820073_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: 40 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Rou ine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 11 al Time: I 0-7Jeparture Time: + d County: -9eart Region:
Farm Name: !�� .3 Part -s -7 -12- Owner Email:
Owner Name: �Q yLO[ f�/�r�jj� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: , if
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: f reg ag.
Certification Number: f ! 721a ^
Certification Number:
Longitude:
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 �o
❑ NA ❑ NE
[:]Yes
Yll 4 `FE
'] NA
[] NE
p,,,::. `.
❑ No •
NA
Design Carrent
Design
Current
Design Current
wine
Capacity ,Pop
WetPonitry
Gapac�ty
Pop.
@attle Capacity Pop-
ish
Layer
Dai Cow
Weaneder
rrFea
]Non -!Mer
Dai Calf
inish
Dai Heifer
ean
Design
Current
D Cow
eeder
D . P.oul
Ca aci r'
P,o
Non -Dairy
inish
Layers
Beef Stocker
FGilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
[]ther
TurkeyPouits
Other
10ther
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 �o
❑ NA ❑ NE
[:]Yes
❑No
'] NA
[] NE
❑ Yes
❑ No •
NA
❑ NE
❑Yes No IF]NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
Page I of 3 21412015 Continued

F:>7leili member: - 7 1 Date of inspection:
❑ NE
❑ NA
❑ NI-
NA
Waste Collection & Treatment
❑NA
❑NE
❑NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
YesrNo
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Struct
e 6
Identifier:—�
Spillway?:
Designed Freeboard (in): l
_
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?
❑ YesNo
[—]NA
[—]NE
8. Do any of the structures lack adequate markers as required by the permit?
[jYes
ZNo
❑ 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
�jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EpNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window .4 ❑ Evidence of Wind prift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes q9
No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NE
❑ NA
❑ NE
❑ NA
❑ NI-
NA
❑NE
❑NA
❑NE
❑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 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
ElWaste Application ❑ Weekly Freeboard E] Waste Analysis F-1SoilAnalysis ❑ Waste Tra fern ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10,
No ❑ NA ONE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Ngrnber: - 7Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?WZ'7 Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ ] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes [P No ❑ NA ❑ NE
�
permit. (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Miffi*uts {ref rao,question #) Explain any YES answers and/or any additional recommendations or;any bi tier COMM ats.
IUse drawmLFs:ol facilriv;to better ezol$in situations (nse,addItrao'alnaLyes:as necessarv).�
HI
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ,33 3
_ Date:
1 617 11 2/4/2015

Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: o ' County: 54^'PSOtJ
Farm Name: 5 J fJw.5 r� 1 Owner Email:
Owner Name: CJTB_ Phone:
Mailing Address:
Physical Address: Q
Facility Contact: Title: Phone:
Onsite Representative: Integrator: 1 f'PS
tir
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: fZ61-0
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: O 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
'
DesignCurrent
❑ NE
Design
C a
1114
Design Current
Swore
Ca _act Po F
p ty P. ..
W,et Poult ,
rY
�
Ca ac ty
P
Po
Cattle Ca aci Po
NA
❑ NE
, ..
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
q
I
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dr. P,oult .
Ga acity
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
lorlother
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: O 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
KbNo
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes ❑No
❑ Yes [�J No
[:]Yes Tom® No
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

4.14
lFaeili Number: - Date of Inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: .Z
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[$ No
fl,� l�
Observed Freeboard {in}: 2-70
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
n 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
N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P 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
J D No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I i. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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 Acce table Crop Window ❑ Evidence of ind Drift ❑ Application Outside of Approved
�Oa A
Area
12. Crop TYP e(s):
fes- � cc rt
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CP 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
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
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
0
❑ 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
10 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 21412015 Continued

F cili Number: % Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1P No ❑ NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �t No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 1� No [DNA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: (
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 Signatur
Page 3 of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
tional recommendations'oran
necessarv).
�
Phone: /0 —Y3 3--3 9e y
Date: 41q /•b
2/4 015

