820103_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit:om ante Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: � Departure Time: do P1County&,+,` P -561V
Farm Name: UE fes) 0 T L. E7 r< f--&VVtA Owner Email:
Owner Name: l._4I &,1- Phone:
Mailing Address:
Physical Address:
Region:l- 1
Facility Contact: ar� j s ,�� c�, i G�� Title: Phone:
Onsite Representative: r/� Integrator: JAUS
Certified Operator: S� . l,J cc 7 �e� Certification Number: R 3Q i
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current. Design Current Design Current
Swine . @apacity Pop; Wet Poultry Capacity Pop. Cattle Capacity Pop.
t4
Wean to Finish La er Dairy Cow
Wean to Feeder Non -La er Da' Calf
Feeder to Finish D2ig Heifer
Farrow to Wean 2g Cow
Farrow to FeederD . P,oul Ca aci Po Non -Dai
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
- -�
Turkeys
Other Turkey Points
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [D>6 ❑ NA ❑ NE
❑ Yes ❑ No [D -NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
[JNA
❑ NE
❑ Yes
E`No
❑ NA
❑ NE
❑ Yes
EEI`No
0 NA
❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: Date of Inspection: �.
❑Yestf
❑ NA
❑ NE
Waste ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ea_Na— NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Yes
Identifier:
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
Spillway?:
❑ NA
❑ NE
the appropriate box.
Designed Freeboard (in):
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0,K6
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ 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?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
e-56
❑ NA
❑ NE
waste management or closure plan?
E3<o
❑ NA
❑ NE
Page 2 of 3
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
orenviron en I threat, notify DWR
&Do any of the structures need maintenance or improvement?
es
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0'5o-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ED
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � o ❑ NA ❑ NE
❑ Excessive Ponding p Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 1-3 X17 � r S(� o to
13. Soil Type(s): Ai,- L%at /met.. 0
Cr: urt'iG - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes Eg-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yestf
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
❑ Yes
E jAi
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eg,?, S
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2<o
❑ 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
F-1
❑ 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
E31go
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3<o
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

FaciliNumber: AT - 03 Date of inspection: Z Z !fC
24. DicLthe facility fail to calibrate waste application equipment as required by the permit? [] Yes U>o ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes 0'1<o- ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes [3lo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [E No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
01] o
❑ NA
❑ NE
ZrNo
❑ NA
❑ NE
�o
❑ NA
❑ NE
6XNo
❑ NA
❑ NE
Comments (refer to question f#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
f�at,l,�Ff �o" 8`- 3- l sc" fq ,�G tet, -- [� S--17 o-11 F A, S 37Z
I v
v to 'J1u+ f e« 0 va -It�G
�J
Reviewer/inspector Name: _ i �� NAI-dPhoneq(0- H3 3--3 33
Reviewer/Inspector Signature: _ Date:
Page 3 of 3 r 2141A15 S

gission of Water Resources
Facility Number ®- 03 IMIKFMAFencv
Division of Soil and Water Conseation
ry
Type of Visit:��om:�pliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
t•-9
Reason for Visit: -Koutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: "7 Arrival Time: ti 1 Departure Time: pJ County: «jf�r"[ Region: F�lL�
Farm Name: '--�-��'�& 13,4 r-�— Owner Email: T
Owner Name: &A— F�----t - Phone:
Mailing Address:s f 2 17wf'�G�'`
Physical Address:
Facility Contact: (fy Lh 5 ��j 6 -C, Title: Phone:
Onsite Representative: j Integrator: fil, — -
Certified Operator: 9b -t, Ga_'PcC
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 11,3o
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E]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 C21510 ❑ NA ❑ NE
❑ Yes ❑ No ['ielA ❑ NE
❑ Yes ❑ No [ A ❑ NE
❑ Yes ❑ No
❑ Yes [2 -No
❑ Yes ETNo
E2'NA
Design Current:
Design
Current - Design Current
❑ NA
Swine
Ga aci Pop.,VVetPoult
P t3'�
t7`
, �a acs
C P. tY
Po ,
P „� ,Cattle Capacity Pop.
�
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
Non—Layer
Dairy Calf
Feeder to Finish
S . Z Els a':,ft.
t.�' Dai Heifer
Farrow to Wean*
De'
stgn
Ctrrent Dry Cow
Farrow to Feeder
Dr ;Poultry
Ca aci
Po Non -Dairy
Farrow to Finish
r
Layers
44A Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
-..I.
Pullets
Beef Brood Cow
Turkeys
Qther =
Turkey Poults
Other T
'
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E]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 C21510 ❑ NA ❑ NE
❑ Yes ❑ No ['ielA ❑ NE
❑ Yes ❑ No [ A ❑ NE
❑ Yes ❑ No
❑ Yes [2 -No
❑ Yes ETNo
E2'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page l of 3 2/4/2015 Continued

