820104_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

F
f O C'
Type of Visit: ( ' ompliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Q utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: OC r Arrival Time: Departure Time: �� County:T Region:
Farm Name: F Owner Email:
Owner Name: tt 6t, ` Phone:
Mailing Address:
Physical Address:
Facility Contact: 2 -tf �z✓' Title:
t�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Phone:
W&—s
le
Certification Number:
Certification Number: ?? It
Latitude: Longitude:
Design Current
❑ NE
D esign
Curren#
Design Cnrrent
Swine Capacity Pop.
Wev oultry
Capacity
Pop.
Cattle C►apacity Pop.
_r
Wean to Finish -
Layer
Dai Cow
Wean to Feeder
Non -La er
I
alf
Feeder to Finish
::.
—,.,,,.
Dai Fleifer
Farrow to Wean-
Design
Curren#
Cow
Farrow to Feeder
D . _I'oult j
Ca aci
P,o P.
Non-Datiry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OuterID --
Turkey Poults
Other i
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ©'No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes ❑No
❑ Yes [3 -?To
[:]Yes
/ No
CT 'NA 0 N
CTINA ❑ NE
LJ'►�H
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: Date of inspection:
Wajte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D4o____❑ 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 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 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 environmrNo
rent, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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):
13. Soil Type(s): C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNSo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!3-<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑-Iqo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
['1 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ �o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
QN°
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑'No
[DNA
❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes eNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilituber: Date of Inspection: C1 G
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA ❑ NE
r
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
❑No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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.
34. 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)
3 1. 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 CAWNIP?
❑ Yes
❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA ❑ NE
Use drawn s,of hcili. to better expla�q situations {use add�t<onal pages as necessary,)^ " any other comments.
Comments g efer to giistion Exp any YE5 answers;;and/or any:.add►honal reconunendattons or
ct� h 6, e, P -
_--i "27
y77
9
rl
Reviewer/inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412015

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Outer Agency
Facility Number: 820104 Facility Statue: Active
inpsection Type: Compliance Inspection
Permit AWS820104 ❑ Denied Access
Inactive Or Closed Date:
Reason for Visit: Rine County: Sampson Region:
Date of visit: 12/08/2017 Entry Time: 08:30 am Frit Time: 9:30 am Incident S
Farm Name: Lula Carter Owner Email:
Owner. G W Carter Phone:
Mailing Address:
1678 Ozzie Rd
Physical Address:
801 Ellie Ln
Faclllty Status
Clinton NC 28328
Clinton NC 28328
Murphy -Brown LLC
Fayetteville
910-592-2809
Compliant ❑ Not Compliant Integrator.
Location of farm: Latitude: 34° 52'35" Longitude: 78° 18'30-
From Clinton, take Hwy 701 South to Butler's crossroads tum left. Go to Ozzie Road, tum right - go 2 miles to farm -on left.
Question Areas:
Dischrge & Stream impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Wayne Curtis Watts Operator Certification Number: 24149
Secondary OIC(s):
OnSlte Representative(s):
24 hour contact name
On-site representative
Primary Inspector.
Inspector Signature:
Secondary Inspector(s):
Name
Mike Carter
Mike Carter
Bill Dunlap
Inspection Summary:
Calibration 12-5-2015 Sludge Survey Extension to 12-31-2018
New Sludge Survey and Calibration by next inspection.
May need to replant cover crop if you pian to do arty pumping this winter.
Title
Phone
Phone
Phone
Phone:
Date:
page: 1