Type of Visit: Q�mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance j
Reason for Visit: ®'Routine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access !1
Date of Visit: Arrival Time: ,pp ,-Departure Time: S County: Region: 1 �-
Farm Name: av o" 3-5 Owner Email:
Owner Name: 0- r`�.J S 1 SCG Phone:
Mailing Address:
Physical Address:
Facility Contact: CC"', 134u`1A1tr61 Title:
Onsite Representative:
t(
Certified Operator: ADAJI
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
Certification Number: L53�Z'
Certification Number:
Longitude:
Design' Current ! Design Cnrrent k Design Current
Swine Capacity . 'Pop Wet`Poultry Capacity P,�np „Ulatu Capacity Pop.
Wean to Finish La er Dai Cow
Wean to Feeder Non -Layer Dai Calf
Feeder to Finish p Dairy Heifer
Farrow to Wean Design Cue -rent m' Dry Cow
Farrow to Feeder D , P,oul , Ca a_.y Po `.- Non -Dairy
Farrow to Finish La ersBeef Stocker
E
Gilts Non -Layers Beef Feeder
Bo
ars Pullets Beef Brood Cow
��Jjjjjjjjljj. � Turke s
Other --.,.-"—Turkey Points
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any pari 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 EL.Ne'O NA 0 NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes
❑ Yes j!�No
C] -IA ❑ NE
[3 NA ❑ NE
2NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

cili 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):
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? k
[�f�o ❑ NA ❑ NE
❑ No 2 -KA. ❑ NE
Structure 6
❑ Yes [&Xb [DNA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
I i o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L21 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[;�r`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes E!rNo ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): D C" S b v �fsit-
13. Soil Type(s):
rd
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[]Yes
�No
[DNA
❑ NE
❑ Yes
[!J"No
❑ NA
❑ NE
❑ Yes
E f No
❑ NA
❑ NE
[—]Yes [;3'No ❑ NA ❑ NE
[—]Yes ErNo ❑ NA ❑ NE
❑ Yes [;?"No ❑ NA ❑ NE
❑ Yes [2(No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? EJYes 9No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

1F c' ' Number: - Z Date of Inspection: bCq
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZJ�Xo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D -Ko- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Ca<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes ❑'5o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
W,<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
To
❑ 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
[20 o
❑ 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
[;;t<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[?rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JEy(No
❑ NA
❑ NE
Comments (refer to questio&#); Explain any YES answers and/or any -additional recommendations or any other comments w
[Tse drawings of facility to ,better explain situations (use additional pages as necessary).
Cab
F
Reviewer/inspector Name: (� �"'J Phone:
e
Reviewer/inspector Signature: Date'PL
Page 3 of 3 2/4/2011

Ii-ype of visit: W uompliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: • Routine Q Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: �,� Arrival Time: :?Q �s,� Departure Time:�County:�-1+��C3"'
Farm Name: v' F-,-, S Owner Email:
Owner Name: �8--+,,�-�" Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: U`l Title: Phone:
Onsite Representative: N Integrator:
Certified Operator: P1 Certification Number: I 77/
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean:..
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design @anent
Capacity P
M.
ti n
9
Wet Pointry
Layer
Non -La er
D . P,oultr.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
10ther
Design
CapaclPop.
Design
Ca aci
Current
Current
P.o
DesigniaGurrent
Cattle Capacity Pop.
airy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes P No ❑ NA ❑ NE
[—]Yes ❑No
❑ Yes [:]No
FNA ❑ NE
IP NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ®NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 2/4/2014 Continued

jacility Number: - Date of Inspection: d'
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? E] Yes ❑ No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: q —j -^ m -17 -
Spillway?: —1Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,5 J �3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes '� No ❑ 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) T�
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®No ❑ NA ❑ NE
maintenance or improvement? TT
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 Chop Window ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �I�[-�•-� Ujj
Ql�$�6[
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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.
[] YesNo
❑ NA
❑ NE
F-1Waste Application ❑ Weekly Freeboard [:]Waste Analysis [:]Soil Analysis
❑ Waste TrTsfers
❑ 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
2/4/2014 Continued

acili -plumber: Date of Inspection:
J211 &IS -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes {ANo ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes " No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 109No ❑ NA [:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes F] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes P9 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. other comineuts * Q S F
Use drawings of facility to better explain situations (use additional pages as necessary).J.,_.:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: dq 3 —
Date:
214/2014

