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
r4Z.NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. P0 Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding 10 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): CS) HIJ k, �'Mjj 11 lJP11 n
13. Soil Type(s):Voy's
14, Do the receiving crops diff r from those designated in the CAWMP?
[] Yes
❑ No
❑ NA
[RNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
aNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[E 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
[,�g NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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. ru-Ves ❑ No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes []No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [WNE
❑ Weather Code
❑ Sludge Survey
❑ NA RNE
❑ NA [A NE
Page 2 of 3 21412011 Continued

F.acili Number: Date of Ins ection:
.24. Did,the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA f g NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [5;[ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [!YNE
❑ Yes []No (] NA [RNE
❑ Yes ❑ No ❑ NA [3 NE
❑Yes ❑No ❑NA �ZNE
[]Yes [] No [DNA ®'NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
❑ No
❑ NA
E,;;�NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
`[;a No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? 9Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paves as necessarv).
(r t)W& Yvas CoAacied, � G, .Sm lth 7)Ds)la d vt 4p ovae flji� Sr�Q�I
y � �
s M
ai�v end sh�nt�h� MQa 04910r�I'i)� s t rry arc c fidesZ�lv
hi�r�
via ]ie. b d `FDdor c-0 a bait a -� 9 }$V -�'h eolrec� �AN, Ire ajjf�i
�s c�ra�t Ica i� j M ) s�gra�/ �1 Ao �d he r
U f t hfl
a b o vla, � YVc4 ¢4 Abra h +he M0 4 to OVJ/ aid Jns�I LC � r r
C�o�
`�
`Rolm , C'2-rvmrn'P� ��4 Ns qie.
any ethem
Wa.r vAabl_o toda al oo-ted��1e� *o7 dve`6 hav�JLjfl 1� a.
y di -stoat 1,1511eJ by �•'J/ nejj9 a��,P4lai 076 �o I
s I
ra� i {/�/sc �Ls P 1 9-- h�'
� —a 4S a or ] �r
a-a s j p_ Po&gw&b —1-nho cs�r� �_ Ad 1io,Rlr atio no%a► �'�xlue cG�r3.
Reviewer/Inspector Name: M2 jz _'�nhnA*
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g1"XI-MQ�[ f �
Date: VA a 7
.11
ianoll

10r la o d Ot A5,, f &-0d
Facility No. Farm Name Date
Permit COC OIC_
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
------------
Lagoon Name S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
Soil Test Date _
pH Fields _
Lime Needed
Lime Applied_
Cu-1 Zn-I
Needs S (S-1<25)
Needs P
Crop Yield
Wettable Acres
WUP _
Weekly Freeboard
1 in Inspections _
120 min-Insp. _
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
UA - --5------�-
Verify PHONE NUMBERS and affiliations wo_y1q -,
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lblac
elf J
NA aom-atb

