820062_INSPECTIONS_20171231

NUHTH CAHOLINA
Department of Environmental Qual

i �..... - df' I 1 I,
L)lldif flit i gI # ",!, IIll,.j�4 I�,I#<rilll+l,ik(IhxSy't( #I,l,ilAtkIIIIII4lliliyyaiih`; I ,'•4i I, rt Division:af Water Resources,!l�fl I r'�I.F', r ,.'E:,. �!ie (� r� ,f I tll{ ![Yi,'II,I i,r.
kf L:. I'I I�IFIlil�r�ll ,t, I
t 1 �..,,rk.311,i,1j:,1 I+Ei, If }'r�NFi{f.lid.4...!! 4 "I#'llf#fExil
II;,,:! I , 4, G I,I?�,�k, u. I
;Facili�y NuEnberrrl, I"r:,,lI+,S,j9Y`I'";`"'Divisianoi.SoiiandiWaterr'Conscrvatiion�ll�{�I,{!{I;I,�nlls,Ifll,, ,;.,I,�k,,,y'I
._., I :E-✓ 11 I[[ �Ih 'J:. I i I I ,Fi, :ruE ,I rail .., s. ,. ,I, p I,.t4V, E".r.r,l:d''' t LI' L p ir4 Ire {l E! u.ei it I (..Il}.,; n..�i
:_�� E Yl I.•A t 'III, r'I:: !. it V'r: ]p.l r:'rl,l •.: III A +IIllllll. ;L -I llr.l, Fxl p:; Ih. IIIU it Iltll, I, i ,y I�.IfL .i�, xl, '[ IE- r.I I :IJ
,1, li I I itV F I I [ jy 1 IjllI 11 pp r .rr M,!'I ",I t, ;:r 31 c IE11A •J rr ,{ rl s 'J #., .
.Other:l'i► encV'r .lfll:toillI�II41111��?Iu!?#.f1I,1.IrNLII[�fllrfllYllllrr,�,r,tlrV', .I .k"L IS J..,.,J
*
Type of Visit: RCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,PZp Arrival Time: ' Departure Time: _J County: ,5_4WI! 40 Region: L�
Farm Name: I.YGYA'�i Owner Email:
Owner Name: F A/ �C Phone:
Mailing Address:
Physical Address:
Facility Contact: 64%G�
,/0614-,5
Title: "�,y sJ2�'044-Z4 ST Phone:
Onsite Representative:
Integrator: !IL11 rT14--l���
Certified Operator:
$fL�jflr� ,� A,)Lj
Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
f"
nli : I i
(_I
..:..,I.
1 ,-1 8' I, r I:.I" I it p i 1" III 1: i F'r
1 li" I 1 9.Pr. I:, I I 1. .1 I !I !L' I" ' I i!I :I. ' I "! i 'I I1 ' fr' 'P ^ 1 '. I'�' ,L , ^ ';1 "I ' JI .I ' ;r.
! 1 J I ,L:J,;II . I I'I', jtr 1 ?�y. ! S r,;�ll , I I "Ei i f''ll!'S E, ,I'I ,,, , I I, �fi i i k II,:,
I ,: " . I 'll : ,. itµ ,+<,.11 it Eli 1N,..1:1 ..I o^.r I is � I I r € ,..�It ak' 1> I. r ji G „r I„a r+ u , „: .!,l, .11l.rlN + . I I�i �#II ,:
{LIIlr,l., ,i I #�li I Ixl . I ! r + !i @I: I I99
��I ,JJ I' Desi :;r=: '.urrentir':'.�'II �.. �Ih;.,} IJ_.,..f �I"..I' ;lr:.,: lit, �Desi ndj-C uIr`rent: ull y�E I ,C+I, �, 1 !''!!-'>a I'.li fir:. b„,�:,rlDesi n� Current
11l r{IH+ gn C �. � � J�,. "I , ,.. � � I I I �,,. .4 ! i
hl- 1�,:.iY 1i11�3 �!'I'� k. fl'!!II i� E. �.',I: y+P ... .,P
(Ijit
1,1a1.-
I,._!. 3!!lllilll:I'1 'Id...'I ilril,l.I,I! :x I
II Swine I II. II I N+FIII,:I •:Ca nit .,;:Po
f. +1j1 t}'I. I..�,P..,,I11
�111VI.yIIII� P
l
rjl!'I .•IyIL1`I. ,.7 ,. ".,:v�l�11.--l!.p:•:'-.- f11. ,+�Ir''�i IJI HHr,.i ,
I ,., •. I If.l. 'Ill, h, llil r�,; +F :ry 1Fi 51�1 1";[. r: ,1:, 1';. SVI I;. .,rl I 3 ill71,� !... li.lilt Irh
,!I',Jila I''WetrPoult l h;.Cra"' aci i".Po 'r ICI: ,V ;:Cattle II IIiIJ"4Ca aci Po !1 rI
Ir. ry¢ILJ.,: P �},IiIII I rII, �I l P ty:..,fcr
y y1VJ a ,I
k ,4
,. I I.i�lk:. ,''II .
! !
II_,IYAL ! I- �..:- Illlll� iitl' rl:^IIt1,lh.3..L.Il,elli:cl F:�Slls..{I!a , 113= --:Cl,i