Permit: AWS820104 Owner - Facility : G W Carter Facility Number.. 824104
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity Current promotions
Swine
LE Swine - Feeder to Finish 3,672 0
Total Design Capacity: 3,672
Total SSLW: 495,720
Waste Structures
Disignated Observed
Type Identifier Closed Date start Date Freeboard Freeboard
Lagoon 1 19.o0 1 24.00
page: 2

rl
Permit: AWS820104 Owner - Facility : G W Carter Facility Number. 820104
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
No No No
1. Is any discharge observed from any part of the operation?
❑
■ ❑
❑
Discharge originated at:
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
Structure
❑
❑
❑
Application Field
❑
❑
PAN?
Other
❑
❑
0 ❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
01111
M ❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No No No
❑ 0 ❑ ❑
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
❑
PAN?
❑
6. Are there structures on-site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
❑
Outside of acceptable crop window?
❑
7. Do any of the structures need maintenance or improvement?
❑
■ ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yea No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820104 Owner - Facility : G W Carter Facility Number. 820104
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
res
No Na No
Crop Type 1
coastal Bermuda Grass
❑
(Pasture)
20. Does the facility fail to have all components of the CAWMP readily available?
❑
Crop Type 2
Coastal Bermuda Grass w!
If yes, check the appropriate box below.
Rye Overseed
Crop Type 3
WUP?
❑
Crop Type 4
Checklists?
❑
Crop Type 5
Design?
❑
Crop Type 6
Maps?
❑
Soil Type 1
Wagram
❑
Soil Type 2
Other?
❑
Soil Type 3
If Other, please specify
Soil Type 4
21. Does record keeping need improvement?
❑
E ❑
Soil Type 5
If yes, check the appropriate box below.
Soil Type 6
Waste Application?
❑
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
E ❑
❑
Management Plan(CAWMP)?
Waste Analysis?
❑
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
Weather code?
[❑
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yee
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
[❑
Rainfall?
❑
page: 4

Permit: AWS820104 Owner - Facility : G W Carter Facility Number. 820104
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yea No Na No
Stocking?
❑
0 ❑
❑
Crop yields?
❑
120 Minute inspections?
❑
0 ❑
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
0 ❑
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23_ If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
E ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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:
❑
E ❑
❑
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Other Issues
Yes No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
■ ❑
❑
CAWMP?
33. Did the Reviewerllnspector fail to discuss review/inspection with on-site representative?
❑
E ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5

i"vMon of Water Resources
Facility Number ®- Division of Soil and Water Conservation
���'���`��� Other Agency
Type of Visit:�o/mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: cel Rou . e 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:l �l Regio
Farm Name: %,[, `�-k, ija `u�Pi1/'
Owner Name: 9 1 C¢vt.`��
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: if C_wTitle: Phone:
Onsite Renresentntive- 1 t Integrator: ` y 'J 9
Certified Operator: f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 7fi �'y
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ff No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No I ] <A ❑ NE
b. Did the discharge reach waters of the State? ([f yes, notify DWR)
Design Current
❑ No
Design Current��,�
- � Design Current
c. What is the estimated volume that reached waters of the State (gallons)?
Swine Capacity Pop.
Wet Poultry
Capacity - Pop Cattle Capacity Pop.
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
}y
ONA
❑ NE
Wean to Finish
Wean to Feeder
Feeder to Finish
Layer
Non -Layer
�__
_
Dai Cow
Dai Calf
Dai Heifer
❑ NE
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
D . P,o_ult .
La ers
Non -La ers
Pullets
Turkeys
DesignCyrrent _ _
Ca ac ' 1?0 .
a
D Cow
Nan -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
F!j"No
❑ NA
❑ NE
of the State other than from a discharge?
Other
Turkey Poults
..,
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ff No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No I ] <A ❑ NE
b. Did the discharge reach waters of the State? ([f yes, notify DWR)
❑ Yes
❑ No
0A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EjrSNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F!j"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: IDate of Inspection:
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Waste Collection & Treatment
C3
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
a-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
J244A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[E No
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[TNo
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JE 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
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
fE] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
En-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
Q Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'No
❑ NA
❑ NE
t t�
morn mance or unprovemen .
1 i. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e�fi.[{yt c5y
13. Soil Type(s): — CJS _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑-iQo ❑ 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 C3 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 0No
❑ Yes [2-- o
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑"o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[E No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking D 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
[TNo
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [3"No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facili Number:- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NoNA C] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No ❑ NA ❑ NE
❑
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes�No
E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA [:3 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ff 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 E3-Ilo ❑ 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
P4o
❑ 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
qo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ea'<i
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
FTNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
eNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewerhrtspector Signature:
Date:

RS 7 pew 15 9D
Type of Visit:compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: lg xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: M.3v Departure Time: County:Regioq� 'T
Farm Name G 61 C (.— Owner Email:
Owner Name: Lt,) -t a6-_4 &_ Phone:
Mailing Address:
Physical Address:
Facility Contact: m 1 (. 4Ctn Title: Phone:
Onsite Representative: 1 Integrator: tq L3
Certified Operator: Certification Number:
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [D.N ❑ NA ❑ NE
❑ Yes
Design 3 Current
[]'l�A`
Design
Current
Design Current
E3 -NA
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
I JNon-Layer
I
Calf
Feeder to Finish
d na
Da'iry Heifer
Farrow to Wean
1DrvCow
Farrow to Feeder
Q-5ylP,oult .
Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:=
Turkeys
Other
Turke 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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [D.N ❑ NA ❑ NE
❑ Yes
[:]No
[]'l�A`
❑ NE
❑ Yes
[:]No
E3 -NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [—]Yes ❑No E3rl�A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eallo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 021 to ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2014 Continued

Facility Number: jDate of Ins ection:
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?
Structure 1 Structure 2 Structure 3
Structure 4
❑ Yes
Structure 5
C3-❑ NA ❑ NE
❑ No D>A--❑ NE
Structure 6
Y Identifier:
❑ Yes
ETNo
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
Ej`�No
❑ 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
❑ No
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[d -Na—
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
Cf�No
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
D-116-
❑ 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
fE]
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a -No—
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L7 ""'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E]-TTo-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D -NV-- ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): d vt� �%, S G d
13. Soil Type(s): t7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETN_ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'! ❑ Yes allo ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑"N- o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Dl o ❑ NA ❑ NE
❑ Yes [3'�o DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ej`�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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Cf�No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [t'No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - p Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D -w ❑ 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 [Bo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [q -Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
L:lXo
❑ 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
L3 "1°
❑ 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
[T 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
�o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑~No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ M
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑-No
❑ NA ❑ NE
Comments (refer to.question #): Explain any YES answervaiidlor_: any additional recommendations or! any -other comments"
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerAnspector Name:
Reviewer/Inspector Signature--
Page
ignature:Page 3 of 3
Phone:
Date: C ,
2/4/2014

I
Type of Visit:. m'Com fiance Inspection operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 11 f? Departure Time: L_" v County: cf r{ Region:
�.
Farm Name.-�F- !i'^ Owner Email:
Owner Name: Phone:
t Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: l j
Certified Operator: 1(
Back-up Operator:
Location of Farm:
'd'� Title:
3i*)r Oz.Zle 0
�� ag
Latitude:
Phone:
��
Integrator: I�'l
'Certification Number: L Liz U �y
Certification Number:
Longitude:
Design Current; Design Current Design Current
Swine Capacity Pop.. R'et PoultryCapacity Pop: Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
,. Wean to Feeder. Non -Layer Dairy Calf
1. Is any discharge observed from any part of the operation?
Feeder to Finish:_
Farrow to Wean
D . Poul
La ers
Design
Ga aci
Current
_ Po .
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Farrow to Feeder
Farrow to Finish
ad't Was the, conveyance man-made?
Gilts
Non -La ers
[ A,
❑ NE .
Beef Feeder
❑ Yes
Boars
„• •.
Other
Other
Pullets
Turke s
Turke Poults
Other
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
ad't Was the, conveyance man-made?
❑ Yes
❑ No
[ A,
❑ NE .
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
['NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[3"*NA
Q NE
1
t 2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
QIo
❑ NA
❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ V<o
❑ NA
❑ NE
of the State other than from ischarge?
_ 'Page 1 of 3
,7
2/4/2014 Continued
1i