i ype of v isa: 0 uompuance inspecuon V tiperation xeview u structure Evamanon V i ecnmcai Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:Arrival Time: [fir D Departure Time: 9/ 7 County; 40*rp " Region:
t6T
Farm Name: S �+nS 7-1Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator. U
Title:
Phone:
Integrator:
T, --e
Certification Number: 17 9 2
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 6 No ❑ NA ❑ NE
[] Yes ❑ No e NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current -
❑ No
Desigq
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
NA
La er
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
Dairy Cow
❑ NE
Wean to Feeder
01
INon-Layer
❑ NA
❑ NE
of the State other than from a discharge?
DairyCalf
Feeder to Finish
Iper$?
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
ul
Cs act
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
r4ATu
Beef Feeder
Boars
Beef Brood Cow
sOther
PouIts
Other
11
10ther
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 6 No ❑ NA ❑ NE
[] Yes ❑ No e NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
L*P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Ji] No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

Facility Number: Date of Inspection: ZZ
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
9 l cD—( Z
Structure 3 Structure 4 Structure 5
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?
0 No ❑ NA ❑ NE
❑ No j IjNA ❑ NE
Lr
Structure 6
❑ Yes ®No ❑ NA ❑ NE
❑ Yes No ❑ NA " ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures meed 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CP No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T 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 Accepta le Crop Window �j [:]Evviidenc of ind Drift ❑ Application Outside of Approved Area
l2. Crop Type(s): %_'L_� u 0� f r t �c
13. Soil Type(s): ,,•f t i I V 6'f kr-a)-
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
1P No
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
q 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
7 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
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 E�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [—]Soil Analysis ❑ Waste Transfers
❑ Rainfal I D Stocking ❑ Crop Yield ❑ l20 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 2/4/2014 Continued

Facility Number: 272.-2' Date of inspection: ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a AOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No 0 NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[:]No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA
❑ NE
Comments (refer to.question;i).: Explain,any YES answers and/or any additional.recommendations or any other commea&
'-
Use drawings of facility to better explain, situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: l /0i j
Reviewer/Inspector Signature:
Date: 7
Page 3 of 3
2/4/2014

type of visit: w t-ompuance inspection V Vperation mevtew V structure tvatuation V i ecnmcat Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: a' 1CQ Departure Time: County:I'MTaca►y
Farm Name: S f 7zw m5 7 — f 2 Owner Email:
Owner Name: f�tY,�,,� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 'v 6m4-el�o l— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
!1
Region: FFV
Phone: 1
Integrator:
Certification Number:-/ '717%
Certification Number:
Latitude: Longitude:
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 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 P 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
n esl ni eu acs
g C rrent
-
Design
Current
Design Current
Swine INDI
Wet Ponitry
Ganacity
Pap.
Cattle Capacity Pop.
Wean to Finish
ILayer
I
i Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
t7
_Y
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul
;C.a aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
r,k..e.-..
.._ _ ._, ...�_
_
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 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 P 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

Faciii Number: jDate of Inspection: 111-712.e,12-
0 No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
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):s
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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`P No
[DNA
❑ 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
❑ YesNo
❑ NA
[] NE
maintenance or improvement?
Waste A»plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P 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 ❑ 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): eoQS—I &rm c q 11 5 S � 1 cSi+.� CJ-rT�u� VLm�
❑ NE.
13. Soil Type(s): D a,4 - - - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j� No
❑ Waste Application E] Weekly Freeboard ❑ Waste Analysis [D Soil Analysis E] Waste Tra`ns'fers
❑ 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?
Page 2 of 3
[—]Yes EP No
[—]Yes M No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
21412011 Condnued

Facili Number: Date of Ins ection: rt 7 7r/Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �VNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E] Yes TP No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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
LV No
[] NA
❑ NE
[–]Yes
❑No
P NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes �n No ❑ NA [] NE
❑ Yes [W No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ YesNo [:]NA ❑ NE
❑ Yes No ❑ NA ❑ NE
E] Yes No ❑ NA ❑ NE
Comments (refer to question f : Explain any YES answers and/or any additional recommendations or. any other comments*,, 871
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �✓�
Date: l LZO,.2—
2/412011