Facili Number: a— -Date of Inspection: 5!'1L
Waste Collection & Treatment
❑ Yes
L?rNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ED_Nv--`O NA
❑ NE
' a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3 -NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:fNo
Spillway?:
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
Designed Freeboard (in):
❑ NE
Require_ d Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ N6
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
the appropriate box.
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'?
0 YesUg-IG
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ Xo
❑ 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
Eal<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
EffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes IVo ❑ 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
t/able Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ` � v'Lva ,t 5 6 G
13. Soil Type(s): U
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L?rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:fNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Require_ d Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D—No
❑ NA
❑ NE
the appropriate box.
❑ WUP E:1 Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes io
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facility Number: 9 - &'; Date of Inspection:
24. Did the faci-lity fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Die-
❑ 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
E] 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes E leo ❑ NA ❑ NE
❑ Yes [i] No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
[—]Yes O�No [] NA ❑ NE
❑ Yes
dNo
❑ Yes
[ 'No
❑ Yes
[ o
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendatitins or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .
C" (.-� P"4, o --I — 8:1.-- r) —i -b
Cell
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3 k-4 vt Phone: ' 0 �j� 3I;
p -f �' r Q.'. L Date: 5 Vtovil
2141201'5'

-Division of Water Resources
Facility Number ®- 103 ffi-�ion ofSail and Water Conservatioenc
type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: f 0 Departure Time: County: ZL2=1d r Region: f
Farm Name:�i,J Owner Email:
Owner Name: Su r W 73�uhr"- Phone:
Mailing Address:
Physical Address:
Facility Contact: r / 1,71ve!`c Title: _ Ll=-, _sem �, Phone:
01
Integrator:
Certification Number: �3c7
Onsite Representative:
Certified Operator: -���.� 0&111
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
D sign
1 jIgIIIII Illn 11
Design
Curren
Design Current
_Current11111
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
er
Dai Cow
Wean to Feeder IELa
Non -La er
Da' Calf
Feeder to Finish j
_-.. .. ..
T =
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,out .t "'
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
ers
Beef Feeder
$oars
Pullets
Beef Brood Cow
- _-- - -;
Turkeys
Other
Turkey Poults
Other Other
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 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 �CB-No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes [-]No
[-]Yes [�f­No
[:]Yes [?�No
❑NA C:] NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: IDate of Inspection:
�Waste Collection & Treatment
,t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [B -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
FZ11 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3 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
I&No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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): /4"V -"S5 �I ��7/i7 �Gfi�., ST�r-mss �S�i C�r;rt CDdr�
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 ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [S -No ❑ NA ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes [x] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [] Yes QC No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 .2/4/2015 Continued

[Facility Number: - 1573 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
f;LNo
❑ 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
)M -No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ff�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
®, No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[&No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
[allo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVR P?
❑ Yes
.5.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
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
ra✓--
� �
l�
/-7 4tf
Phone: �`OJD3= O
Date: le .
2/4/2015

Type of Visit: aCom liance 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 0 Denied Access
Date of Visit: Arrival Time: ®v Departure Time: ' UG County:
Farm Name: �G�- O- ,>��rrrri- _ _ Owner Email:
Owner Name: l� y f [J �1�'7�-f T Phone:
Mailing Address:
Physical Address:
Facility Contact: Z Ire r-- Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: " /.
Region:
Certification Number: /9- �t�4
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
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)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued
Design .Curre_t
DesignCue�nt
Design Current
Swine
Capacity. Pap.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
U 'ent
Dry Cow
Farrow to Feeder
D , Ploul
@a aci 3 l?o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkey Poults
Other
I 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)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
r
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): 'Z 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
2!�No ❑ NA ❑ NE
[—]No E] NA ❑NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
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?
❑ No
❑ NA ❑ NE
the appropriate box,
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
[a 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)
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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 E] Application Outside of Approved Area
12. Crop TYpe(s)f�X�F���B[irr�r� /6D /a
13. Soil Type(s):/.�i�c_$�
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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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

y Facility Number: :_/_0 Date of inspection: —1.
w 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes C2�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 allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes allo
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 rMNo
E]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 0 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 [!3 -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 r';Z1 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 [Z -No
❑ NA ❑ NE
y .: N r _ dditiother comments
lUse drawmgs of facility to better a plain sitanyuations s [use additional uaies as necessaecammendatzons'a y
�GE�-3 � 4:;2
Reviewer/Inspector Name: Phone: 22L' 333 r -)V
Reviewer/Inspector Signature: Date:
Page 3 of 3 214/2014

s>74e ?�;;Z3-1y
Type of Visit: cc:�"CompEi nce Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 'QD
Departure Time: '3D
County:
Farm Name`��'lL�r��
1-Qei►y1.�
Owner Email:
Owner Name:
�j U (.[_lyy--
Phone:
Mailing Address:
Physical Address:
Facility Contact: �St'Ze�/' /%/'�Cr Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: 14=W b
G.� Phone:
Integrator: /���.�i�r 25 uy"& -
Certification Number:
Certification Number:
Longitude:
Design Current L� �. 'Design Current Design Current
Swine Capacity Pope W,et Poultry Capacity Pop Cattle Capacity Pop.
Wean to Finish La er x Dairy Cow
Wean to Feeder Non -La er"" Dai Calf
Feeder to Finish (� Dai Heifer
Farrow to Wean j�
Design Current :: D Cow
Farrow to Feeder �D , $aul Ca acs PopNon-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
n Turke s"
Other Turke Poults
Other Other
_Discharges and Stream Imuacts
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 g4J4o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes IN No
❑ Yes %-No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