Facili Number: Date of Inspection:
rWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes [L].Aicir NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q_DAI ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[-N70
❑ 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
[31o�❑
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
IJ " o
❑ 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
❑r rio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Jo`
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p 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): + j L7 C Ito
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. is there a lack of properly operating waste application equipment?
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ Yes [g-3Go
❑ Yes []-lTo
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ Yes [2r& ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
❑ Yes 0,Tfo [] NA ❑ NE
❑ Yes E�t<o ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [E'`No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p 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 [;Ko
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number:Z - Date of Inspection: 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �b ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ler ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3 -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
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
0 -go—
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
[T No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Eyes
g6o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. --
Use drawines of facility to better explain situations (use additional pages as necessarv).
Cai 1
si�� sww
Reviewer/Inspector Name: YN
Reviewer/inspector Signature:
Page 3 of 3
-/z
Phone: `I C (-
Date: a V
V4/2014

SIV''i.S 4L0 pau
rR
pe of Visit: (DoCompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
ason for Visit: QXoutine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
141— a d I
Arrival Time:
Departure Time: Countyt&Region:
Farm Name:
Capacity Pop.
1y o
_ Owner Email:
Pop.
Cattle Capacity Pop.
Owner Name:
o Finish
La er
phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
iiZCl` �Gc� Title:
It
Latitude:
Phone:
Integrator: & 4
Certification Number: 47 of ly
Certification Number:
Longitude:
Design Current
i 11
Design
Current
Design Gnrrent
Capacity Pop.
Wet Poultry
Gapacity
Pop.
Cattle Capacity Pop.
❑ NA
o Finish
La er
Dai Cow
o Feeder
Non -La er
Dai Calf
to Finish
" "'
Dai Heifer
to Wean
Design
Current
D Cow
to Feeder
L
D . P,onlf , ..
Ca aci
Po .
Non -Dairy
to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
ON
urke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ 4o"" ❑ NA ❑ NE
❑ Yes
❑ No
M4A'
❑ NE
❑ Yes
[::]No
[Z KA
❑ NE
[:]Yes
❑No
R201NA
❑ NE
[:]Yes
Ra'<o
04*'�A
❑ NE
[:]Yes
tj,No
❑ NA
❑ NE
Page l of 3 214/2011 Continued

Facility Number: Date of Inspection:
[!�<o
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
10
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rid,Wo
❑ NA
❑ NE
a If yes, is waste level into the structural freeboard?
❑ Yes
Q.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
[&fb
❑ 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
@-<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
02,4'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Lt_1,Ko
❑ 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
[71,Ko
❑ NA
❑ NE
maintenance or improvement?
Waste AUolication
10. Are there any required buffers, setbacks, or compliance aitematives that need
❑ Yes
E:Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Zjll�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 Approved Area
12. Crop Type(s): P
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[!�<o
❑ NA
❑ NE
❑ Yes
EKO
❑ NA
❑ NE
❑ Yes
10
❑ NA
❑ NE
[:]Yes 41 0
❑ Yes UK)
❑ Yes [-]No
❑ Yes [:]No
❑WUP ❑Checklists 0 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

FaciliNumber: jDate of Ins ection: "6VOT
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C::I `Vo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes rl-<_ ❑ 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 [Z�,hTo ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [FTo ED NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ZY
❑ 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
[&Wo
❑ 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
[&Ko
❑ 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
EJWo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
G][ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L2 No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pie - 4633-3
Date: 1 �VVLA 0-
21412011