:.,.P; I ,
: 1. ,: ,1 #�I ,r 1 II r V III'..II .:Il ��..II•n. k' f !. r'r r�i{
'+"r..11lll1l,Y �'1. II 1 I; lur'I I�,:, I fl�4te.. ,ii rlLi, tl . ", I [FII. 'd.:::xl. .11 }(, - F s is 111r1 1"li .E !- . lih !'. F,. ',.2t 3.f .,..[.:.
r��
IIiiI:L
Wean to Finish
�I !, La er 1i,4' Dairy Cow ill;
Wean to Feeder
;ii! Non L.a er fI DairyCalf Y '
1
t >Il
y
Feeder to Finish
Ikl Y ,i ,,„ ILd�b li�al ds^ �I�iI rp3, + I �, o'#,I11 J�1 #IIE DairyHeifer ' I�
! >F , II III r
3
99 J i {
E
Farrow to WcanI
y
r dt1 1 !I L rlgi�'
ti� eliobn �ElCur>rentf �" D Cow
NIP
I1llllNlr,g.lnl 41 ` !L 4
j
Farrow to Feeder#I
, } IStiir�lllNll��
IItD , Plouit ,I,�1,;Ca aci IIPo i ���'': Non -Dairy
Farrow to Finish
I � i Layers Beef Stocker '
Gilts
Ill
I ` Non -Layers Beef Feeders i
Il
I , Ij
i
Boars
{
Beef Brood Caw
ll�li Pullets �ilI I.I.
i...Y
,J^ , .,
,. ,llr 1 I IiE I ir!•t.. Ill I Y, I 6I+' II, Ii I'll I�'ifXrl r�':'r tEF !� I I!y P n..f[ I rlllll�#�IIt IIE 5ti"dlrklf llu I '�1 tlrt y.:.rq,f,, 'th I :, I,''jjL�.#
s Turke
Ill l 3 i t h 1, I ii III.
!`iLul�:llll�
OthIZrlCr! iililt•; JIE�uI".!J tl'NI i It�ikJll�I�ii!#1l1�±� li��l�i� �ll�I� i ,'r , 'ii�Jllsl
ll i Turkey i'oults 7 r II
I d+ ' � ,'��' � � I� I {� i�l�! �� ��,; �'#i i�liEl t � Il i'
�:
Other
I� � Other '�:�#'i i� hf� �I�iI�E h Ilia � I•� �
"I,
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 4No ❑NA ❑NE
❑ Yes
]No
[]NA
❑NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
8 No
❑ NA
❑ NE
❑ Yes
f� No
❑ NA
❑ NE
❑Yes
9�No
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facili Number: 2. jDate of inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes j] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T1 ] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 �� Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
I' bl f d ' d k Al-
(not app ica a to roo a pits, ry stac s, an or wet stac s}
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop TYpe(s): 1 �l�-+� )VY94--1_ IJOZL-?Mle 24- /i'✓v�Y�1L3�+7
13. Soil Type(s):
14. Do the receiving crops differ from those lesignated in t e CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes]
No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 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 ❑ 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
A No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
`->e No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1�' No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 1P
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.
7�
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? Ifyes, 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
rM 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
��i��el C6}-rl/C� .�GC���i✓GC l z�-�,tr 0 i��'I
Ang Z
Reviewer/inspector Name:
Reviewer/inspector Signatut
Page 3 of 3
Phone: 9,10 3. 41 0'9-
Date: 211 l8
21412015