193
Facility Number: - Date of inspection: q
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 5g. No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes 5g No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[R No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0No
❑ 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
1ja No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or) 0 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
/"-.ad.
12. Crop Type(s): �erX/3� �01n / ✓Ar� zr fp •�, s /S �0/�r'a_: c—
i
13. Soil Type(s): � � J z� 1
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 fR..No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ 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 5Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 12 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;Q No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

5
Facili Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA D NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [B�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 [XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphors loss assessments (PLAT) certification? ❑ Yes JKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[&No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[B�jVo
❑ 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
ER 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
C.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
ANo
❑ NA
❑ NE
fry, AS --/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: GYrompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: G'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; iDp Departure Time: County:
Farm Name: su � Owner Email:
Owner Name: Su". U-) z z-� Phone:
Mailing Address:
Physical Address:
Facility Contact: 9?fnnr mom -r. Title:„ `1r
Onsite Representative: �G. s.�•C�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: 01
Certification Number: f -1-3 p7
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 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 RNo ❑ NA ❑ NE
❑ Yes
Design Current
❑ NA
Design
Current
Design Current
❑ NA
Swine
Capacity Pop.
Wet'i?oult .
GapSki
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . foul
Ga aci
Pio
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑No
❑ NA
0 NE
❑ Yes ❑ No
[-]Yes ® No
❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of —Inspection:
❑ Yes
JR No
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
0 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
® No
❑ NA
❑ NE
a. 1f yes, is waste level into the structural freeboard?
[] Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in): C_
Observed Freeboard (in): A 11-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CE�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
5a No
❑ NA
❑ NE
waste management or closure plan?
U any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
ER -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
3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
Eg-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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 ofWind Drift [:]Application Outside of Approved Area
12. Crop Type(s): Jif! 'Vu; ef'Sv—W— f a,-rt/t.elle re �✓�'8'16r�
/
15�MQj&
r�
.
i
13. Soil Type(s): k yjaz V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LU No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R No [:]NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�K 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 Lj�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 54 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: 103 Date of Inspection: — /•—/
❑ Yes
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ®,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
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
List structure(s) and date of first survey indicating non-compliance:
® No
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ® No ❑ NA ❑ NE
Other Issues
❑ NA
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes r-71,No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
K No
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
B 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
ig No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
K No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better egalain situations (use additional naees as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:3".3�
Date:
2/4/2011

03
Type of Visit: OACompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ¢/ - Arrival Time: Departure Time:County: �'/'—� Region:
Farm Name: 'er "�—
Owner Name: -5-0 -e. to ,5 1' e—
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: 1a rte/-" /yl > Title: Phone:
Onsite Representative: ��� Integrator: u/fli�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
snCurrent
❑ No
Design Curre t -
Design Current
Swine �, ���'Capactty Pop.
We# Poultry
.;�'Capac�iPop -
C►attle Capacity PoP.
Wcan to Finish
Layer
Non -La er
Dai Cow
Dai Calf
Wean to Feeder
eeder to Finish
�� *�"z "�'
Dai Heifer
Farrow to Wean
TL
DesignCu rent
Cow
Farrow to Feeder
D . P,ault
La ers
Non -La ers
Ca c�
Non -Dai
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Broad Cow
Turkeys
Otheraim
Turkey Poults
Other
Other
Discharges and Stream Impacts
L is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes R3�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[::]Yes ❑No
[]Yes li^3 No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

' Facility Number: Ex - 3 7 Date of I n sp ection:
Waste Collection & Treatment
' 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `j D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z No ❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes [a No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes � No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [K No ❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes MNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [&No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/�h2/d
13. Soil Type(s): _ ��' 0_%¢ f� afla T�-
14. Do the receiving crops diifEer from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes Rj No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2 No ❑ NA ❑ NE
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.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements F1 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [2j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall E] Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FXJ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 42= - Date ofIns ection: ,V
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C. No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to 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 CR No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[4 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
E� 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 rile 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
&I 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 ft Explain any YE
S_answers and/or any additional recommendations or any other com�men#s.' F F^
Use drawings of facility to better explain situations (use`additional pages as necess
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91-,9 OD
Date:
2/4/20II

