820116_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

4
t p+13 ani e)( --T i `t
Type of Visit: 40 -Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
A �
Date of Visit: Arrival Time: t Departure Time: � County: `� 1'`�` Regions '
Farm Name: 9'`Ck_4_4 �[,.� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: — _�1�"tLTitle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
ti
Latitude:
Phone:
Phone:
Integrator: 46— f
Certification Number:{
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: —
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes E�J ❑ NA ❑ NE
❑ Yes
❑ No
[9 -N -A
❑ NE
❑ Yes
Design Current
E31TA
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
WeFinish
Layer
Dai Cow
Feeder
Non -La er
EE
Dai Calf
o Finish
Dai Heifer
o Wean
Design
Current
D Cow
o Feeder
Dr, P,oultr,
Cs ael
P.o
Non -Dairy
o Finish
Layers
Beef Stocker
I
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys___
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: —
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page 1 of 3
❑ Yes E�J ❑ NA ❑ NE
❑ Yes
❑ No
[9 -N -A
❑ NE
❑ Yes
❑ No
E31TA
❑ NE
[:]Yes ❑ No 0-N7C_ ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continuer)

I
FacilityNumber: nLo�, - e jDate of Inspection: (JG (I h
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z NA NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [_-�❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -ZA()
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes jt'1 oo ❑ 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 ❑>i' ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes [Er No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes a<o ❑ 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 Approved Area
12. Crop Types):10 �C- D
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 [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes IBJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes U 'N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L 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 EjNo ❑ 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 o [-] NA [:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

J
Facility umber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑"Tq_o_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CD-Ni57_❑ 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 b No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes LD_Nn-- ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CJ 11U ❑ NA ❑ NE
❑ Yes
NA
❑ NE
❑ Yes
NA
❑ NE
❑ Yes
[:kNcr
❑ NA
❑ NE
Comments (refer. toquestion #): Explain anyYES answers,dlAl
inor: "any additional recotnmendati6nsar any other comments;, t�
Use';driiwings of,facili to`bettci ezp lain slfuatioris;(u'se additianalr a`g'es'its;;necessar "
c�.
L
- h8S[
Reviewer/Inspector Name: 1-v 1 1
Reviewer/Inspector Signature:
Page 3 of 3
Phone". L� M'. —
Date: h6 (4
2/4/2015

Location of Farm: Latitude: 34'52'36` Longitude: 78° 18'12"
From Clinton, take Hwy 701 South to Butler's Crossroad - tum left. Go to Ozzie Road, tum right - farm on left - 2 miles.
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):
On -Site Repreeentativels): Name Title Phone
24 hour contact name Mike Carter Phone
On-site representative Mike Carter Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspectorle):
Inspection Summary:
Calibration 12-5-15, Sludge Survey extension to 31 December 2016
New sludge survey and Calibration due by next inspection
May need to replant cover crop If you plan to do any pumping this winter.
page: 1
M Divlslon of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number:
820116
Facility Status: Active
Permit: AWS820116
❑ Denied Access
Inpaection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Vlslt:
Routine
County:
Sampson Region:
Fayetteville
Date of visit:
12!08!2017 Entry Time: 09:30 am Exit Time: 10:30 am Incident 0
Farm Name:
Michael Carter Farm
gn2r Email:
Owner.
Michael A Carter
Phone:
910-385-4694
Melling Address:
3118 Ozzie Rd
Clinton NC 28328
Physical Address:
1801 Ozzie Rd
Clinton NC 28328
Facility Status:0
Compliant ❑
Not Compllant Integrator:
Murphy-Brown LLC
Location of Farm: Latitude: 34'52'36` Longitude: 78° 18'12"
From Clinton, take Hwy 701 South to Butler's Crossroad - tum left. Go to Ozzie Road, tum right - farm on left - 2 miles.
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):
On -Site Repreeentativels): Name Title Phone
24 hour contact name Mike Carter Phone
On-site representative Mike Carter Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspectorle):
Inspection Summary:
Calibration 12-5-15, Sludge Survey extension to 31 December 2016
New sludge survey and Calibration due by next inspection
May need to replant cover crop If you plan to do any pumping this winter.
page: 1