,i ,�..r ! :::':. 3,.!:.!ri .. , YI„y •: h '4u." 1'rY--:I' is"I :I. , !..... , :......,Irl,
ff�III °I,;r. ,�I.I' I:,Irli 1.14rslr{Iil,r.11'1ofiWatcrResources,l
!.lr ill. is .Ill1. 1•F-rl ! I. I-� IIU:I 1" I
} 34':,: i Ills II ilil I;G; I GGN�
r I'!'pi�'!flli, I.,.,l14k 4' i1141 h I I f I`?'t }I
4.h>r I II II Ikl � 13 t.��
II Fatt(t Number,��,;' {, i
'.
�',: I: ryr... .. _.•� S. i.•1 V
i.: I � . 616i I
,� Y� II ,14
rl4l ll :,Illy.' irI
j i }3I(l'�ti ,.! Yi
Y I 'I r, . �hg,lYllf,ll � i t, i, :,lln IIV �¢In II u!Illllll!9i:.aai'dh rn,l:, � !I
N{5 O,'Divisipn of5adiantl Water Conservation ilia; II!
IIFIIIFII1III§Iiy,Yle•rfi,"'ti :
Y
diil�nl
� I tl�. e
t 1�
ff
,11ii'{i�;l' Ifni'" I,i
I::.:,.,111j Y:1, 61 I
111�
114
i71
lit
! I•u f,fi) 11 F 1' 3• l.r
1111:���Ir���111�� rl,ill��i���1�11���il��tll�ll!�I�1N.II�a�.L: �II�IF��I.:�IIiPJiil�lll�l111i19.1,.�,1f�1•,..:��
KY Yir'
rrIIMIII111113f.}li'ii { f
!1.I l 11
Other'Agency I liiY1, ��ili�114f11NW�11��:�jot I
�;9,:. _:rtl.•:...:...:.:::.II.L, r.:,.rt �i�
1
F.
Type of Visit: O'Compliance Inspection Operation Review O 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: ll Arrival Time:! Departure Time: l County: j7*_Region:
Farm Name: ?/ Ycz�r i ✓jdi1� / --
Owner Name: . �� f x_�— . %<-' —�-
Mailing Address:
Physical Address:
Facility Contact: 6: r- ?70oe t: Title:
Onsite Representative: s "ez-�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
== Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
,... i
li ii .
.r. it
" Id
YIIf
i ,,,4: •
: .,;. r, : I -I .' 1,
tr, ,f ,1111 n 1 I,
.1.:�,. . ,' lali �t.
I I , , I IV . :f ;(
l ,4'Y li•:,,1,14ICurre.ntl
.., ,. ..
I Yr, .k, I:
,;. I
I !lu1 U
•�r ,,,I :.•: .. :.:-' I 1 : ., 3':,514.' I - - III -: I... _i :: ;...,
YI S :,:, 11,1, . Yl , la !l I I a'a .: 1 6111 h x
,., ., :I .L ., ':.r-I .1!:x I rl!! ";n.F .Y .II I „::,.1. � �, a.1.:.1.�..,:1 -I: lIYi1 It,i,th,
II 4 II : k. I ! 4 L!, f I . 1..I ll 14
]{y� g f
� ..114�, IDeSI n.:,
j!
II !:I
! 11,ir,.. .l�-ill
�Gurrent'
P1I
i 111
i
I
",'s:..;rl.
� ,.
rsj §I slab
„ ,III, ll,.k:
., 11
l
!iI , , Il,lll
yl!Y„p I ers rl
Desi nl:
g
I
Current
!I
1 �• r1 r;,
1141111y,
�tr '`!#II, I'1 i ,:
Sw(nel ! r�l:ll
�JJ ]]
,
� fi!4!CI�{
�H
',�,
l ,4,r4::ri .n, 91 t:lii;ll ,� r!h r u �' 11 >lil4Y lii.a,l, �rlr tl It! lilllly^,: ,!�
I�Ca acllt .Ai 'WetPault t ^.III(IPa
I 13
Ir Ilie 1
i rllil cur 111,
1 i
���
lI
1
i
tiE1} 11
t�l:l
Cattlel {
clil,
I -. :1 1 u
,.,
Ca ael tJ'
�
1:.IIrII1' �i
l:..: I1,11P
j { P
�1
il,
� �} Ill r !
Y'I 1Pa !I :
P;; . yl Yi N..11i r + i r ! Y yI P
h� it ll3i(LIStI,#t3iFil1
„ . P .,{ p
10 I
.I
� 111111.(�1,�
I P , ,.
i P !!
l:..II#.,,ai(tlls�Rl.,.lr�
E
n l I�
si ,lh.,i,l:^,
{ , i,r l ullll1E�1I161111Ln11119111
U11,rl1:_s.:tfEiilt:ll,INI')�liliiltlu: w,,, l ICIItI lilt}l�iliili111.1111.1i14iilllilui
�I
La er
(i
si%dAlt4 1 i1161
p , :IIft11111a1E1i siLkllulll
.
„ I�f1 ti3 Eillullpl�i.�l
I� !
Wean to Finish,
'Dairy
Cow
# (IIV
j�l
I
p �i
1 1
I' �
Wean to Feeder
1i Non -Layer
YK }df i 1 ll L r I i
11fM1 i #3 r a I'- I �Ilki I
1 I III I I!I
f �y
Dairy Calf
DairyHeifer
Feeder to Finish
, I
>111i ( r I +11�1 '4
i {4 ,
r �
Farrow to Wean
Dry Caw
I ..
'�VrlI
��lil,[l
4 1s�, rl , I [ SDestgnlG,Currenti
,tI,r l-.Cli {
l N.
III
Feeder
it
Non-DaiilAFarrowto
Toul,I aIJ c!II"iIII1
1op.
�
1,
I
Beef Stockerrill
`` tM
Farrow to Finish
;4l Layers
I°ili!
Gilts
19 4 Non -Layers
I
Beef Feeder
i II
It
Boars
P 11 t I I^!� trq arl,llll}iif' 1i '' ` li
!
F i ':iql lfl [ -
alrlll f 1 1 l,rl'41
I<I,
u, �Ir�l� iI1
�lltill!
j
�
Pullets
Beef Brood Cow
f�
Turkeys
llr,Yl!'°
i r r ; ]r ' ll'!q
it , i �il�f � �! l �1111
�,°1
IIli1 I I i05 lT1! YI
� f i � � �
[ �1�11 l
!,�I'j
1
��
Turkey P 1
T ou is
�s.!.
!��
r!�! :Ir
111�p :
i I�111 �rsilll' l �' `i' i 4'
�1,...�I'll� .,I:..,.• ii :Il.: ,...rt.�.�IL:.Y"r:,
nl
"1"Ir i1 11r
1
IIIIr4:,•,
1f,r w
li•:gg!
N
j, il�'; 1 ;! 4
1I a I I
Ip1 �rMII ��'� I
f 1 "Y= ! I iii
Il+il �I s i � t
1.• . �:II . rl' �.•.4. �1 .�� ✓V
Ifluli
.l.l. (!1= l ! I� k ; l Ll � !, 41 ! �`
p+! 1 IiIYI41
�I
111I II Isi! r,1 I��I r rIII a.Il.
j III l �1�11 �IY �i I114t I� I4I li
url Ili:... :�li „cl�lE .. 13'YI � 111!:!. 1l.tll I �I I I�I , II'4
+';:IL..Other
Mother
'
I.
�1
:
II
I�1
u'.u.xu
Other
,,. .- Iu.. � : :-..! ,.: .4'.." '.e
I
II
M I.I� •;::Iu'u,'.I r.u:: :, a 'r I I-.:...::�.IIII�.
I!! , u.: :,-.- ....':I... r.....:. �., .'. :: :�., '. ..:,I,. ,n: u.f, �' :.;. r u: u1..•:, a
Dischar¢es 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 �o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes INo
❑ Yes &LNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: %�—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 51
Observed Freeboard (in): —-- �7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes SNo ❑ NA ❑ NI?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[& No
❑ NA
❑ NE
maintenance or improvement?
Waste AijAication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 51No ❑ 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 "I ype(s)=
13. Soil Type(s) � � �!�/�►��'Q+ir+ �%. sue.-, 111-1- / EP2a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,j No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ZLNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[X] No
❑ NA
❑ NE
Reauired.
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
4'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes ZtNo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,LNo
❑NA ❑NE
❑ Weather Code
❑Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