Type of Visit: OEWmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q Departure Time: lLvJ CountyRegion:
Farm Name:pt,/' j�Gr�i��- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
a Phone:
Onsite Representative: Integrator:
Certified Operator: ���i� - Certification Number:�7g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
II Currents Destgn Current Design CurrentPv f �'1'et Poult . wine
La ers
Non -La ers
Pullets
Turke Turke Points
s
Other
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure E] Application Field El 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?
E] Yes ® No E]NA. E] NE
❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ZLNo ❑ NA ❑ NE
❑ Yes L�"
J,qDel��6i_y
ap city * P� "
]try
Capacity Pop
Cattle Capacity Pap.
Wean to Finish
�rc ..._... << .
La er
Dai Cow
Wean to Feeder
]Non -Layer
Dai Calf
eeder to Finish
j �p
M
Dai Heifer
Farrow to Wean
Design Curren
Cow
Farrow to Feeder
D_ , P,oultry,
Ca act Po P
Non -Dai
Farrow to Finish
Beef Stocker
Gilts`
Beef Feeder
Boars
Beef Brood Cow
Other
Othcr
La ers
Non -La ers
Pullets
Turke Turke Points
s
Other
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure E] Application Field El 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?
E] Yes ® No E]NA. E] NE
❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ZLNo ❑ NA ❑ NE
❑ Yes L�"
Page I of 3 1/4/2011 Continued
o
❑ NA
❑ NE
Page I of 3 1/4/2011 Continued

lFacility Number:�3 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): �3`D
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e_, large trees, severe erosion, seepage, etc.)
C&No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes [j, No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes F&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? it yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes JKLNo ❑ 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.�i ❑ Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): � �//.!/�r.�/ Yt��+� 1 r�/'YJ�"�� /0"_ _'—j
13. Soil Type(s):
14. Do the receiving crops differ from those
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes Eallo
❑Yes � Na
❑ Yes allo
[] Yes ENo
❑ Yes EE�No
❑NA
❑NE
❑NA
❑NE
❑NA
❑NE
[] NA
❑ NE
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5INo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JjKLNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ELNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 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
Eg No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes jg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes M, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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
jr2'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
XLNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DQ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
CEI No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-No
❑ NA
❑ NE
IComments. (refer to gaestioo- #1): Explain any YES':ainswers°and/or any additional recommeadahoas=orany outer c4mmeat5
tNO-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
2/412011

F/
6�
ivision bf Water Anality i� �
Fa:miumnelF� 03 Digsion of Soiland Water Conservation
Q Outer Agency
Type of VisitCC"ornpliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
E Routine Q Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:/ a"7 �(7 Arrival Time: Departure Time: �p� County: Region: zt�
Farm Name: c5L4- 41=v— Owner Email:
Owner Name: :5 Lt !?-- Phone:
Mailing Address:
Physical Address:
Facility Contact: _ �-syr Title: Phone No:
Onsite Representative: 6'l"xY� /2%ot`2,- Integrator:
Certified Operator: dS f�'f amu=/ �r'- Operator Certification Number: Z � a�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c [= , [� Longitude: =0=6
e=6 = «
Design C*urrent
Swine Capacity Population
Fl ---]Wean to Finish
❑ Wean to Feeder
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dai Calf
Ofeeder to Finish 7 L7
Dry Poultry,
❑ Dai Heifer
❑ D Cow
❑ Non
❑ NA
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Non -Layers
El Pullets
❑Turke s
urkey Poults
ther
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Gilts
❑ Boars
Othe
❑ Other
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
{� o
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — O Date of Inspection
he -e" 5�-e_ 31�LDI o
Reviewer/InspectorName Phone:-/0—�33`3�
Reviewer/Inspector Signature: Date:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q5 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
151 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
13 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?
[A Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
El NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) a $7.�C /tt= t< 0. -'o0. -'o/ W
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �Z 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):
he -e" 5�-e_ 31�LDI o
Reviewer/InspectorName Phone:-/0—�33`3�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: g' — Date of Inspection 0`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW W readily available? If yes, check ❑ Yes [21 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
El NA
El NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,9
0 -No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
12� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C,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
ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewertinspector 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
JA.No
❑ NA
❑ NE
12/28/04

cwt S 1I-23 -zop9
ivision of V1'ater Quality
]Facility Nuutber �Z - /17,3 Division of Soil and Water Conservation
Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visitoutine
0 Complaint
O Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: %1 -IG �d `� Arrival Time: 02: / Departure Time: 03; DS' County: � Son/
Farm Name: sue- B�'�ic.� F ccr�
Owner Email -
Owner Name: SL.e— �u.�iw Phone:
Mailing Address:
Region: of2e-0
Physical Address:
Facility Contact: G91 rd e_i M aDYW__ Title: ~% �C c� • Phone No:
Onsite Representative: Integrator: 1111u Bf-0
Certified Operator: 'S� e- 7R>kOperator Certification Number: 9'30
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: [=0=6 =46
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
2<o
❑ NA
Design Current
esign Current
ll)—
Design C*urrent
Swine Capacity Population
WE et Poultry Capacity Population1
Capacity Papulation
❑ Wean to Finish
IEJ Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ NE
❑ Turke s
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑ Other
plumber of Structures:
other than from a discharge?
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
2<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
8'NTA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ 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
❑IqA'
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O'1Go
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B<o
❑ NA
EINE
other than from a discharge?
12128/04
Continued