t 'l1,61U&I
Type of Visit: U 7outine
ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ate Arrival Time: Departure Time: q; County: fln Region:
Farm Name: Owner Email:
Owner Name: 1—%J\ Ll C g -t Phone:
Mailing Address:
i
Physical Address:
l
Facility Contact: ►`I I � 2- C(aR-[�� Title:
Onsite Representative: MZ) (IL ppzTZ(Z
Certified Operator: N iAtn t
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: MV R pAN'i � Rnz k7
Certification Number: C� $uuH
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 O No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes [:)No
❑ Yes Q No
[]Yes [v"No
1g NA ❑ NE
Eg(NA ❑ NE
ETNA
���II
5_ Desr n Current
�, g
f ^ ; �` �� a �v�' � �
� Design
a"
Current
Design Current
E] NE
Swine Capacity Pop.
� t
Viet Poultry
apacity
Pop.
Cattle Capacity Pop.
Wean to Finish
f
La er
Dai Cow
Wean to Feeder
Feeder to Finish 00
Farrow to Wean
Non -Laver
.
'Design
Current
Dai Calf
Dai Heifer
D Cow
Farrow to Feeder
D . Paul
a $ci
P,o
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
-
Pullets
Turkeys
Beef Brood Cow
_-
Other
OtherI
Turkey Poults
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 O No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes [:)No
❑ Yes Q No
[]Yes [v"No
1g NA ❑ NE
Eg(NA ❑ NE
ETNA
❑ NE
❑NA
❑NE
❑NA
E] NE
Page 1 of 3 2/4/2011 Continued

Facili Number: -CLk I jDate of Inspection: t
ff
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Er<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No gNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /YNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
["No
❑ NA
❑ NE
waste management or closure plan?
[-]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
[SrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[TNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑WUP ❑Checklists ❑Design p Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�rNo
❑ NA
❑ NE
maintenance or improvement?
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p Weather
Waste Application
❑ 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
9No
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[gNo
[DNA
❑ NE
maintenance or improvement?
❑ NE
Page 2 of 3
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U 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): �ksr�' c> CA IV � _ (j
13. Soil Type(s): �j C
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [ rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes g No 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[—]Yes
[yNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[-]Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design p Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p 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
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: IDate of Inspection: �t,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RrVo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [v]'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [B No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [gORo
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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
132. 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?
Comments (refer to question f: Explain any YES answers and/or any
Use drawings of facility to better explain situations (use additional paV
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
F] NA ❑NE
[:]Yes [B -No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes [B"Ro ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
[g'No
❑ NA
❑ NE
❑ Yes
[+ 'No
❑ NA
❑ NE
(litional recommendations or any otn
as necess$ry)i.
DoNF_ Xwt '.b%7
Cac'ahqL +e� wosal- or` s P0."St 3. l CikopI W
v czar• VOR srsQ on
C0rCV_.%\17_ iZl�� o \ j,,*•SOdt-k �ONN P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _Q�1
_ o -'a �- tasl
Date:
2/4/2011

1 ype of visa: ® Lompttance tnspecuon V uperanon xeview V Ntructure r vaivateon tj i ecnmcal Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: ArrivalTime:
'po A X Departure Time: j%rte County: Region:
Farm Name _ �, C A 6RR Owner EmTTa''i``1��
Owner Name: S Phone:
Mailing Address: ^aZii dZ'zz g Rd A d C�it�TC) n Z Fs 3�A
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: M- }jt C tA9.10 Integrator: 80412Li jG/i0&t1AJ
Certified Operator: raRT@fL Certification Number: 4
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design y Current
Swtne � Capacity- Pap.
Wean to Finish
t Design i Current
Wet PoultryCapacaty Pop.
La er
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da Calf
)( Feeder to Finish "l� ex7
v :
Da Heifer
Farrow to Weank
_ en.
DesignCurre
D Cow
Farrow to Feeder
.
D , 1P,oil try.' ,Ca` aci 7�Po
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
[] NE
Turk. s
Other
Turkey Poults
Other
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 14 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes.. notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
Eg NA
[j NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
MNo
E] NA
[] NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: a - ICA jDate of Inspection: tt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA
a. If yes, is waste level into the structural eeboard? ❑ Yes M No ❑ NA
Structure 1 cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 14
1_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
❑ NE
[:]Yes ® No . [:]NA ❑ NE -
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ca 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
g] 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 [X] 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. CropType(s)- RSD
;�FRro.tl441
13. Soil Type(s): wyk b; [� •• CS a� V:�' _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [%] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes M No ❑ NA ❑ NE
Required Records & Documents N
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 CA 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 fj] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes EP No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: - fU[{ Date of Inspection: it 1
If
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 No ❑ NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ONE
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
00 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
171 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 CAWW?
❑ Yes
( No
❑ NA
0 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 r`
( q #�: Explain any YES answers and/or any additional recommendations or�tany other comments. �I Mod
Use drawings of facility to better explain situations (use additional pages as necessary). -
�, 22fl CP�b RP•�tTon `fly ��, [ 3.1 ae � 1
at I- 9[b-
Reviewer/Inspector Name: -So e-\ I DS Phone: TiaY33-333D
d
Reviewer/inspector Signature: ��ab r
0 -Date: I
Page 3 of 3 2/4/2011