btW of VIVrr
Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: aCompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (a Routine Q Complaint 0 Follow-up 0 Referral Q Emergenev 0 Other Q Denied Access
Date of Visit:I--' Arrival Time: ,(,rJ Departure "rime: � County:A$�
Farm Name: $ 4 f0fti j IV pia/ Owner Email:
Owner Name: $ U S!?1 �[ Phone:
Mailing Address:
Region: F-P-0
Physical Address: y(�j ?R[l �&m L12 , 6 :Ithd
Facility Contact: ,± © yvo-e/' ��j'� Sjrll � Title: Phone:
Onsite Representative: %(01 J/X L-h Integrator: H-12
Certified Operator: SiacV "Prat► k Mpor� Certification Number: �Q Y
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder SMO
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: Ti, - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes K 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): ate_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C'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
2 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?
IR Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�allo
❑ 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
R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
gNo
❑ 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 offWind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): CneAQ 1 't .t�I(6 f whp off -
"- - -
13. Soil Type(s): B ,mBh
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C'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 N'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 §�rNo ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
�Z No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
W 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.
Iff Yes
❑ No
❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard JgWaste Analysis E] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections 'S Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�Po
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
❑ Yes
❑ No
Z] NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: $ t
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
RYes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey faFailure to develop a POA for sludge
levels
JZ Non -compliant sludge levels in any lagoon
l
List structures) and date of first survey indicating non-compliance: U4" —
1pig� f
�� to
26. Did the facility fail provide documentation of an actively certified operator in char
❑ Yes
2 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
5'NA ❑ NE
Other Issues
29, Did the facility tail 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
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 Q No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 52 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes N'No ❑ NA ❑ NE
Comments (refer to question ft ExplA,n any YIES hswers,'and/or;: a& additional recommenilotions or -'any other comments 77
Use drawings of facili0jo better explain. `situations' use additional:pager as necessary)
Lx� o� ba^es-�otr 0(%0p A d- ©*jde of lu�poj bin ks . w! ) I nab
feA
(i Imp soO
spry 4 yi1 v 1 Gil , -K I ate' ) iyDah C/moot.
fad baj } t hAve, (• God66LPl'
�1. Currmf - p wnfr j v3ftDD k o ins
'�o �a r�0� '�'D Chat e CI 4OM �TAI �ceebaarl �a� I D 1111D — la 1311 101
�CUrrt9s� Vwj% oar y(I-r ad )Je � 1dAe se y U
oe ±60 do Si�, e f �a ,h
cam U �R Qas y �, `� wn oid- have �im.,
Lase p f�T�° d� e d e
�a 1049 s is v" noi�oC�P n 9
ot �e / ins etw r6l;hea D�1� - T - W7
P)&ie Glean o �{, old
d e- I �V2{.S a . Lki— •D- 0+ rN 551 ��IQ`a
ri i 11 check ,�a s Its e pLM .rV T
`� I d of echn li�1 � CIIfU�C� Q'
Lynn SNIhell 15 COMA $
�, x s� Feldsive
nddhiohctl r taf%0.1
Reviewer/Inspector Name: n�i1'�-
Reviewer/Inspector Signature: %lu
Page 3 of 3
Phone: Q/Q—q3 M60
Date:
21412011

Facility No.�Far Name 61 Y (DIOI J, Ck) Date S I ITI I I
Permit COC OIC jNPDES (RRainbreaker
�n FW�„d lDlr iabdin
,31rq
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
Wn-vo
M,
Design Flow
Igiv
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-I L--Zn-I ✓
Needs P Ct lT �^
Wettable Acres ✓ RAIN GAUGE
WUP v Dead box or incinerator
Weekly Freeboard>D Mortality Records
1 in Inspections votow-
120 min Insp.
Weather Codes
.. Yield Transfer Sheets
• GT�G�IGllt�1�
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
C
$
u
aaos
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump 45,ok yl
Start Pump Lhof 014ti�
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

Facility Number 5�
WIDivision of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
r�
tTRomp�utine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
® iGt 0County:4 o�c1
Date of Visit: Arriral Time: , UO Departure Time: �
Farm Name: 1aGl� Uack Owner Email:
Owner Name: Phone:
Mailing Address:
Region: /,=?�
Physical Address:
Facility Contact: _-3 4,1*<S 'Sklo-A-A 111: Title: 490JAILK Phone``No•
Onsite Representative: .3a&U -_S a5r„ - Integrator: /144L',Q 4 43VCLJAJ
Certified Operator: S 511+q6 JIT— Operator Certification Number: y$ 2—
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = 0 0 1 Longitude: 0 0= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I EE11
Other
❑ Other I
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: cul
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 D o ❑NA ❑NE
❑ Yes
❑ No
2<A
❑ NE
❑ Yes
❑ No
B NA
❑ NE
EJI A
❑ NE
❑ Yes
❑ No
❑ Yes
�
❑ NA
[3NE
❑ Yes
,�
Ci No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