t
Permit: AWS820116 Owner - Facility : Michael A Carter Facility Number: 820118
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Qlecharaes & Stream Impacts
Yea
No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
❑,
Structure
❑
❑
❑
Application Field
❑
Other
❑
M ❑
❑
a. Was conveyance man-made?
❑
■ ❑
❑
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)?
❑
❑
❑
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?
❑
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
Yee
No Na Na
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑,
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on-site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑ .
8, Do any of the structures lack adequate markers as required by the permit? (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
❑
❑
❑
maintenance or improvement?
Media Application
Yea
No Na Na
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑.
0 ❑
❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑
0 ❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 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, AWS820116 Owner - Facility ', Michael A Carter Facility Number: 820116
Inspection Date: 12/08/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Stocking?
❑
❑
Crop yields?
❑
and report mortality rates that exceed normal rates?
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
M ❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
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
❑
Other
List structure($) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
■ ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ❑
91hedt ours_
Yea
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
28. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/inspector fall to discuss review/inspection with on-site representative?
110
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

5 ra
q, � UDivision of Water Resources
Facility Number ®- F17P 4 Division of Soil and Water Conservation
1 Q Other Agency
i
re f
Reason for Visit: Q'Routine Q Complaint Q Follow-up Q Referral C) Emerge
Date of Visit: Arrival Time: -' Departure Time: (Ih
Farm Name: I �� t-- Owner Email:
1
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: t z�
l�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
n
y O Other Q Denied Access
County: Regior - T�
Title: Phone:
Integrator: 046----s
Certification Number: �'?Wy
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes do ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ErNc ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes / 'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: -//71 Date of Inspection:
Waste Collection & Treatffient
4. I` storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q•l'd'6 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F::f'1�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes r 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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes t ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I__I No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes Q No ❑ NA ❑ NE
maintenance or im rovement�
F
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window i,❑ Evidence of Wind
ind Drift [3 Application Outside of Approved Area
12. Crop Type(s): `i-� e`�'� 'bl -% Z)
13. Soil Type(s): W14
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2311�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
23 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2 o
❑ NA
❑ NE
acres determination?
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
L_.I 1V�
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesNo
E] Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio;"Nj
❑ NA
0 NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes "O M
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesNo
❑ NA
❑ NE
[3 Waste Application E] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
E] Waste Tr nsfers
❑ Weather Code
E] Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio;"Nj
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ 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

4 14 14
[Facility Number:Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Flo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z14o"' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
Z
❑ 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
ZNo
❑ 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
OE�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z leo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
96 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Z/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
j f No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

S DtE-c- IS
sQWNVhMm of Water Resources
Facility Number ®- ® O Division of Sol] and Water Conservation
O Other Agency
Type of Visit: (@ CC mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: GMoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 30 Departure Time: lie County:
L
Farm Name: 1-?� C at'4 e- Owner Email:
Owner Name: / f Phone:
Mailing Address:
Physical Address:
Facility Contact:
Im 1 kt, 6&% Title: Phone:
Onsite Representative: I k Integrator: l�
Certified Operator: t
Back-up Operator:
Location of Farm:
Latitude:
Region: FFV
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
oars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er I ]EI
Non -L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes To❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes []No
[:]Yes [3o
❑ Yes �o
❑ Yes Q No
P ISA ❑NE
0 -N -A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

Facillt Number: Date of Inspection:
f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C51'�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes [] No [5] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0]_NV ❑ 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 Q'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
ffNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑'No
❑ NA
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
[:]Yes
E]rNo
❑ NA
❑ NE
maintenance or improvement?
[D'Iqo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E:fNo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [3"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 16 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): " a
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 "
<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'No
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[D'Iqo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [,leo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes [2,lffo
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections/
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes �_e o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes l__I No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