` Facili Number: - le bate of Ins ection: O—
9-
y 24. Did the facility fail to calibrate waste application equipment as required by the permit?
{
❑ Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check
❑ Yes
© No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[Z-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
K� 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?
Ifyes, 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? byes, 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatul
Page 3 of 3
❑ Yes M No ❑ NA ❑ NE
❑Yes ®No ❑NA LINE
❑ Yes ,® No [DNA ❑ NE
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes [ No
❑ Yes ® No
❑ Yes allo
❑NA ❑Nl,
❑ NA ❑ NE
❑NA ❑NE
Phone: /G�'3� 3
Date: _zlg
21412015

I
C"ivision of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: CMompliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: V Arrival Time: [� Departure Time: ` 7 County: Region:
Farm Name: Frye'--- K ra drrc� Owner Email:
Owner Name: wry Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &j p Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Im !acts
1. Is any discharge observed from any part of the operation? ❑ Yes E!�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
[DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
1 Is there evidence of a past discharge from any part ofthe operation?
❑ Yes J2�1Vo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes „g No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: IDate of Inspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r�_l No
❑ NA
[D NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
9, Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
ffj 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
1!3-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑ No
❑ NA
�E
maintenance or improvement?
1 1. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
fANE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
PNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
® NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
❑ No
❑ NA
.® NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes
❑ No
❑ NA
�NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
KNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
ZC 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
a 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 bail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
JaNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
❑ NA
S-NE
Page 2 of 3 21412015 Continued

` Facility Number: - Date of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA C3.NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA JNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
D NA RNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA _"RNE
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?
Reviewer/inspector Name:
Reviewer/]nspector Signatut
Page 3 of 3
mmPT
[:]Yes [:]No ❑ NA ,KNE
❑ Yes ❑ No ❑ NA 0. NE
O Yes ❑ No ❑ NA JZ�NE
❑ Yes ❑ No ❑ NA f�]_NE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
2.z
Phone: 9,/U �p3/✓��
Date:
21412015

/1t,
S"Ivislon of Water Resources
Facility Number � - 0 Division of Sol] and Water Conservation
0 Other Agency
Reason for Visit: 0outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � /D % ^ Arrival Time: Departure Time: J t7 County: Region:
Farm Name: IS Y-u a,� ) 1:2i� na li�drr►. Owner Email:
Owner Name: j ,,v_ j'C; ,1„ Phone:
Mailing Address:
Physical Address:
Facility Contact: ��Yx'Y'��✓ Title:
Onsite Representative:
Certified Operator: _ L L-2 r"�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: 'jal :t- �o/
Certification Number: / 7i�1f 2
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
4 z I
Dry Ir
Layers
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? W
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ej�_No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 91 No
[� Yes S_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): 9 _
Observed Freeboard (in): 14 Z _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
D Yes 2No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Callo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
51Yes
4KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ©No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D 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 ApprovedArea
1
12, Crop Type(s): an, ����r�jS�i/ �� / a`c� �'09 mow-r'//
13. Soil Type(s):
14. Do the receiving crops differ from those
MP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes
❑ Yes
❑ Yes
No
MNo
t&No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes [2_No ❑ NA ❑ NE
❑ Yes [SNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®. No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Uli No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
S No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
29 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
!�-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes allo [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [3,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ZLNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes [KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes [allo ❑ 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 allo ❑ 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 4No ❑ 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 Callo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C�LNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Q� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,M No ❑ .NA ❑ NE
Comments (refer to question #} 'Explain', any YES, Answers and/or any. additional recommendations or any other comments.,
Use drawin s of facil ecessar ).
i . to' better ex laln situntions(use additional a es as n
-
Reviewer/Inspector Name
Phone: !7d31)3 D0_�
Reviewer/Inspector Signature:
Page 3 of 3
Date: /"/—/D _1__414
21412015

GYbivision of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cam lance 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: 1 Arrival Time: ) Departure Time: ,�' County: Farm Name: `}j f y�r�— f C ij ��* n^-� Owner Email:
Owner Name: r'Z%- Phone:
Mailing Address:
Physical Address:
Facility Contact: ���z-�/' %%'jtl w— Title:
Onsite Representative: 511­
Certified Operator: ijl t/ar- r
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
(:arrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
Integrator: H'f IV
Region: {�-D
Certification Number: / %s,4% %7
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Non-]_,
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes allo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [] No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZkNo
❑ 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
allo
❑ 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
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
i006_6 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
["No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
UK -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): vt.1ay�/�
13. Soil Type(s):9.a�f(1 yt v-•v— 1`'vr
14. Do the receiving crops differ from 40se designated in the CAWMP?
❑ Yes
[f-No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
&g-No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: /-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes SNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA [3 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
[—]Yes ®-No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
[]Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
[]Yes
allo
❑ NA
❑ NE
[]Yes
J�ZLNo
❑ NA
❑ NE
Comments (refer to question.'#): Explaln.any YES answers and/or any additional recommendations or any other comments.
lise.drawings df fat lli to better ex' lain situations (use additional ages as necessary).
7 ' �� ,< 1 cr a. ��• 5 - Ga- ram-- � '
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 -1 D_D
Date:
21412014

ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
y , 0 Other Agency
Type of Visit: Q<ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ! County; Region:
Farm Name: f yam.�.� �-ti Hq . FG✓'!3'%- Owner Email:
Owner Name: K vne Phone:
Mailing Address:
Physical Address:
Facility Contact: ejrrV-' /npTitle:
Onsite Representative: !fr��
a
Certified Operator: ze
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /�liiry'Y�r1/L
Certification Number:
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -Layer
Non -La
Pullets
Other
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
Won -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [ -No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes []No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes ®-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