r
Type of Visit jp�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
/� Arrival Time: Departure Time:
Farm Name: L'11 /i7_ /
Owner Name: &' W • Cleve
Mailing Address:
County: Region: 25—Z
Owner Email:
Phone:
Physical Address:
Facility Contact: 44 j Titled- Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=' =" Longitude: 1=1 o E_-1' = L
Design Current
Design Current
Design Current
El NE
SRine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ NE
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ No
Feeder to Finish �� 7
C No
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Da
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes & No ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection 1
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
10 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
® 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
9No
❑ 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?
ER Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
W 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
[:1 Yes
R] 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sfudge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)_Z""&,
13. Soil type(s) GilgL: Z',!�Zg e,-,, I �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;K No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
ERLNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA ❑ NE
w k CIJ��k ej-1 w � s . ft Yp ,s D`� of L,a�as�--�
�l, v � f��"6�Dgi l �rn�.•- Y/l Wye S
_57711
Reviewer/Inspector Name N
Reviewer/Inspecter Signature:
Phone: . �/ f,� •-( 3 3;_3_��
Date: �i—.�2L/-�d�0/ p
Page 2 of 3 - ' 12/28/04 Continued

Facility Number: AiL— D Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ VTUp ❑ Checklists ❑ Design ❑ Maps p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections .Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CK No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
❑ NA
❑ NE
Other Issues
2$.
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
[ZNo
❑ 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 inunediately
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
[R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additionai;Coinments'and/or Drawings:
C3Z�Y�p` =tom a _.�5urp7 m 773,_ aej�,, 6,Ai;�
Page 3 of 3 12/28/04

Type of Visit OL-e6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 046utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:- Arrival Time: - Q Departure Time: ; Qa County: Region: v
Farm Name: Owner Email:
Owner Name: �L[ �.. �.�.rt�' Phone:
Mailing Address:
Physical Address: j
Facility Contact: &Z &Zr / �ir/�� _ Title:
Onsite Representative:
Certified Operator: —
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=. =Ed Longitude: = ° = I =1 u
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Design @urrent
Design Current
1.
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Sw►ne
Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ No
ElWean to Finish
❑ NE
❑ Layer
El Dairy Cow
ElWean to Feeder
❑ NA
ILI Non -Layer
El Dairy Calf
Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
❑ Yes
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Z Is there evidence of a past discharge from any part of the operation?
❑ Yes
[:1 Non -Dairy
El Farrow to Finish
110
❑ NE
❑ Layers
El Beef Stocker
❑ Gilts
❑ NA
❑ Non -Layers
El Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Cowl
12/28/04
❑Turke s
Other
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
Z Is there evidence of a past discharge from any part of the operation?
❑ Yes
09j�o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes
jgNo ❑ NA
EINE
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
(9 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
19 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? ayes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EffNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
0 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
S No ❑ NA
EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
261-1140 ❑ 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) �r
13. Soil type(s) p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
fiigNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? RYes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
j, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
allo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
0 -No ❑ NA
❑ NE
Comments {refer to question #): Explain any14and/or any recommendations or any othercomments_-
Use drawings facility
of to better explain situattonsTM use additional pages as necessar})
7 ObnVFftkr Vvrgr�, er7't-
J eV V C i' of `� E7H f
V V _ tad P
Reviewer/Inspector Name I�, Phone:
Reviewer/Inspector Signature: Date: / 3
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 U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP_readily available? If yes, check ❑ Yes ,&No []NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 29,jVo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[,&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
SNo
❑ 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
4No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EKNo
❑ NA
-❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9[No
❑ NA
❑ NE
Additio iid�g, mments and/or Drawings _
i
12/28/04