,[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[34do ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[g -N -o-' ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
2<0 EI 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
❑ 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
ETZo ❑ 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
[3,N -o- ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[5 -No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[no ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ETNo ❑ NA
❑ NE
Comments (refer to question #); Explain any YES answers and/or any Additlonal recommendations or any other comments.:.
Use drawings of facillty to better,explain�situaiions (use additional'paOs as necessary) �a , ' s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: l�•r, U
2/4/2014

IDAON_�Bo
UfDlvislon of Water Resources
Facility Number - O Division of Soil and Water Conservation
O Other Agency :1
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ti
Farm Name: ttL 64 a�L' �. Owner Email:
Owner Name: l KC C2 4.- . Phone:
Mailing Address:
Physical Address:
Facility Contact:
t'`r ,A Title:
Onsite Representative:
Certified Operator: 1
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:
Region j�ED
Integrator:
Certification Number: 4�fvjb/v
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
"Layer
Non -La er
Discharees and Stream Imnacts
Non -L;
Pullets
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dai Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. is any discharge observed from any part of the operation? ❑ Yes [ j>tr— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3 -NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ❑ No [a -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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [-]No
❑ Yes 3 --No
❑ Yes ❑ No
E2 -KA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

F4ility Number: - Date of -inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q�No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No Q,NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ oo ❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
To ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
To ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CEI<o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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 ❑pplication Outside of Approved Area
12. Crop Type(s): ey- /,, ,,� S (
nz
13. Soil Type(s): OL `
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [B<oo ❑ 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 [;H,;Fo ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes [D No ❑ NA ❑ NE
❑ Yes EIN-o ❑ NA ❑ NE
❑ Yes [2-Iqo ❑ NA ❑ NE
❑ Yes 0,tTo— ❑ NA ❑ NE
[] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑-<
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [ErNo
[:]Yes E3050
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

FaciNty Number: jDateof Inspection: 7aZ_0 100/1-
2i,4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[19U F] NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0_5 ❑ 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
� ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑,No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
-❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes tM,< ❑ NA ❑ NE
❑ Yes Cao- ❑ NA ❑ NE
❑ Yes [30 o ❑ NA ❑ NE
❑ Yes [J" <o ❑ NA ❑ NE
[—]Yes ❑-1<0
❑ Yes D1<o
❑ Yes ❑ No
❑NA C] NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional:, recommendations or.any other: comments.
Use drawings of facility to better explain situations (use additional pakes as necessary).
3V I�.J
ts
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 433-3,33
Date: 11—��1 q
2/4/2014

vwk 5 1' \*Q
C1'vision of Water Quality
11 Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit: (jrtom lance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /� Arrival Time: Departure Time: County Region: f -7(Z
r l
Farm Name: tG t( i� G� Owner Email:
Owner Name: ��' C / Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: &
Certified Operator: it
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Phone:
Integrator: &8
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
La er
Non -La er
Dry rouitry
Layers
Non -Layers
Pullets
Turkeys_
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes �Ko E] NA E] NE
[:]Yes ❑ No V, ❑ 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
J�rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Elo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
�To
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Condnued

Facility ry umber: ID 4 jDate of Inspection:/ARVIV
IF
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2],6o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [goo ❑ 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 ❑ 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 E].I'd'S ❑ 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 l i 4o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z 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 0,Wb ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I�kV° [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �i'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 ❑ videncceeof Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): tMNA 1, C"',AA lkfj,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E?5o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �,XO ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �1Qo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [(�F4 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑'Wo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes G2,Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z>6 ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z:].Mo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V<o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Elillo` ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q -<o ❑ 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 ET<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? . ❑ Yes EZ>d- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes �To ❑ 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 FZKo ❑ NA ❑ NE
Comments (refer,to;questio.n #) Explain any'YES answers and/or any -additional recommendations or_any other :coinments- A= =Y
lise'drarvittgs offueilityto betterexplain situations (use additional pages as necessary):
❑ Yes [g<o ❑ NA ❑ NE
❑ Yes [ENo ❑ NA ❑ NE
❑ Yes hTo ❑ NA ❑ NE
❑ Yes CiiAo ❑ NA ❑ NE
Sri sav'ox-t't
c
ReviewerlInspector Name:
It) - 3,,o -13
'%4(1%
i
Reviewer/Inspector Signature: DatelfAw his
Page 3 of 3 _W 14T 2/4/2011