rJ
type or visit: w uomprtance inspection V uperanon tceview U structure tivaivarlon U iecnntcat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f p , Arrival Time: Q Departure Time: County: C ? A&j Region: FM
or 'Farm Name: syh 5 7-12- Owner Email:
Owner Name: _ RC t� &-eLCCL Phone:
Mailing Address:
Physical Address:
Facility Contact: Aal-R- 4C4_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
0
N
Latitude:
Phone:
Integrator: I_rfS4ztg t
Certification Number: 17794
Certification Number:
Longitude:
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?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No(jam
Design Current :
❑ NE
Design .Current
.;
Deslgn Current
SwineCapacity
" .Pop:
Wet Poultry
Capacity
: Pop.
Cattle Capacity Pop.
Wean to Finish
dl
La er
Dairy Cow
Wean to Feeder
1
Nan -La er
Dairy Calf
Feeder to Finish
a.
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr}y Poultry
Ca acity
P,o .. -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
NJ Boars
Pullets
Beef Brood Cow
x'
Turkeys
O,#her
Turkey Poults
11 Other
10ther
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?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No(jam
NA
❑ NE
❑ Yes [:]No
❑ YesNo
❑ Yes INo
MNA
❑NE
❑NA
❑NE
❑NA
❑NE
Page I of 3 2/4/2011 Continued

Facility Ntmber: - Date of Inspection: p 2p 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3Q
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No q NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7-9 10-12—
Spillway?-
Designed
0—/ZSpillway?:Designed Freeboard (in):
Observed Freeboard (in): _ 3 ! aZ
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 b No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes FZNo ❑ NA ❑ NE
maintenance or improvement? r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..)''
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
nWindow
- [:]Evidence of ind Drift Vit❑ Application Outside of Approved Area
12. Crop Type(s): �lsiUi �XIKI w4�l C-"RSS
13. Soil Type(s):t T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &I 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
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available`?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Il'yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)@ No ❑ NA ❑ 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? ❑ YesNo ❑ 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 2/4/2011 Continued

Fa 1i Number: - 3 Date of Ins ection: u_ 14
�9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P No
❑ NA ❑ NE
the appropriate box(es) below.
No
❑ NA
❑ NE
❑ 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
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
1W 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)
3 L 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
�9 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
0 Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: Jr"i Date: lbb�Lu
Page 3 of 3 2/4/2011

Type of Visit 4P Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit 4PRoutine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 140 Arrival Time: Ze` a0 b% Departure Time: County: ps Region:
Farm Name:�1 r 1Y15 I Owner Email:
Owner Name: da[ f iv f"J -e 1 Phone:
Mailing Address:
Physical Address:
Facility Contact:i-+'_ r'' p Title:
li
Onsite Representative:
Integrator:
Phone No:
I
I
Certified Operator: Operator Certification Number: 7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o E:j ' 0 Longitude: = o E=1'
ET
Design Current
Design Current
Design Current
Swine Capacity Population
'Vet Poultry Capacity Population
Cattle Capacity Populatiou
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ NE
❑ Dairy Calf
Feeder to Finish
❑ Yes
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
El Farrow Farrow to Finish
❑
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑
Number of Structures: DO
Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V) No ❑ NA ❑ NE
❑ Yes
❑ No
f#NA
❑ NE
❑ Yes
❑ No
92 NA
❑ NE
fi@ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
El NA
[:3 NE
❑ Yes
P No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
Facility Number. Date of Inspection
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
[B No
Waste Collection & Treatment ,
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
10 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:I` f ��� I �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f ' It gal L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes[�
No
❑ NA [—INE
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
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
`P No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[11 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
[B No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
533 No
❑ NA
❑ NE
Comments (refer to question #t}: Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. {use additional pages as necessary):
Reviewer/Inspector Name t'� Phone:
Reviewer/inspector Signature: Date: /
Page 2 of 3 12/28/04 Continued

t J
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ?PNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. r
❑ WUP ❑Checklists [:1 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes]
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or 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
[PNo
❑ 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
q No
❑ NA
❑ NE
Page 3 of 3 12/28/04