•, Facili Number: - Date of Inspection: O'
/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �b _C�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
Waste Autflication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg No [DNA ❑ 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): V vr,r
/
13. Soil T e s .
14. Do the receiving crops differ from those in the CAWMP?
❑ Yes
QNo
❑ NA
[3 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
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
5�,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
)2 ,No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
J,.
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[,] Yes
jg[No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [D Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

lFacility Number. - Date or inspection- D" — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [RNo ❑ NA ❑ NE
J
s 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [X 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 C�gNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes jRN9 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ®,No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
J0.r
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 4 No ❑ NA ❑ NE
❑ Yes f[ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V1 No ❑ NA ❑ NE
331.;,Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes ®No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
21412011

W'Division of Water Quality 're - —
Facility Number ®- © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 1EYCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I q-711Arrival Time: D ; 3 o Departure Time: ' County: Region:
Farm Name: 1f'yea r► t-C;
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,�'�ry-y�,^- /nyorr- Title:
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator: �/}2�y 2512yn.
Certification Number: 17s''q1
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
on -Layer
Discharees and Stream Imnacts
ury routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
1. Is any discharge observed4RG 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 Eg No ❑ NA ❑ NE
❑Yes ❑No DNA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: —
-•�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eii-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): S-Li
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(a 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
[�Jo
❑ 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
Z_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
[g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
[S No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): Ler'f :UL &v �'riy'r� �L-t�/iR / itJ�r ems. •-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
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
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5[ No
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®,No
❑ NA
❑ NE
the appropriate box.
❑WUP [3 Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No
440,
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ®No
[]Yes E!�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ja- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CNo [] NA ❑ NE
.� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E&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 ZNo ❑ 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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No
[—]Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question „#) Explain any YES answers and/or any additional recommendations or any other comments.
Use draWIhgs;of facility to better ezplain:.situat#ons;{use additional pages as necessary).
re &r -- 0_4 D S ogre- C_ I D - I - 1-3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �f17 y3-33
Date: ..../ ,% f✓
2/4/2011

I
Type of visit: gKoZpliance 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 Visit: Arrival Time: 0 r oj�7 Departure Time: County Region:
Farm [Name: Z r'yah- 1��; .ti ��crw —
Owner Name: T r
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ff00r'_- Title: 72:G/� Phone:
Onsite Representative: r r/- K yam/ Integrator: �y
Certified Operator: s' yQ,,, ��(`, ,1,, Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignRAM
Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
9 b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P*oult
Layers
Non -La ers
Ca aci
Po P.
r,
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
Turke s'
Beef Brood Cow
it e
zMaTurkey
Poults
Other
III 10ther
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
[:]Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes No
[:]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑'NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: / — f —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes allo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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?
❑ Yes E] No ❑ NA-- Ej 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 structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2[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 ❑1Evidence of Wind Drift ] Application Outside of Approved Area
12. Crop Type(s): Cp/'h hQ/1A �54�bra^�1 f ��rNr,�� /a�•�r.5rv-�
13. Soil TYpe(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes jq No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
nNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box,
�No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
54
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
"No
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
25 No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

s
Facili Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes CR No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes fallo [DNA ❑ NE
❑ Yes FLNo
[]Yes Q No
❑ Yes [Z-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to questlon ft. Expla€n any YES answers. isnd/or any additional"recommendations or anyother comments.
[Tse-drawin s offacilit 4o better„ei lain'situutions. use additional a es as necessa
g Y ( g )•
d:S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �1/0' `/T 3 D O
Date:
21412011

Type of Visit: 7Routine
Hance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11� Arrival Time: Departure Time. -I County:
y-�-
;ap!:--
Farm Name:_ &yft Owner Email:
Owner Name: Mta Phone:
Of
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Title: zd
Integrator:
Certification Number:
Region: 6 -02
Certification Number:
Location of Farm: Latitude: Longitude:
D€scharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[5] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
� No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - 4 Date of Inspection: 4t44 --- /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [KNo
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No
Identifier:
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 19,
Observed Freeboard (in): yO
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan? -
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? aYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 01No ❑' 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 5� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a -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): 6�DC.2 f�r.�el� ,4&ter3.t..,�
13. Soil Type(s):
14. Do the receiving crops differ from th se designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists D Design ❑ Maps ❑ Lease Agreements ❑Other:
21..Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Eg No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 97 - Z= Date of Inspection:-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;21 No
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[]Yes
JZ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2 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 S No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes J8 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments'(refer to question Explain: any YES answers and/or any additional recommendations or any other comments " .4,9 x '
Use.drAwines'of facillty to better explain situations (use additional uaees as necessarv).. ° , _ � �
,u � Gt1o�r � Gtim{/� dt� Gtooks C�aa�
10
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

vision of Water Quality —Ir
Facility Number _ _� O Division of Soil and Water Conservationel
------ --
Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t[l� Arrival Time: as % Departure Time: ii O County"-
Farm Name: i`Y K "� Owner Email:
Owner Name: �R c:2za" — �5Y- Phone:
Mailing Address:
Region:
Physical Address: /�
Facility Contact: _rye~ "t 2. Title: �l72221_d'� Phone No:
Onsite Representative: 6 1=i-Yd­ &Z=A 7 Integrator:
Certified Operator: Operator Certification Number:��7�
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = = & Longitude: = ° = ; =
td
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Nan -Laver
❑
Wean to Finish
❑
Wean to Feeder
El
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other l
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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
c, What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: U-11
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
[:3 Yes
❑No
❑ Yes �R.No
❑ Yes ,,No
12128104
❑NA El NE
❑NA ❑NE
Continued