Facility Number: g 2— f03
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: ¢
Spillway?: NO
Designed Freeboard (in): /915—
Observed
915JObserved Freeboard (in): 36
Structure 2 Structure 3 Structure 4
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 2f 0
❑ Yes [3 o
Structure 5
[I NA 0 N
❑NA [I NE
Structure 6
❑ Yes C No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q"'1`Io ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,-3�
9. Does any part of the waste management system other than the waste structures require [ 1 Yes E- o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q�lo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
81156
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /t-�/g A- B
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0".,
NNo/o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement? [:1 Yes
,
o
El NA
[:1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
,[3
1�Vo
❑ NA
[INE
17. Does the facility lack adequate acreage for land application? [:]Yes
ALT
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0-ido'
❑ NA
❑ NE
P Y Y� 1 r comments
Use dra.win s b � Ex lain an YES answers and/or an recommendations ov an fothe s�
'.'Use:
grefer to. gesho etter explain situations. (use additional pag s as n` ecessary�)-. `
( f faci to b � CeMF
Reviewerlinspector Name Ki CK Phone: 9/0. 933, 3300 I
Reviewer/Inspector Signature: /' A-4__ Date: 9
12/28/04 Continued

Facility -Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [, No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes EK ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �,/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes B o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
214o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ YesO'l�lo
NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o ❑ NA
[_1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,.�,
0-1<o' [I NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E] NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El0_Yes
,-"-,No
NoN❑ 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?
El Yes
�,
L_I'tao ❑ 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
Qdq-o� ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
IJ'No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[hq-o--❑ NA
❑ NE
12/28/04

)?_re4 S RZ-
ivision of Water Quality
Facility Number 2 %Q� Q Division of Soil and Water Conservation
L-- Q Other Agency
r
of Visit ,C�ommpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
on for Visit l"l Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !Z -OZ- Arrival Time: /Z: ZD Departure Time: County: _5a .-/ Region: 'IrAo
Farm Name: Owner Email:
Owner Name: _ S u g ul- PJ1� Phone:
Mailing Address:
Physical Address:
1q_
Facility Contact: Yt G tr aDtrC Title: G s Phone No: {�
Onsite Representative: C9 tr e_Y cal' C_
Integrator. %�.�u-vim 4, , CSrOtJ^J
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: e Longitude: 0
S. a
❑ Wean to Finish
❑ Wean to Feeder
Discharges
Design @urreot
Ca aci Po ul ion
P ty
Wet Poul
❑ La er
❑Non -La er
DestM�Ctirre tat
Ca aci Po VIII ti nN
!!type .
Design Current
C•attle Cops aci Po ulation
P ty P
❑ Dairy Cow
❑ Dairy Calf
Feeder to Finish
(o
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
Dry Poultry
[VI,TA
❑ Dry Cow
❑ Farrow to Feeder
Yes
[IElL
No
El"NA
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Yes
❑Non -La ers
[3<A
❑Beef Feeder
❑ Boars
❑ Yes
❑ Pullets
❑ NA
❑ Beef Brood Co
__
,,•,�
❑ Turkeys
❑ NA
❑ NE
Other
ElTurkey Pouits
❑ Other
12128/04
❑ Other
Number of Structures-
tructures:
Dischar es & Stream lmuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[VI,TA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
[IElL
No
El"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
[3<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,�o
[TNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [30'No ❑ NA EINE
❑ Yes [�i"o ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): lv
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Mlo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes R o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? C3 Yes B o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Digo
❑ 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
,�
Levo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E1 Yes
B<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[-}-N-o❑
NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) lJC-4-l" Gc. �ar� i�f<�ta rcy „J (/Q S , ,...ate..
GliN AM, 1 -S
13. Soil type(s) 4 6o,4 (,Jag AR
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<o
El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L� o_
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0'1 0
❑ NA EINE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3.10-
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q�Ko-_
❑ NA ❑ NE
Reviewer/Inspector Name I - e l/�/S. Phone: 9/'0 f`-33� 3300
Reviewer/Inspector Signature:�y Date: %Z -42 "ZOOS
Page 2 of 3 12/78/04 Continued

4
Facility Number: $Z — _Z�0 Date of Inspection 1z—Ox
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ��lo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 1T No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
D o
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
N
❑ NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
[:1 Yes
,a go
L_f oo
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
(39 Yes
o
❑ NA
[j NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
E] Yes
,.,
L�'1Vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Io
❑ 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
,� ,�
LSNo
❑ 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
to
❑ 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
L.j'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D<o
❑ NA
❑ NE
Page 3 of 3 12128104
t
Page 3 of 3 12128104