1
Facility Number: Z, — Date of Inspection
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElB Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Strnrtnre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard.(in): 2—
Qj �
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 2No ❑ 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 nNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,J
4. Does any part of the waste management system other than the waste structures require ❑ Yes t No ❑ NA Cl NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L!INo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes hdlNo ❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s) dC�e!/�uQk, [/7fty J S"wr// AaVA';
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N"o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i ❑ Yes
,�,
L2"Na
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name N trg .. T ;" � ^'�� � n"a` A" .h . a ? Mtn Phone: 21J . Y3 on
�J
Reviewer/InspectorSignature: Date: 7-07— 7—PI
12128104 Continued

Facility Number: —„s�p Date of Inspection
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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 L1No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L7 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
D o
El NA
El NE
❑ Yes
Ej<o
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ 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 , to❑ NA El NE
El Yes M<Om❑ NA ❑ NE
❑ Yes
lJ'No ❑ NA
❑ NE
❑ Yes
DlZo ❑ NA
❑ NE
❑ Yes
0'N00 NA
[INE
ElYes
21CIo,❑ NA
❑ NE
11/18104

Facility Number 82 __j
J , 5
Cnivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eloZtine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: /O'Z/-O q Arrival Time: Departure Time: %�,�D� County: •Z�AS0ti
Farm Name: Gt C.�C J�'�"f-x -�st/G Owner Email:
Owner Name: �� ��`�' Phone:
Mailing Address:
Physical Address: Facility Contact: 41 sit, A Title: LOLJAJ e4'` _ Phone No:
Onsite Representative: rrW�
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
Region: 15-12-0
Integrator Y,r _��0'�`! ^v
Operator Certification Number: 4w,4~ 99?41�7
Back-up Certification Number:
Latitude: ❑ o = 6 = Ii Longitude: ❑ ° ❑ , 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
5-2oo I SI9S' I ❑Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other -- -
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Ell
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 L7 No ❑ NA ❑ NE
[]Yes
❑ No
NA
❑ NE
❑ Yes
ElNo
B`NAS
❑ NE
IA
❑ NE
❑ Yes
❑ No
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

•-w
Facility Number: IR2 — 'Sr'o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes VNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7t_ /
Spillway?: 10
Designed Freeboard (in):
Observed Freeboard (ir ): z ��
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA El 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 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LTI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window' El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Fe_.mGCt7� p- C �ri,tall ,iv �O.S,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
Usc
S fec�ey� 5 /
[TNo ❑ NA ❑ NE
No ❑ NA ❑ NE
(3 N El NA [I NE
ZNo ❑ NA ❑ NE
KNo ❑ NA ❑ NE
i
Reviewerllnspector Name Phone: /V, -U. 33a 0
Reviewer/Inspector Signature Date: /�-2j-2D09
12128104 Continued

Facility Number: — Date of Inspection
RecLuired_Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3rNo ❑ 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
g ❑ Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;.-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2—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
3No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
fo
❑ 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
LSNo ❑ 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
ElD Yes
o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
N
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
12128104

Dlkj, $113tor m1
0
Type of Visit WCompiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit t[Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Q; 3D Departure 'Time: County: s Region:�
Farm Name:) or Klock �#_iM r In t, Owner Email: Owner Name: admipt A S Phone: 3n-606S CCI
M �l � T qy
Mailing Address: a I/
Physical Address:
Facility Contact: Title:
Onsite Representative: ZQ�J 5-1h t „
Certified Operator: latyho1 4
Phone No:
Integrator: Murl01ti5=&A4n
Operator Certification Number:4
.Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
❑ Wean to Finish
(5 Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = o = 4 = {! Longitude: = o = 6 = i1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischnrees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: FT
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 �jLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
Wlo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: -- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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): 9�..fn
Observed Freeboard (in): a�D
5. Are there any immediate threats to the integrity of any of the structures observed.) ❑ Yes MNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CgNo ❑ 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 J&No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V No [I 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 N No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ 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 types) VO f,`64 ear,,+da (") ! ,56
' J
13.
Soil type(s) BnB
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
n No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
2TNo
❑ NA
❑ NE
ffidray
ings of fucilih5tn�[ti tter.�ezpl�aa' situations. (uyse add.itlonal pages asneccs asry}:a t i. + ry
Reviewer/Inspector Name C A S - -� Phone: 0 y-33�DK33 3
Reviewer/Inspector Signature: Date:
Pate 2 of 3 U 1212810 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 15iNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1,�R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[SNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
IR NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ffNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U 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 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
99 No
❑ NA
❑ NE
i,,pleo e- read- 4 rewd roil- at dfl40- each r4An
WWII ke r1- revards s
I L a aw cow- i s if) p jots hake_ , Vi II a �PIW &e fob
small.
I D q, V le, s e- d o coo If6A,, b c�d a-e�yew,
Page 3 of 3 12128104