Facility Number: — b Date of Inspection 1"D
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Kyes �-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [$l'es C5 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed I'Yes XNo ❑ 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
T Do any of the structures need maintenance or improvement? 04TOcs allo ❑ 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes �&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13.
Soil types) ESL ��-- ,lld la
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
PS No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
S No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
N No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment'?
❑ Yes
54-No
❑ NA
❑ NE
refer to,q ) p r, anyfrecommenclations or any other,comments . k
win s,of:facility toj b # ' Explain an YE s:' use a and/o Comments { y answer
17se dra _ g otter-.:explairt situation { dditlonal pages:as necessary)
Reviewer/Inspector Name " ?"« 3 � �` Phone: 9,1101
Reviewer/Inspector Signature: Date: — /D
Page 2 of 3 I1/ld/U4 c;onnnuea

( Facility Number: — Date of Inspection �1�---
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
FINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B 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
[8 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did'the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
®No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[-]Yes
&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
rV,,',-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
allo
❑ 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
F.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5UNo
❑ NA
❑ NE
Ad ditional.Commetits and/or Drawings:
Page 3 of 3 12128104

3T114-S iz - 0 9 2.009 r . �u -
Q'1f%A ion of Water Quality
Facility Number Q'Z J �(J O Division of Soft and Water Conservation
-- — O Other Agency
Type of Visit &Zompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Arrival Time: : S`.>ra... Departure Time: County: Region,
Farm Name:
&1'e4nJ
Owner Name:
'g,y
CIA/
AK, `..v
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �►'<�� lucoty t Title: 7t c 4, Phone No:
Onsite Representative: c''G'e-y" `` 6i't— integrator: 44` �` �=✓�
Certified Operator: 8L—XA^1 �tNci
Operator Certification Number: / 7S5 4 q
Back-up Operator: Back-up Certification Number: 1$3�6
Location of Farm:
Latitude: = Q 0 6 = Longitude: = ° = 6 =
Design Current Design Current
Swine Capacity Population Wet i'oultry Capacity Population Cattle
❑ Wean to Finish
[]Wean to Feeder
Feeder to Finish 1OU
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Otherw - - — -- — - - —_ -- -
❑ La er
❑ Non -Layer
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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-DaiEX
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (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 El<o ❑ NA ❑ NE
❑ Yes
❑ No
E A
❑ NE
❑ Yes
❑ No
215-A
❑ NE
3 A
❑NE
El Yes
El No
❑ Yes
Blgo
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
12128104 Continued

c '
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 1 Structure 2 Structure 3 Structure 4
Identifier: cL • /
Spillway?: ljo
Designed Freeboard (in):
Observed Freeboard (in): 37-
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 B"go ❑ NA ❑ NE
❑ Yes alga ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 21qo ❑ NA ❑ NE
❑ Yes 9-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 [Mo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q-Nn ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) SrriziK�%� 6/47reO.S.)
13. Soil type(s) &B
14. Do the receiving crops differ from those designated in the CAWMP?
El��,,
Yes
//
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
014o4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
E3 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ET'No
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,N
LJo
❑ NA
❑ NE
y�$ ° ?Stir n ohs w.�r�a" 14
Reviewer/inspector Name )�c K � ie�L ✓C ;.ii:;, ,„ . , , � �, ?. �, �� ,;.t .. Phone: , P-fS. 330 b
Reviewer/inspector Signature: ,:y Date: /1 -Oz(y' -QUO?
12128104 Continued

Facility Number: Date of Inspection i77-14__111
Required Records & DOCUments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [4-Ko"' ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EIC ❑ 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 Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,❑',to ❑ NA ❑ NE
,,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes EK ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes DIq­o' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑-<o
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,,�
Ergo—
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[71vo
[] 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
2iqo
❑ 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
,�,/
[2 o
❑ 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
[ 10
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5?9o'
❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

✓ ;.�- .s /-0 9 - oy R2
2
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outlne 0 complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: /L t98- $ Arrival Time: ; qn Departure Time: Zr 3 County: a Region: dr
Farm Name: airy CLOIJ . I�a,t—r^. Owner Email:
Owner Name: 911-164&61 R1 +�f c Phone:
Mailing Address:
Physical Address:
Facility Contact: 6(r-cLir Akcrav<_ Title: Phone No:
Onsite Representative: 6V-4 te_ / -C__ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = Longitude: 0 ° =1 =
dt
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I EE
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Ciits
❑ Boars
Other. .
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream I_ mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: a
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?
;I
❑ Yes [ 'No ❑ NA ❑ NE
❑ Yes
No
El NAEl NE
❑ Yes
�9q—o
L`'J"HA LJ NE
21q.A ❑ NE
❑ Yes
&' o
❑ Yes
LE No
D A 0 NE
❑ Yes
C No
[9'1A 0 NE
Page 1 of 3 12128104 Continued

Facility Number: — Z 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: ZaXf-/
IV
Spillway?: ND
Designed Freeboard (in):
Observed Freeboard (in): ZQS f�
❑ Yes B<o ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,--,.�
6. Are there structures on -site which are not properly addressed and/or managed Ell.,
Yes _I 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 [31go- ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[3-fq-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
[ to
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[3' oo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
-��
t,-wo
❑ 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) ,3.a1 w.� ac.� V lam. Gros [�J sl+4d1 GraO
13. Soil type(s) � n bd
1-3
Q g
- - - - --
i4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
3<o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑'1<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
3'5o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
2'fo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
3150-
❑ NA ❑ NE
Reviewer/Ins ector Name ,# Phone: 9�0, 5�33, 3330
P th S
Reviewer/Inspector Signature: Date: /2 -p Ig--20a
Page 2 of 3 I1/15/U4 cannnuea

Facility Number: 2 — 2 Date of Inspection 12-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [`{<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3'50- ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Cjl o ❑ 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
[��o
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Divo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E;-Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2'�lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑<
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2'go-
❑ 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
3'5o
❑ 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
211ot O
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
G'q'o— ❑ NA
❑ NE
Page 3 of 3 12128104