r
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:q /� 0 Arrival Time: lZ Departure Time: 1 •' County: '` "Ps0f*j
Farm Name:_g, J �` - S_ „ —tC -� Owner Email:
Owner Name-" FiW U Avj '1��]� plI
Mailing Address:
Physical Address:
Facility Contact: _Wr'1 Title:
Onsite Representative.
Certified Operator:
Back-up Operator:
Region: HOT
Phone No:
Integrator_Rre�_16�
L/
Operator Certification Number: r ��
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = I =1 11 Longitude: =0=6
°❑6 ❑
Si
Design C*urrent
Swine Cam p city Population
❑ an to Finish
❑ an to Feeder
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
❑Dai Cow
iTy Calf
Feeder to Finish
❑ NE
iry Heifer
Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
a. Was the conveyance man-made?
❑ Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Cowl
❑❑Beef
Turke s
Outer
❑ Other
0:'Turkey Poults
❑ Other
Number of Structures:
❑ No
NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2_ is there evidence of a past discharge from any part of the operation?
[:]Yes
`9d No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes�No
[:1 NA
[__1 NE
other than from a discharge?
12/28/04
Continued

t
Facility Number:
Waste Collection & Treatment
Date of Inspection
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No El NA ❑ NE
a. if ves, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Stricture l Stntcture 2 Structure 3 Structure 4 Structure ? Structure: 6
Identifier: 1 —9 -20-12,
Spillway?:
Designed Freeboard (in):
t �
Observed Freeboard (in}: 'r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes o El NA El 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
IRNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? Yes
No [:1 NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes[
No ❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of/Acceptable p Window cf Wind Drift ❑ Application Outside
�Cro�of�Area
, f❑]E�videnc
4 12. Crop type(s) t iLIS �l ^ (T{ -44.q-)SPt I VW YEA
__ II
13. Soiltype(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
1, No El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes
#No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
1P No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ YesNo
[INA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
tNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,,, 19CL.,-e 04-05a4� w-",� I a5cv L-
Reviewer/Inspector Name ` 1QArvte_ Phone: `f t Q-4 S 3—
Reviewer/Inspector Signature: Date:
IZ/Z8/04 Continued

Facility Number: — Date of Inspection IK
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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
� No
[INA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
rl-A 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
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1P No
❑ NA
❑ NE
AdditionaEtComnients and/or Drawings: ;- 4.AN i"
Page 3 of 3 12/28/04

L7 division of Water Quality J- tll_
Facility Number 3 O Division of Soil and Water Conservation �� S
- O Other Agency
Type of Visit &C�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: p Departure Time: ; t7 D County: Region: XO n
Farm Name: irow, Fa: i Owner Email:
Owner Name: d _ d%l / ; i»yl _ Phone:
Mailing Address:
Physical Address:
Facility Contact: i 13y"D w fl Title: Phone No:
Onsite Representative: integrator: /, `+�/ ,
Certified Operator: �iL,..� Operator Certification Number:
Back-up Operator: Back-up 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: =0 =
o= t = Longitude: =0=1 = K
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑
Layer
❑ Non -La et
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
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Humber 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 C4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CkNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12/28/04 Continued

ti Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 19 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): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0 N ❑ 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
A.
7. Do any of the structures need maintenance or improvement? 9 -Yes &N?o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
No
[I NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Rare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) Z!„W•1d.1i11[.--,(.
13. Soil type(s) zzy- 1,4a /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®.No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
g,No
❑ NA ❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable acre determination ?
❑ Yes
14 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
L No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other colon nts,`. k g
Use drawings of facility to:better explain situations. (use additional pagesas necessary)r``���'''AL
Reviewer/Inspector NameT�T W Phone: 9/b"Z-13"33a
Reviewer/Inspector Sign ature:Date:
Page 2 of 3 12/28104 Continued

7
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9 No ❑ NA EINE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 EgNo [INA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
❑Ycs
4No
[INA
❑NE
❑ Yes
KNo
❑ NA
❑NI-
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
EINE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ELNo
❑ NA
❑ NE
Additionaltomments and/or Drawings:
6 `
<_
T
Page 3 of 3 12/28/04

A
of Water Quality sf�
Facility Number �� :g:D:vision
vision of Soil and Water ConservationME JKther Agency
Type of Visit GIC�O—M pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Lr'_222A Arrival Time: p Departure Time: " Q County: Region: L
Farm Name: J +t' CD Uj P, Fr, 0 rA— Owner Email:
Owner Name: P A./ j �.� .4n 1 u t'— - Phone: /
Mailing Address: 1 (tea { �?d ����1 _
Physical Address:
Facility Contact: rl- Title:
Onsite Representative:
Certified Operator: -s
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
Phone No:
Integrator: t4
Operator Certification Number: l79_"4 S
Back-up Certification Number:
Latitude: [� o [=,
longitude: = ° =I ❑ N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
EMR a er
_ I 10 Non -La ei
Other
❑ Other -
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.:; -
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
DDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
l I
Number of Structures: ®s
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,@ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
EINE
❑ Yes
LNo
❑ NA
EINE
12/28/04 Continued