Facility No.00a—Farm Name Date
Permit ✓ COC .i OIC� NPDES (Rainbreaker PLAT Annual Cert }
ff -
MT M,—��--�—
• . - .
�1�----®-
-Calibration Date
. - • •-------
Soil Test Date
pH Fields 05 S•p Ali
Lime Nee
de
Cu ZnVf✓
Needs P Y— twoo �►�
yD-00 I *.OVS6
Crop Yield
Wettable Acres
WUP
Rain Gauge
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
Day
J
�o
f I1{ 1
,rr/hr, `0,W Oar

ZH0
.7
(Type of Visit Compliance Inspection 0 Operation Revlew 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit �k Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ` 1 Arrival Time: t7 Departure Time: County:
Farm Name: r k 3ack17arM. Is Owner Email:
Owner Name: —�a ryy-S r7 "► Phone: T
Mailing Address:
Region: Ff(
Physical Address:
` 3 S o< (X
Facility Contact: l Title: Phone No: � �.1.
c r +
Onsite Representative: .�C 11► Integrator: P���'1�-1-}-� I�
Certified Operator: (� ` `14�' Operator Certification Number: 4
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o ❑ 4 ❑ Longitude: = o ❑ d
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity
Population
❑ Wean to Finish I
I 1 10 Layer
I
I
❑ Dairy Cow
R�Wean to Feeder Z, bU
I
IEJ Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish I I
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
pry poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Qther
❑ Other
❑ Turkey Poults
❑ Other I
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 hNo ❑ NA ❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
❑ No_q NA
❑ NE
❑ Yes
❑ No A NA
❑ NE
❑ Yes
,R No ❑ NA
❑ NE
❑ Yes
1❑ No ❑ NA
❑ NE
Page 1 of 3
12128104 Continued

facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): �Q
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CFNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
?�No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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 ❑l Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) f►') , a7 r I Gl C V! .,----...--
13. Soil type(s) i ]O 's r L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
;Comments (refelr to question #) Explaen any YES answers and/or any recommendations or any other comments
;Use drawings of facility to better explain situations ,,(useladditional pages,easanecessary).1
�
i
T
Reviewer/Inspector Name
41
2 �7i ' ..n.r Phone: 0
� t�
Reviewer/inspector Signature:
Date: NO ✓
Page 1 ojj l7,/28104 Continued

Facility Number - Ili Date of Inspection l I V-07
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes [�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�kNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
19 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus lass assessment (PLAT) certification?
❑Yes
❑ No
NA
El
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,fNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
f�)No
❑ NA
❑ NE
Additibnal' Comments ..and/or `Drawings:
Page 3 of 3 12128104