Division of Water Quality Oil
Facillity Number Q Division of Soil and Water Conservation
- Q Other Agency L
(Type of Visit _'V Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit NiMoutine O Complaint Q Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date or Visit: 11 bl Arrival Time: Departure Time:
Farm Name: _ Sud 1`l Ir
Owner Name:
Mailing Address:
Physical Address:
Co
Owner Email:
Phone:
Region:
Facility Contact: Titre: hone No:
Onsite Representative: �� rgtz ' " C)o r e Integrator: &ti
Certified Operator: SUS �� mil` Operator Certification Number: ti
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =' [=] Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
'4( n z 15 T1
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Cur"r(
Cattle Capacity Pop�ulai
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures L
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
❑ No
A
❑ NE
❑ Yes
❑ No
WA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes 10No
El NA
❑NE
11/18/04 Continued

Facility Number: _1Z5 Date of Inspection iZ b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes _(1}To
El NA [INE
a. If yes, is waste level into the structural freeboard?
Yes No
ElPa
❑ NA ❑ NE
Stru e I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes Po
[INA ❑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 XNo
❑ 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 ,Wo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of
Area
12. Crop type(s) ✓ C� e- a 3 UMSOZt, rt
""'4
tNu c3rn nT , 1/`� +
C a►
13. Soil type(s) F41 q A u
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 acre determination?❑ Yes 23 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes JSbNo ❑ NA ❑ NE
I& Is there a lack of properly operating waste application equipment? ❑ Yes ANo ❑ 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
Reviewer/Inspector Signature:
a
Phone:
Date:
12/28/04
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,5 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -o ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes,,O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ANA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R10
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_�JNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
jN34o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NrNo
❑ 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
WNo
❑ 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
0 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?
Oyes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
.❑ Yes
tg*o
❑ NA
❑ NE
Additional Comments and/or Drawings:
m u. Ick. bac a aaz �alj 1
12/28/04

Facility No.% -a `� II Time In Time Out __ ��_-� Date 1 0~1
'Farm Name S �w`t �_ {(� Y YV\ Integrator e m �C
Owner V Site Rep G%,A R k.
Operator lawNo.
Back-up 4) (1 t r, 1k�.• No. t
COC
Circle: General or NPDES
Design Current Design Current
Wean -'Feed Farrow -Feed
Wean - h Farrow - Finish
Gilts / Boars
Farrow - Wean Others
FREEBOARD: Design
.Mudge 12
Guy vey
Crop Yield
Rain Gauge
Soil Test ��
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Observed
Calibraticn!CZPM ' h(, joy_ cR 1-10
Waste Transfers
Rain Breaker
PLAT Wettable Acres
Daily Rainfall
3 ho ¢IK
120 min Inspectic
Waste Analysis:
Date Nitrogen (N)
Sin ZQ
3.
1 -in Inspections
h Ito G
Date Nitrogen (N)
1/11 Z.c.1
Pull/Field
Soil
Crop
Pan Window
ZOL
r 0, Z�
1 1,
S SLI �►!4
� � �
t5
GZ,r �1�z
til
-
Z�

Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 19 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit -Arrival Time: Departure Time: 2 ; 3d County: S404j2Znea Region: 22.0
Farm Name: Su e- &.1Al_."� EM7Ly-'._ ,,. Owner Email:
Owner Name: 5-(A S 13L,+Gc, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 41'1'j yo uS e
Certified Operator:
Back-up Operator:
Title:
Pt --f
No:
Integrator: r t --f ur— S.�4.' J' y t!
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [�J o [—] ' [--] " Longitude: o = u
ine
Wean to Finish
Design Current
Capacity Population
Wet Poultry
❑ Layer
Design a Current
Capacity PopulateoEi
Design Current
Cattle Capacity Population
❑Dai Cow
Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ Yes
"°'"
❑ Da' Heifer
Farrow to Wean
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Dry Pouftry'
"4 r s
'$,
❑ D Cow
Farrow to Feeder
IFC
c. What is the estimated volume that reached waters of the State (gallons)?
wd
y° "'
❑ Non -Dairy
Farrow to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Layers
QfNo
❑ Beef Stocker
Gilts
2. Is there evidence of a past discharge from any part of the operation?
❑Non -La ers❑
[�No
Feeder
Boars
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
PulletsBeef
FNo
❑ Beef Brood Co❑Turke
❑ NE
other than from a discharge?
ser
❑ Turke Poults
Continued
Other
r_1 Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
ftNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application f=ield ❑ Other
a. Was the conveyance man-made?
❑ Yes
[N)No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
0 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
QfNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
FNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