1 \ • V`
Ilivislon of Water Quality �C�01
ivaeffity"
Number �. Q Division of Soil and Water Conservation C /Z
O Other Agency C �
(Type of Visit `%Compliance inspection O Operation Review Q Structure Evaluation 0 Technical Assistance i
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access Ij
Date of Visit: —f u� Arrival Time: 3 a Departure Time,
Farm Name: �Ya CLV rt.— - ----
Owner Name:
�. ah `
Mailing Address:
Physical Address:
Facility Contact: y/t Title: W�
Onsite Representative: C-11
Certified Operator: Y U
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
County:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =]o =' = Longitude: =° =' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
. r . ❑Non -La et
1 i Tl
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy hleifei
❑ 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:
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No �PNA
❑ NE
❑ Yes
❑ No )9LNA
❑ NE
❑ Yes
❑ No 4wNA
❑ NE
❑ Yes
�&No ❑ NA
❑ NE
❑ Yes
kNo ❑ NA
❑ NE
12128104 Continued

Facility tiumber: a.— 6 Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IRLN0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes NNo ❑ 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 A 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 >;jKj No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes &No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J�5No ❑ 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 O 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?
t 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fiZNo ❑ 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
I❑ Evidence of Wind Driifl ❑ Application
Outside
pof,,Area
12. Crop type(s) '&fhlj. a tr F( I G r d S L `.r4::�:: '�Sf-� _
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
-Q:yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
P6No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
8 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name �) N� Phone: 3 3 Wo
ReviewerA n specter Signature: Date: 7
12128/04 Continued

Faeility Number: _�. 492 Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )} No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �D 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 �Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:1 No ON NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
ElYes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No gNA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
[INA
❑ 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
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�dNo
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
❑
;
❑
❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
No
NA
NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[I No
❑ NA
❑ NE
Additional Comments and/or Drawings:
- L-LI -At �� �
r
�
— N ode '. S c+t. r CrQQ �Ck�� — IJo C" rn, &.Qj c[ , %,,
12128104

Type of Visit @( C.,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit +t9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:11r.(3 I Departure Time: I ,1 ` 01() County:
Farm Name: T,Sr ", 4(i&x, 7myrf\_ Owner Email:
Owner Name: Z"lX-\ 1QV\ K nln j Phone:
Mailing Address:
Physical Address:
Facility Contact: 0. Title:
Onsite Representative: I Integrator: _
Phone No:
Region: E'--`- )
j
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E] o 0 = {1 Longitude: = o [� l =
DesignLurrent
Desicitypulation Wet Poultry " salty Population
C►attle Capacity
Population
❑ Wean to Finish
❑ La er
iry Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Weeder to Finish
❑ Farrow to Wean
77
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Laers
❑ Non -Layers
❑ Farrow to Finish
❑ Gilts
[I Beef Stocker
❑ Beef Feeder
❑ Pullets
❑ Boars
❑Beef Brood Cow
Nu II ber of Structures: rn
❑ Turke s
Other ❑Turke Poults
❑ Other ILI Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�tNo
rr __
❑ NA
El NE
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
_5a4A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
—�—�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[�)NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
tANo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
$3 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

F�tc�lity Nr�ttber: —O Date of Inspection a 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [JNA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
+r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes IS 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 A 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 �kNo
❑ 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)
9. Does any part of the waste management system other than the waste structures require
❑ Yes XNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 9
❑ NA
❑ NE
maintenance/improvement?
Z�`"'
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes �lo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift_ Application Outside of Area
f❑
12. Crop type(s) � vYtU f�U Yc
``r �
1~ W � "
C
13. Soil type(s) W n
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Wo
❑ 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 If10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 5jPNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
`Use drawings'of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �; / �` . Phone: 3 3 M
Reviewer/Inspector Signature: Date: Qcr .;�V to
Page 1 of 4 12128104 Continued

Itµ
Fm
Facility dumber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes '&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef 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 V No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes QjNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Ip No ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
[:3 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
g] 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
QNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,�.h}�,,,,
LNo
❑ NA
❑ NE
Additional Comments andloir. Drawingsc,
dur l,lki.4e
0tall dcs
nol
� C- �� a��oG'co-Zip. W, 0qd&05 f ,
CXUp s
! �`
N
�o l U .
-Qxctf1en4,/ oyd,&f . M ' cq&'rrn �
Page 3 of 3
12128104

z
'FacilRy No'
Farm Name
Owner
Operator `
Back-up
COC
C
Time In 11 13
Circe: General or
Time Out Date d��L
Integrator iPit'Yl
Site Rep
No.
No.
PDE
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Farrow -- Finish
Feed — Finish
$
Gilts 1 Boars
row — Wean
Others
FREEBOARD: D sign Observed
Sludge Survey i<, Calibration/GPM 1
Crop Yield Waste Transfers
Rain Gauge / R in Breaker
Soil Test ILI PEAT Wettable Acres
Weekly Freeboard S Daily Rainfall ✓ 1-in lnspectionsl:
Spray/Freeboard Drop F�� mar C,nr um AQ
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
is
Date Nitrogen (N)
q
Pull/Field Soil Crop Pan Window
�I- $ T
uz S ✓ _ C
0 1

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: J�r'r]� Depurture Time: County: 49=�O�Snn Region: Frio
Farm Name: BtA,r 1%� Fctrn Owner Email:
Owner Name: ��„yyc�� _I�i'?9/ Phone: 1O" S_�j� ' LfO4
Mailing Address: _S'0I.a_1_QO_ra[�rt—�or�sci _I-L -Ae
Physical Address:
Facility Contact:
Phone No:
Onsite Representative: ��`C%�7_, v%s? S7`�.t�"r-el
p %3�yati _K�.-'!�9 Integrator:
Certified Operator: Q��+un �(,'h-y Operator Certification Number: _I?8`+9
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
=o =6 �� g =o =6
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Layer �I
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
U<eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy 1-ieitet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State'? (li'ves, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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 ❑ NA ❑ NE
El Yes El No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2-no
❑ NA
❑ NE
❑ Yes
e"N'o
❑ NA
LINE
12128104 Continued