Facility No. 'Q� `� Time In r J Time
Farm Name Gi QCk
Owner J�� J� .�rr�' L
Operator Aj+.�.
)ut Date
Integrator rL` r 6
Back-up No. _
COC Circle: General or NPDES
w
Design
Current
Design
Current
Wean -- Feed
Farrow - Feed
-
Farrow - Finish
Feed - Finish
Gilts I Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Observed
CalibrationlGPM I
Waste Transfers
Rain Breaker
Soil Test Wettable Acres PLAT—,
Weekly Freeboard �� Daily Rainfall 1-in Inspection
Spray/Freeboard Drop '%Ajv� G -,T� >,
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
�u 9
1• .
Date Nitrogen (N)
3.
Pull/Field
Soil
Crop
Pan
Window

(Type of Visit @ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit @rRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 ti V Arrival Timed® Departure Time: = County: ` Region:
Farm Naive Zxo C CILIA 0. f N1a __ _ Owner Email:
Owner Name:. r'l \ ' • - �` � Phone:
Mailing Address: L4 uc� ' � 1 atm �aVW, C�L h d. NC a&q q I
Physical Address:
Facility Contact: V) 1 Z; , 4 , Title: Phone No:
Onsite Representative: t ntegrator: �-
Certified Operator: S 14 513
1perator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 6 064 Longitude: = o =, =
Design C•urrcnt Design Current N
sign CurrenSwine Capacity Population et Poultry Capacity Population Cattle Cpacity Population
❑ Wean to Finish
I0 Layer
I
I
Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ La ers
❑Non -La ers Pullets
s
Turke Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑Beef Brood CowElTurke
Number of Structures:
Eff-Tarrow to Wea
Farrow to Feed
Farrow to Finish
Gilts
[:EE]l Boars
h❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes b4No ❑ NA ❑ NE
❑ Yes ❑ No 1�4 NA
❑ NE
❑ Yes ❑ No IRLNA
❑ NE
❑ Yes ❑ No ,"SNA
❑ NE
[:]Yes '0�yo ❑ NA
❑ NE
❑ Yes V No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: -2--65W Date of Inspection tit I
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes bg No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 19 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?
may,
❑ Yes 9 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 PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 6No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ,,�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes &No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes Y%No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .UNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [:]yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 0No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [;VNo ❑ NA ❑ NE
Comments (refer to question #}; Explain any YES `ansrve'rs andlor any recommendations or any other comments...
Use;grawings of facility to better explain situations. (use addifionat pages as necessary):
— OtAne, jSSo �i'�r� ,oC Cc�v�✓ SeQA FJ0.re '5�.TS d. �-+v� 1I7lJmxyL I'L�r1
a
V
f�
�ttaLr .'e)f:/q(►_
T
Reviewer/inspector Name NIP- - - w� Phone: C1, 10 33L7
Reviewer/Inspector Signature: Date: t�0V
Page 2 of 3 12128104 Continued

Facility Number: %7— Date of Inspection It I O
Required Records & Documents Xyes
19, Did the facility fail to have Certificate of Coverage & Permit readily available? [INo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes ®No ❑ NA LINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El 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 ❑ 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 P No
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
❑ No
IRNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
t@ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IN NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ 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
111
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
19 Yes
❑ No
❑ NA
❑ NE
AdditionalbCon ments and/or'jDrawings ¢ s f
SoVC_ 4,o �c Gar r e C- extq Cod e
re_�
i
jj
r t rl U-- V, ; `- h14 Y tc-C. 11%V'1 e-trL40.-A-Gb S -
`r, cik JC Qv�f
C huh I d� I a1 e. on l ,Q. -`Z_ -�oCs�i� h V Q-LC( V 014t,
— Qr r en� C Dr- # 9L4 r ,4 . ) - ,Lded OZofnei- 4-a con4j-
Sr(GA c og• ce %mme C: a�ef
��ryry�� �,V A 110 ►�,,`SA� Ir kC- 'e CL
(-�a
UWV\ Q_y �o zv,,, L u+�4 S�'24 e 64- Ct 6A SOYC �0.h
vw r %JW p s L ►I e{ o C-e c Se CP.
Page 3 of 3 12128104