Type of Visit (3 < mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f1©,, Arrival Time: Departure Time: County: - 02` Region: f5Z_0
Farm Name: r Owner Email:
Owner Name: 1(r ,-_ (_ rz ✓ I G Phone: Z12 4-1
1 ` y
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=1 =" Longitude: E—_1 o =, ❑ u
. , �►
t* t = Destgn.Current
1-
�. Des�gri ,@urrent
-
Design Curren#
SwtneCapacityPopulaiion
Wet Poultry CapacityP�opulation
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
iry Cow
❑ No
❑ Wean to Feeder
Layer
iry Calf
ceder to Finish % D
iry Heifer
❑ Farrow to Wean
Dry Poultry _
❑ Dry Cow
❑ Farrow to Feeder
- ;"
❑ La ers
❑Non -La ers
❑ Pullets
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑Beef Brood C o
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
Other
El Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes C.No ❑ NA EINE
❑ Yes ❑.No ❑ NA ❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — I Date of Inspection
x'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2�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
[9No
❑ NA EINE
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?
ElYes
❑ 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
ERNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[! No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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. Croptype(s) r''14 V4, Z���
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
RNo
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
BNo
❑ NA ❑ NE
fay
Reviewer inspector Name �`� — — Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of ]inspectionPER90ar
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21N0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [WNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ,K Yes ❑ No ❑ NA EINE
O -Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ERNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[,NO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PINo
❑ 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
[qNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
q No
❑ NA
EINE
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
4No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ryes
❑ No
❑ NA
EINE
Additional Comments.acsdlor Drawings :.`.r .�_ ,:r � � �� • -
r� r
7
Page 3 of 3 12/28/04

z
ivision of Water Quality 5 / i�
Facility Number �p2 / p 0 Division of Soil and Water Conservation a —n7
Q Other Agency
Type of Visit �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f Departure Time: D County: Region:
Farm Name: `'a �� Owner Email:
Owner Name . C'.r+' Cr _ Phone:
Mailing Address:
Physical Address:
Facility Contact: `T - Title:
Onsite Representative:
Certified Operator: _ _ ge=zs
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' ❑ Longitude: ❑ ° ❑ ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population.,
❑ DaiTy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
FINE
12/28/04 Continued

Facility Number: �Q
Date of Inspection %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 16
Observed Freeboard (in):
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 14 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 10 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?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)A---V1 t yam, L A --J
13. Soil type(s) W, Z> la& e— � 720
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PdNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [9No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes JRNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�u/Vv G O G vii'`
Lt ri a✓ G "(-
-07
Reviewer/Inspector Name P one:
Reviewer/]nspector Signature: Date: �(d e3- 1 R'9a
12128104 Continued

Facility Number: — Date of Inspection —03b7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 9 Yes *NdoV_ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ZINo [INA ❑ 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 ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CHNo
[:INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Cl Yes
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ yes
XNo
❑ 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
Cl 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
[4 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
K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

lype of Visit (AMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 14--16-404 Arrival Time: % Departure Time: County Region:
Farm Name: //77 Luka_ L >✓r Owner Email:
Owner Name: C:I to - 7 ��' Phone:
Mailing Address:
Physical Address:
Facility Contact: 2zisSs1 4 ti z"✓ Title: Phone No:
Onsite Representative: �CCS�-sem-� _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: =0
=' =" Longitude: =101=11 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
• ❑ Non -La et
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other I F��]
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 Heifei
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: TD 1.
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 QiNo ❑ NA ❑ NE
❑ Yes
EqNo
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
- ❑ NE
❑ NA
❑ NE
❑ Yes
RNo
❑ Yes
2—No
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
KNo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
Waste Collection & Treatment
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
!LNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ja No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j*fir_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
ER 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
J4 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
n No
El NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 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) & Zz-2e-
13. Soil type(s) fj G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
(R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
M No
El NA
El NE
IReviewer/Inspector Name r♦ 4 . B,n� Phone: L/X;2,
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: Date of Inspection r= D
Reouired Records & Documents
+ 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NJNo [--INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No [3 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield x120 Minute Inspections X1 Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JKNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes]
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 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/luspector fail to discuss review/inspection with an on-site representative?
❑ Yes
14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[.No
❑ NA
❑ NE
Additional Comments andlor Drawings: r
all
12/28/04