Facility Number: Date of Inspection `�7t
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 23 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C3,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 [X 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?
KYes
❑ No
[:INA
❑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)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) ff�i / �!J>o/'�cs•' --.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes LgNo [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
❑ NA
[:INE
17. Does the facility lack adequate acreage for land application? ❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name T" Phone-g%� L�3� ;�
Reviewer/Inspector Signature: Date: eoj� c2Lo 7
12/28/04 Continued

Facility Number: — Date of Inspection -D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L2�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 ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes % No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
jj�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[5&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
R 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
KNo
❑ 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
CO No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PLNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit�C,oL/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C40utine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3i- Arrival Time: i 00 Departure Time: Oa County: Region: _ V
Farm Name:dr zrowr" Owner Email:
Owner Name: �Cc r/i r� -„ _ -o) "-0 w Phone:
Mailing Address: Ale, ';;"wq1
Physical Address:
Facility Contact: 222 v: J ('p UJ /t- Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:..,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [DO =
0= t = Longitude: 0 e=I = w
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes r7 No ❑ NA EINE
❑ Yes
RNo
❑ NA
EINE
❑ Yes
[0 No
❑ NA
EINE
El NA
El NE
❑ Yes
5-7 No
❑ Yes
L@ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number:— Date of Inspection�6
Required Records & Documents
s_ 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No [INA ❑ NE
r
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check ❑ Yes R[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 KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tM No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ 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
7❑,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
Cl Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[$,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
Ad�dit on#," Nudm�ents and/or Drawings -
]MV04

Facility Number: 8' —
Date of Inspection 1<3rD
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:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): �— _ '32
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes 5,No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes XNo ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? %Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ 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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 4�1 _3e7j,,-r�--e-
13. Soil type(s)�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ayes 1 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes ` 1 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RINo ❑ NA ❑ NE
r
Reviewer/Inspector Name fir/ -C i [ ,'' �r ,...� :;,' , ;;; Phone: �v
Reviewer/Inspector Signature: Date: t.
12/28/44 Continued

cr
0 Division of Water Quality
Facility Number g a J '73 O Division of Soil and Water Conservation
-- — O Other Agency `•
Type of Visit 4F 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: I ,j 7/e?/a Arrival Time: Departure "Time: County: _5cit"12460 Region: qW_Q
Farm Name: QaA i-. _ __— e w m ro• �^_ Owner Email:
Owner Name:�r ov ; a L . _a —,, A Lo N Phone:
,flailing Address:i' t► 1� wt;jar �r�d2.�N C
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:
d p�=�
.ow+�
Integrator: Qr ss+ t-
Ccrtified Operator: �_Qv
o&r9
�.+..s
Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number.-
Latitude:
umber:
Latitude: = o ❑ Longitude: =0=1 o=1 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ELaver
Non -La ei
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ®:
b. Did the discharge reach waters of the State'? (Ifyes, 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?
El Yes WNo ❑NA EINE
El Yes
El No
El NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
EINE
❑Yes
El No
❑ Yes
[;Z No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12/28/04 Continued

s
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: /. ?A. 42 / p.3o - 13 -
Designed Freeboard (in):.7._ G G
Observed Freeboard (in): 53 07
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R1 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
[0 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
[A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit?
❑ Yes
[A No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) -
9. Does any part of the waste management system other than the waste structures require
❑ Yes
m No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W 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 Drifl ❑ Application Outside of Area
12. Crop type(s) �7G r r►r �c� C I' a i. ` S C� 8S
13. Soil type(s) Va. A,, 014
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes �M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes CH No ❑ NA ❑ NE
�- Reviewer/ll nspector Name Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