.Facility.No.
Tim In
Time Out
/1
Date
Farm Name
V Cl ✓ v"
Integrator
Ow
Site Rep
Operator
'Es_
No.
3
Back-up
No.
OW
fn�
COC
Circle: General or
NPDES
Design
Current
Design
Current
Wean —Feed
S Z oti'
Farrow — Feed
Wean _- -finish
Farrow — Finish
Feed -- Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design c:,, 3 Observed
Sludge Survey V Calibration/GPM
Crop Yield
Waste Transfers
Rain Gauge Rain Breaker
Soil Test �Q- laa1y
PLAT Wettable Acres
Weekly Freeboard S Rainfall 1-in Inspections
Spray/Freeboard Drop 4 I? 3112 5I Y i f �. -1// ( `'/ZA ''/11_ 4l�~
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N) Date Nitrogen (N)
� � ob � Z Zs.� Z. • lv
z .
�lc
� cJ'
rP•',l
PulliField Soil Crop Pan Window
Seat
-4 1 h `av

e2 SS .,(O
Type of Visit IS Compliance Inspection Q Operatlon Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2 8 0 Arrival Time: r = 1 s Departure Time: Z: County: .e..ti _ Region: -6
Farm Name: r-PV& _T�- Owner Ismail: p
Owner Name: i'T1 _5m+ _ - -_ _- - Phone: 1 /0 522 2-
Mailing Address: t?s-O old, Mids. Hmjv _Gr L r2.8-M t
Physical Address: C
17S-0 01, /C e-JR aa-rf%1R,Y!
Facility Contact: ___AL __ _sr►4 Title: 1094J w2.r Phone No:
Onsite Representative: Integrator: _Pfew�r
Certified Operator: �p✓.N�2S Operator Certification Number:
Back-up Operator:-�Gty`e-S r+1 L`F(--L -�r - Back-up Certification Number: g l iZ
Location of Farm: Latitude: = e ❑ 4 ❑ Longitude: 0 ° = 4 a 4l
Swine
® Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
SZ40 K qib ❑ Layer
❑ Non -Layer
Other
❑ Other t
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dai Calf
❑
Dairy I-leifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
©I
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 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [52,No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
12128104 Continued

Facility Number: L? S(o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity -(structural plus storm storage plus heavy rainfall) less than.adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier; l
Spillway?: Ao
Designed Freeboard (in):
Observed Freeboard (in): '94-
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 0,Vo
❑ Yes MNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4 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 91 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, chegk the appropriate box below. ❑ Yes RNo ❑ 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) sP fyvt U 4L S Ara-, w 10 Q-V_Ce_9A e ru R ej os to ew ]
13. Soil type(s) gtsa"�)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA
❑ NE
Reviewer/Inspector Name ' a iy, ` h ^.�, s =� ��; -.'�. Phone: y�(� —
Reviewer/Inspector Signature: Date:
12128104 ' Continued

Facility Number: 8Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes M..No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? ll'yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropirate box. ❑ WUIY ❑ Checklists✓ ❑ Design✓❑ Maps❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �} o ❑ NA ❑ NE
❑ Waste Applicatiolp/❑ Weekly FreeboaM""❑ Waste Analysis"'❑ Soil Analysie ❑ Waste Transfers ❑ Annual Certification
❑ Rainfalls❑ Stockist' ❑ Crop Yiele ❑ 120 Minute Inspectioit"[1 Monthly and 1" Rain Inspectiorre' ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes P,No ❑ NA ❑ NE
23. 1f 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 perinit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility sail 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 ofdead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative'?
33. Does facility require a follow-up visit by same agency'?
❑ Yes
❑ No
C5NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
$4 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
❑ No
®.NA
❑ NE
❑ Yes Zq�o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
❑ Yes [,t'o ❑ NA ❑ NE
❑ Yes t.No 0 NA ❑ NE
❑ Yes U@,No ❑ NA ❑ NE
Additional Comments and/or Drawings:
�aL..� t;.es : t 2�ra �� K 2 • �
�tirtsio� �•�
I/I(tt°Y
21. w e- (n3Tc" &IMX- 1 Wi_ 144AA.) 40 i_400- s+ G�4 i' -
rui,,.•�..�1
V1 r*� C'Ur "� C" `Ss4-e_ re—Go4S.
L
12128104