4,
l
Facility Number, $ 2 — / Date of Inspection
Reviewer/Inspector Signature: Date:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[X No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[9 No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): H.
Observed Freeboard (in): 32 If
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
(R 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
(1l No
❑ NA
E] NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area}}
// S,.TR// 6";- (O/Sl
12. Crop type(s) Wi�I�c,i�rnRcc rl �Lt�.t/w� .��y1✓uC4J . Sut 4 �Cvrr�e� Ce' N, L1�. So 71'�c(.►
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 acre determination ? ❑ Yes [9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes ®No 0 N 0 N
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES`addnswers and/or any recommendations or any�otiieT.corttments
Use drawings:of facility to better explain situationi (use i ddiii nal pages as necessary)•
l
Reviewer/Inspector Name �K i� >�2.V � :: -----� Phone: ` 10)41.33-3330
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: jg2 — 1031 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 09 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [IFNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[8 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;RNo
[:INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UNo
❑ 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
[XNo
❑ 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
EgNo
❑ 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
Page 3 of 3 12128/04

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 1 wZ & G.S 1 Arrival Time- g: U Departure Time. County: S a—W 442 Region: riP-0
Farm Name: sv`�- ��.-�1Gir r. Owner Email:
Owner Name: Say.., c Gam-+ d2_Si e- 13ut\r_r, Phone: (300�
Mailing Address: _ /Ofe75' Al !/—S V.?fn • .c-fo�v /V P3 -2F
Physical Address: _ •�_�(,�+eo� /mal. _ /,'AJTO.r� NC 1106.3 alp
Facility Contact:
Title:
Phone No:
Onsite Representative:
M.
El NA
integrator: _� er,-7.�u►ve .S1 4"-aQgr�Q
Certified Operator: ,�u
�- _ _ _
_1'3_��r�e1e
Operator Certification Number: 5 -3 O _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� I 0 Longitude: ED ° [--] ' EJ
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 0ev
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Iva 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
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
F
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 dischame 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 [4 No ❑ NA ❑ NE
El Yes
0 N
El NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12/28/04 Continued

~iFadlity Number: YR — / a3 Date of Inspection
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? D. Yes
Waste Collection & Treatment
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[,2 No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ; y
Observed Freeboard (in): C26
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
M No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 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 Drifi ❑ Application Outside of Area
12. Crop type(s) C � 7-a f, rZn%X Acz ra ze.,e _ LIA ue'r_ s c� as LJ�►c��,
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 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[--] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? D. Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[,2 No
❑ NA
❑ NE
Reviewer/inspector Name . , a, c. Phone:010) gg - /s yj_ q.
Reviewer/Inspector Signature: Date:
12/28/04 Continued

+✓Facility Number: g,Z — p3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check R] Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists [0 -Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [9 Yes ❑ No ❑ NA [__1 NE
L� Waste Application 21 -weekly Freeboard
�,/❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers El Annual Certification
El Rainfall FKtocking Q top Yield L� 120 Minute Inspections 0'<onthly and I" Rain Inspections �eather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [X No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U No ❑ NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
[:INA
❑ 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
DNo
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2No
❑ NA
❑ NE
Other Issues
�nn.l1�
hG o►� �1 prDv> �c7rn+t ls�tGf rum �vcrPn•'f` GocaoQ:�fidAls.
4_ L, G 1F t2 a O � Cc_er a� 4-�r recr� r� kc�p:.v� ►.� 4+i...�ds �s l abt; Skz.� �'�r
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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?
[9 Yes
❑ No
❑ NA
❑ NE
Addetioaa! Commentsand/or•Drawings: �. , . b ,„*•';
�Q .'L 4 f 001[J dc", s ►� r e -4 ; �. o r. 'qa V I -Ln r C C,o * s• P E C a� c S G Gu•►G a
i5
,A L a C. G l .� o r +w t CCA r -ks..
+
o v-< -Cla v ;M S -Co Y
�nn.l1�
hG o►� �1 prDv> �c7rn+t ls�tGf rum �vcrPn•'f` GocaoQ:�fidAls.
4_ L, G 1F t2 a O � Cc_er a� 4-�r recr� r� kc�p:.v� ►.� 4+i...�ds �s l abt; Skz.� �'�r
c C.i dpw_,_p I. spec e`oN.
t' JG4. G pC.s* r r_T c�rC 4 •7 6rGj C.<_�­k ,
12/28/04

Type of Visit (SYCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &4outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �
Date of Visit:
30 Tune:
Q Not O erational Q Below Threshold
Ql'i'rmitted ErCertified [] Conditionally Certified
13 Registered
Date Last Operated or Above Threshold: -.
Farm Name: �c�•+{c r
rArrh
County:°S°!^....
Owner Name • �aw+es ct,n d
�tk Ie
-m.....
Phone No: g f - $rG ` - ' �6 _
1+laii mg Address:..-
4r./;m4:a'_4
l�a�c w4rnN
Facilih� Contact: ............_ .. ............„....................—............Title:..
i� -
..... c� ..... Phone No -
Onsite Representative: - I�rs4D--
i.i �!^...Ww_"-`-----•-----
Integrator:
Certified Operator.-•-----,. �%R4l .
f!U�t�1 Gn_
... _ _._.
Operator Certification Number:---.-Aq
Location of Farm:
E9,6wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • z && Longitude • 4 44
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes To
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 gallmin?
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 Pfo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 944 -0 -
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ISO
Structure: I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ..�................. ................. ......... I--------
Freeboard (inches): 31 ;'J'S
12112103 Continued