Facility Number: 9.2 —G 2 Date of Inspection -/ o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: 00
Designed Freeboard (in): �) y '-
Observed Observed Freeboard (in): 1-/3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2"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
RVo
❑ 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
91�o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`?
❑ Yes
❑1-4o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
ENo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Qa No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2-1o
❑ 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
�H
17,0 'Ll r ..
12. Crop type(s) %t/SeQ _4�&j ieo...s Qom. *1V C,
sJft A // Gr.rin
13. Soil type(s) l� a i� "4 -
- - -- - - -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ 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
ZNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA ❑ NE
P'�aSG e-..411 aG fo w0r/( Oj
4a/G G�PteS ���t�nGr
rd� eat, ri/ ,
��. h' i S nrakw,
Dark
pleas 7t,y 3�o Bios:n
A��
f,fa�a�G grans
Co�e�.
Reviewer/Inspector Name j ` f Q Q .iy,;�. <'t'' `t ""'
Phone' j'/U- `i$& -/f`'1! t JV,4l3
Y
Reviewer/Inspector Signature:
Date: - /S-or
11111)0in.e

Facility Number: f —G 2 Date of Inspection -1 0
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ICJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNNo ❑ NA ❑ NE
the appropiiate box, ❑ ❑ s D> i ❑ %Ws ❑ er
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ N E
❑ W pp ication ❑ W❑AuCon s rtf
❑tall ❑ St ng ❑ field ❑ 12 ❑ ns ❑ WPth�
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes 2' o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
25. Did the facility fail to conduct a sludge survey as required by the permit`?
26, Did the facility fail to have an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
2-No
❑ NA
❑ NE
❑ Yes
2'�o
❑ NA
❑ NE
❑ Yes
❑ NA
El NE
❑ Yes
,,[,_,*NNo�o
L-�fNo
❑ NA
❑ NE
[:]Yes [21�o ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [3r<o ❑ NA ❑ NE
❑Yes 21o ❑NA ONE
[--]Yes Q No ❑ NA ❑ N E
❑ Yes 2'IQo ❑ NA ❑ N E
A�tldttlogal Cummer 1.ts� artd/or.Drawin s rF
g '' a
12128104

1
Facility Number Date of Visit: Time: D; DO
Not O erational 0 Below Threshold
Permitted © Certified CI Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ... .. ...�!.. .... ��!".................................................................. County:........s?°M a` .........................................................
OwnerName:................................................................... Phone No:..... S911 [;r1 r�...........................................
Mailing Address: .... ..R!2.......... ile?l..... A. ..... ...... 1kol....l..ML............... .... A31 .....
FacilityContact: ..........Ir. ..... P.W..................................... Title:................................................................ Phone'No:...................................................
Onsite Representative :............. ........ .... Integrator: .... 0 Prot".Lft. .......... ..... `` .
Certified Operator: ............................k!^...........!Aa........ ......................................... Operator Certification Number:..........................................
Location of Farm: fl
QSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 1 46
......................
in;.
❑ Wean to Feeder
,%
i ,
❑ Layer
❑ Dairy
eeder to Finish'
99
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Other
'i' JTotal Design Capacity i'
E ��
Tota1,SSLW
❑ Farrow to Feeder'
❑ Farrow to Finish
.S
i ❑ Guts�I�f
[I Boars
Discharaes & Stream Impacts
1.,'- Is any discharge observed from any part of the operation? ❑ Yes Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) D Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes G�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ["No
Struc.................. ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.....................................................................................................................................................................................
Freeboard (inches): 3a.
12112103 Continued

j Facility Number: 0— pj, Date of Inspection-=Z--�
S. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes 2'1' o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2'flo
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 [l'%lo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Gallo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ONo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes L!'No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ER No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &`WWAA. 'rorAll &-A;
13. Do the receiving crops differ with thoddesignated 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 �@44o
El Yes 0? No
❑ Yes j0Io
❑ Yes M'No
❑ Yes EfNo
❑ Yes [v "No
❑ Yes ErNo
❑ Yes [a'No
❑ Yes [Klo
❑ Yes M<O
.§i �§ 3.,. 6f�.k,..i� §F9, F• -i:t'¢ ',°L �:li­s,r�i}Jl��.. . i.. lil=4. t.. i:➢§:DER" ¢ .. i1�..4 .,�""�+^f�,Y Eku �..i'i. q E, 1..6�6n�IE I d �. �.i�� § l,��Y!i �4
i
<Comntents {refer toE,+Iueshoni#)�r7l�iExplajnsrty 1�ES answet� and/or:any;recummend'atioasEardany utlier coparnents}{[3,,; (!k E }i# dl,>f '
�
$G k ! ii°F wi? ¢ bi. 4ts'�
t V�r..t E',.4G .
:1vse;drawings�:�of facility}to better explain situations''{useaddidanal page(s asph..stecessary):Eli' �((j'Meld Copy ❑Final Notes
Ig4E 'i�� ,. il: i !
��.i5i
(�.N"Fk{V "S,t�n¢:r�;'��.x;»}�,fR"EE,�k,
esthW,5W �.rwss oV% Ian 6aas ,
r
Reviewer/Inspector Naare
Reviewer/Inspector Signature: Date: / p
12112103 (/
Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes B No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [ti <O
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes OKO
❑ 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
[Ko
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Ergo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
21qo
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
B'I o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[flo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Flo
NPDES Permitted Facilities
34.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
G? Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
24,
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
01�0
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
M40
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
Q<o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103