1
Facility Number: ra — illDate of inspection S /i /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes V[ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes 10 No [-INA ❑ NE
ElElElthe appropirate box. WUP Checklists Desi s
Design ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IX No ❑ NA ❑ NE
❑ Waste Application [:1 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 IM No ❑ NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
51 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
QU No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Additional Commentsand/or Drawings
12/28/04

r,
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O f=ollow up O Emergency Notification O Other ❑ Denied Access
Facility NumberDI F= ]Date of Visit: �! O Time:
Q =Not Operational Q Below Threshold
® Permitted 'Q Certified JJ13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... ......
T..»_..
Farm Name: ..... .............. County: »_.»»$ . tw- s�a,ti.� ..»_» ...F W
Owner Name:....__.. ..s„u 3..ci......»... ....,rpt, u ........ Phone No. _ 9S !
p» » »...»........... _.».�4.!'� .»... r ... 9 ...� 3.. ...L....... ».
Mining Address:» j 0 O �'L._. d.� «�s ... � � U� Y- » �� � �r� i-9� 410, .1 a ^
Facility Contact:
Title:
Phone No:
Onsite Representative:
a ,.:.
Y
Integrator: P±-„ »s f •• 6 +�
Certified Operator:.- ,
pe •.»....».»....»,...»
D ov i ck L.
........................
ro w 1J
..»....�---�-».».».»..........»...............
!
Operator Certification Number: 7
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 9 `6 Longitude & ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [--]No
c. If discharge is observed, what is the estimated flow in gal/rain? A-' jp
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 M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V1 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _..__._._..... .......
Freeboard (inches): 36"
o��e
12112103 Continued

Facility Number: Date of Inspection
ti
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IF No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes[�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN //❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ccsa J � 6sprw tXg- , Srr+o I y K-1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes R No
15. Does the receiving crop need improvement? ❑ Yes Cd No
16. Is there a lack of adequate waste application equipment? ❑ Yes [Z No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
rvCo cents {refer to question) Ex lam aay YES arlswei s abdfgr anyi ns or aay oilier oommeats. `= ,,
J`^ ...ern µ
the dravvtngs oifaciLly to better explain sttuafzons{nse ahanal p ,es as necessary) Field copy ❑ Final Notes
Y
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: AY14 / D
12/12/03 61 1 / Continued

]Facility Number: gDate of Inspection
1 -1
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Q1 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes (J No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes 19 No
❑ Yes � No
❑ Yes .0 No
❑ Yes (XI No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddzttonal Caiitments andlar Drawtn ����- = � ��_ >� °' .-.� �- �� � � .•` � �_
Q �1 11 pp /
jaQrG Qom«? .L r1 �O/"' G CC,4L4 � k` 1L1P'S adc r
YWU cow, ':,.e►++c�.1� �+ok�� �aoQ SYr,all SCeloq C �Ga�a 4,' 1'1'1r r
r � DLJ
,f i+ +'" C Pp•er: *mel
�y P -
Pt C &'4'0 G IS 4. da m r, lS t Oya l� Q C�p� O� '� S �j �tl�Q G S�J� V vty 'vim
f 1 l
�►'� s rec.o�c,Qs,
Faw w 0.-OtAZ re C_&,,Rj
12112103

Farm Name/Owner:
Site Requires Immediate Attention: NO
Facility No. V z - 73
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Zu 1$ , 1995
Time: 3 , 49
Mailing Address:_ &t 2 TSa6 $i G�- i /q -Z 84-41
County: sv� 224 So+� -
Integrator: _37ric-, _Phone: C910} 59z--S7-7t
On Site Representative: �v i d f3ybwnr Phone: (910) .5ZI — '753 -
Physical Address/Location: —
Type of Operation: Swine / Poultry Cattle
Design Capacity: y410_ A;r4;st.*- Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ha a sufficie
(approximately 1 Foot + 7 inches) es r No
Was any seepage observed from the la oon(s) J
Is adequate land available for spray9 Yes r No
Crop(s) being utilized: Serw k d RT e
nt freeboard of 1 Foot + 25 year 24 hour storm event
Actual Freeboard: 3 Ft. _Inches
Yes or N�Was any erosion observed? Yes o No
Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell in 9 Ye or No
100 Feet from Wells? �e 'r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 4o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 00
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<&) If Yes, Please Explain.
Does the facility maintain adequate waste management reco s (volumes of manure, land applied,
spray irrigated on specific acreage with cover_ crop)? Ye or No
Additional Comments: l
R;C_&, Reve15 _
Inspector Name
er
Signature
cc: Facility Assessment Unit Use Attachments if Needed.