• Facility Number: 9A — p7, Date of Inspection I lht/o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Eyl o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes K3"No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) !
7. Do any of the structures need maintenancelimprovement? ❑ Yes OR"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes BNo
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [(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 ( to&.1 &+uM'AA , FSCug . Sr ru l jf m im
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Cl Yes [vrNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [914o
b) Does the facility need a wettable acre determination? ❑ Yes Ef No
c) This facility is pended for a wettable acre determination? ❑ Yes [rrNo
15. Does the receiving crop need improvement? ❑ Yes 31NO
16. Is there a lack of adequate waste application equipment? ❑ Yes E+flo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below [:] Yes E►TNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q"No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [T] 4o
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 C3'No
Air Quality representative immediately.
Comments (refer to questan #) F.aplain any YES answers sud/o� any. reeommendattons or an other comments. . _
`Use of fa to llietter sttaatrgns. nse at3dthonal es as aecessa .q� ��1� _: -� A:�= - � .
��� �. cildy � ��i P�� t7'). [ Fteld COPY ❑ Fina.1 Notes ��"� ._
�_:- _ .m .r_a. -tip._•__-"__- ,.�_<:-....___: .._, x_'a._.-_ - ...r_-_z�, . . .._.. '�.r. '-_-.,,.`-:�.._._r.-_!' ..-a ..._:_-... -`.»c.,.: .��i-='"-��.n=-,.r':e':.:_'
Reviewer/Inspector Name
Reviewer/Inspector Signature:AL Date: 3 j 6
12112103 Continued

Facftity Number: 4;t _ ro3 Date of Inspection
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/ WIT, 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?
(ie/ 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?
29. 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)
31. 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 Bl o
❑ Yes [rrfio
❑ Yes Dggo
❑ Yes " NO'
❑ Yes 2 9o'
❑ Yes Bggo
❑ Yes El -go
❑ Yes Bfio
❑ Yes [fNo
B' 1fcs ❑ No
❑ Yes [-To
❑ Yes Bfio
❑ Yes DNo
❑ Yes &1�o
[:]Yes E�go
Er No violations or deficiencies were noted during this
visit. You will receive no further correspondence about this visit.
ddittoaal Commeats and/or Drawings
— 4ep
cl o ltwc/!s i M t +�s�c a•► s
rr. fs L3 1)
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12112103

— racutryNWWPer.-
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date -
(v
T-ime: Lid
ne
Farm Name: 90a 80-1 f e.r w, _ County: S o
Owner Name:_ See, RA( Q -n--_ phone
No: LSG _ (,G 0�
On Site Representative:— ��• �ef�s en tegxator. 4vA h
Mailing Address• fz-+ 1 60W
Physical Ad on: 6 .13 31
Latitude:
Qperation Description (based on design characterises)
T)re of swine No. of AnhnaU Type of Poukry No. of Animals Type of Castle No. of Animals
0 sow o Layer o Dairy
O Nmmy O Non -Layer O Bad
❑ Feed= _
OtherType of Livestock y► �'S� %n a Number of Animals: 3672,
Number of Lagoons: __(include in the Drawings and Observations the frxboard of each lagoon)
Facility InIpectioe:
Lagoon
_
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes 0
No,6-
Is seepage observed from the. lagoon?:
Yes a
No
Is erosion observed?:
Yes 0
No
Is any discharge observed?
Yes ©
N�
Q Man-made G Not Man-made
Cover Crop
Does the facility need more actrage for spraying?:
Yes 0
No;k
Does the cover crop need improvement?:
Yes O
- No
(Ulf the crops which need impnovenew)
Crop type: Y e Acreage:
loaf
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes O
No
.
Is a well located within 100 feet of waste applicadon?
Yes 0.
VoA
Is animal waste stockpiled, within 100 feet of USGS Blue Line Stream?
Yes ❑
No
'Is aminal waste landaPP lied of spray irri ated within 25 feet of Blue Line Stream?
P Y S
Yes O
No;
AOI - Januat717,i996

I _I—
Hawenance
Does the facility maintenance need improvement? Yes 0 NqA
_ h there evidence of past discharge from any part of the operation? Yes 0 No
Dees record keeping need improvement? Yes 0 No
�t Did the facility fad to have a copy of the Animal Waste Management Play on site? Yes O No 0
Explain any Yes answeas•
Signattae:,
cc FacM:y Assessmm Unix Use Aaachm=u jfNerded
Drawings b e .
• --- . wnNr..4s•y..n ��a:•�r •f i� tia- .214' A1�t��.p itiwRw+gFar+�sa tira...r ."1�_�_
• r�ra:s«..a.n�. r• �1 mow.+- •.r •fftF? elf- �!.•y.r�a w�� !"!i�l�..a a. tea.
AOI — January 17,1946