Type of Visit 9C_oLmpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint 0 Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: � Time: D
O Not Operational O Below Threshold
Permitted certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName: ...... .'w"' ..........�................................................................ . County:.........�`!.......................................................
OwnerName: .........l7..................................... N!41........................................................... Phone No:....f. '.?.�'� 9..� 9$I`.................................,
ou
Mailing Address:..... M...0 ........... 114101t 1 !!`!.................................... .....lid!{ ...... f.......................................... ...r T.I�...
FacilityContact: ................!!".! ..................... ............... Title: ..... 1....................................... Phone No:............ ...................................
Onsite Representative:.................5.......'.�.......................................................... Integrator:........ Akwit...... . ..........................
Certified Operator: ............ t'^'.5....................�..1.`^ ............................... Operator Certification Number:.,9�7,f.�...............
Location of Farm:
916'W'Ine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• & 66 Longitude 64
Swine
,1
l Current
aPo ulatibn.. <I Cattle ;1 , ,. •. E
-
- - --
�,
-- ----
❑ Wean. to Feeder
Savo
a
1 Layer
❑ Feeder to Finish
❑ Non -Layer
❑ Farrow to Wean
;,l
�,r,rio; : ,,,o,_0 fir ,.a�a d! I il, �. M'. ,r �r5 �.
❑ Farrow to Feeder*
I
❑ Other
❑ Farrow to Finish
a f1
°T1411i` TOt�I �}CSI�
• Ill J
r`'
❑ Gilts
1 Yllll it i L r- f s 14 rtb 3 e
�
�1
B
❑13 oars
w�i �I jii% YY �rll ,,a z,� _�. i �� ,n■
nl •r� Ilili.� it r{ -,. �� � - - .. �{:� .. S� 1 �. � I � 43� {ai �lJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
Current .
i� ' ipo F u6t6ion-,r'
,i ❑ Non Dairy
�i
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identificr: ...............I ........................... ..................... ..... .............. ...... ..........
Freeboard (inches):
' �
❑ Yes M140
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [moo
❑ Yes @oNo
❑ Yes [moo
Structure b
12112103 Continued

Facitity Number:
Date of Inspectiongr
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes S<0
seepage, etc.) ��
6. Are there structures on -site which are not property addressed and/or managed through a waste management or El Yes [R o
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes &Ki0
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes GXgo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [Rio
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes j�lo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes (;+No
[]Excessive Ping ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [I Copper and/or Zinc
12. Crop type pq 4kj -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes G2,lqo
❑ Yes [@'No
❑ Yes @14o
❑ Yes [?Io
❑ Yes @' o
❑ Yes El"No
❑ Yes B10
❑ Yes �o
❑ Yes [�lo
❑ Yes �No

Facility Number: 7%L Date of Inspection pf
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ®1�10
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes 2<0
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G;Ko
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I K<o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
52<o
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
R No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
f a'No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[R'No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
BlNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
9<0
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After l" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. 8 z -s6
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: ::Yf �►►
Mailing Address: JS± z
County:_:�2&mps,&
Integrator: L.6 5 l c.
On Site Representative:
Physical Address/Location:.
DATE: , 1995
Time:
c
a C .s
Phone:
Phone:
_r ,
Type of Operation: Swine Poultry Cattle
Design Capacity: 5Z - Number of Animals on Site:
DEM Certification Number: ACE,._DEM Certification Number: ACNEW
Latitude: Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (�&or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o o�was any erosion observed? Yes oKQ
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
lOD Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orel�5D
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(SD
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate was a management r s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No ?, SN{ r#- -
Additional Comments:
Aex,72r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.