Type of Visit ® Compliance Inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit • Routine 0 Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number a j p j1'ateofVisit_. Mine: g: 3 Q
Q Not Operational C Below Threshold
® Permitted ® Certified © Conditionally Certified [3 Registered Date'Last Operated or Above Threshold: ........
Farm Name: ....._ _.... W _...._ C a5 _............_ ....� ...� _ - _ County:
Owner Name: ........................... C Wkw-..............---------- ,.. Phone No:
:Mailing Address:..___ L L �Z L ` .WAS__. _._ 1 ✓ k� �- �..�..�'
Facility Contact:
Title:...... - ..._...... ��. �_.. Phone No:
Onsite Representative: Ch C_1.0. l Ca.--vC_.-- ........................ Integrator:.
Certified Operator: t�2 Operator Certification
on_ -±'.-------_................G.............
Number:,_,.._ ............... ......
Location of Farm:
1,3 Swine ❑ Poultry ❑ Cattle ❑ horse Latitude 00 < 0" Longitude • 6 C4
Swine
- - DesW Currrat - _
,a ;Po uiation. - Catde .
MIT`Ini ,
Wean to Feeder
❑ Layer
IN Feeder to Finish 3, 4-7.)-
321 2,-
''
❑ Non -Layer
Farrow to Wean
- =
Farrow to Feeder
Other
Farrow to Finish
' } -
- TOW D"
esil
Gilts
nrr�ent _
ninlathon
Number of I.agooas _
xaldii Pot�dS salsa-Tt�a,ns
Ihse� & stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes 29 No
❑ Yes ❑ No
❑ Yes ❑ No
P
❑ Yes ❑ No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes to No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier-----............................._..��............_._..._...........�.�......................................
Freeboard (inches): 39 it
12112103 Continued

Facility Number: e a- — ! 0L[
4/43/pY
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures *an -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is thereievidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type S r t yes U& S R r a r. 5) cdQ / Syr, CO
, • t t r.L i ws
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
' 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
I8. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 14 No
❑ Yes ® No
❑ Yes JZI No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes © No
❑ Yes ® No
❑ Yes Q No
❑ Yes ® No
❑ Yes ® No
® Yes 0 -No
❑ Yes NJ No
❑ Yes IM No
❑ Yes ONo
❑ Yes 1'No
❑ Yes (p.No
Comments (refer to gaest.on) F.xplatn any YES answers and/or any reccmiiiendai.ons or any other wmments.- a
>Use,drawings. fatty to better explam sttnattons. (ase addttwi�sl pages as necessary) s ( ] Field Copy ❑ Final Notes s`
�- _
IS- r; C1.1 W ,.j L P E - P.zP
go 1 4 -Ls }iGl� h a4P%1'or J;:d r dabs �GY�h�` ow
P* C r_;o ^ &*--e •..•ea 4-t
T
Reviewer/Inspector Name"�-
Reviewer/Inspector Signature: Date: rs� / j'7/y jA
12/12/03 ✓ �J -
Continued

9
yaciIitg+Number: k _�_ — i0 y Date of Inspection Y
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS 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 fortes need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
9) Yes ❑ No
® Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes No
❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,bf
3 �- Y1�Lr. Ca• kr_.r- w• 11 , 6.. �:+� c kw�w, �l tiut
rya l
h�� J s�4tC4 St,�rV4y
l2/I2103