'� gl cel t a
Facility Number O Division of Soil and Water Conservation
Q Other Agency
type of visit: Uruompliance inspection V operation Review V structure Evaluation V Technical Assistance
Reason for Visit: Q(Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:
Farm Name: 1#sa CV tragi\ C p {aa i`i' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact:Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Region: tKa
Phone: 2
Integrator: %�.iR�I,V �13Re►
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I -::]
Non -La er
Pullets
Other
Pouits
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impact
1. Is discharge
any 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
ENA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[JNA
❑ 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
g� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No --'
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - ILL, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cg�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No rZnA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
&No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
dNo
❑ 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
2No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[!!rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste managemept-system other than the waste structures require
[] Yes
62fNo
[DNA
❑ NE
maintenance or improvement?
Waste Application r
10. Are there any required buffers, setbacks, or 6ompliance alternatives that need
❑ Yes
Ee4o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
gtNo
❑ 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): %v %j
13. Soil Type(s): J.kW-\
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑Rio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[DeNo
❑ NA
❑ NE
Required Records & Documents
of
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[DYes
[io
❑ 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
�o
❑ 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
[Veto
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
[;?44o
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

4
Facility Number: - /114 JDate of Ins ection: 61 tAl
24. Did the facility fail to calibrate waste application equipment as required by the permit? [a Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

• �1 �1'��J�ljJf
Facility Number - F7T771_,_
w uivision of water duanty
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ![XJ M Departure Time: .'Qd County:
Farm Name ]'�� C >p1`�_ CRCk-*uL _IFN(km _ Owner Email:
Owner Name: �ha)042_1. r^ N9J t'K VA& K" Phone:
Mailing Address: _ N 11 C)27 --1E- ROA -0 , Q_UN-lo r, 2$3a g
Physical Address:
Region:
Facility Contact: J= C ea3kL Title: Q I.anup, Phone:
Onsite Representative: V%% jQ_ Qj4), 0_Q Integrator: M Vaph.t EsezGW N
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non- L,
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
—Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑YesLly
MNo [3 NA [3 NE
[:]Yes
® No
NA
❑ NE
❑ Yes
Ep No[IN
NA
❑ NE
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 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

0 , %
Facility Number: jDate of Inspection: ( t
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (0 No E] NA E] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [� No [:]NA [:]NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes X No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[?� No
❑ NA
[,] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [D 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): LH�1 Qozcl,"'j-OA tip Cvs
13. Soil Type(s): J p'%; w"
t4. 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 F4] 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 ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP [I Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[:INA ❑NE
[DNA ❑NE
Page 2 of 3 2/412011 Continued

Faelli Number: 1 - -Ltp Date of Inspection: 17 CI
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [� No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No
Other Issues
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[4 No
❑ NA
[3 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
R] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commentsg�'
Use drawings of facility to better explain situations (use additional pages as necessary).
hWNL V .,
Carl -
Reviewer/Inspector Name: d\ }n -TL \ids. .,, Phone: Of 333
Reviewer/inspector Signature: Date: %. 1Igajae.5t'1
Page 3 of 3 2/4/2011

Type of Visit C&e6mpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit GPK-o'utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r l "] I County: Region:
Farm Name: GIllr 1 CazV?ri'" rh'� Owner Email:
Owner Name: —mi — h a ".. I "e_11Phone:
Mailing Address:
Physical Address:
Facility Contact: _ t,�, CLs! _� e't/ .,_ Title: zf-, � Phone No:
Onsite Representative: ����� Integrator:
'Of
Certified Operator: S�"��� Operator Certificati n Number:
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
Longitude: = o =' = "
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?
Page 1 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
�_Ulrrent
Design Current
Design Current
Swine apacity Population
Wet Poultry C►apacity Papulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish �!i
❑ Yes
[I Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
ElNA
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl I
L
El Turke s
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?
Page 1 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
0 N
[I NA
E3 NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
ElYes
RNo
ElNA
NE
�❑
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 0 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 5,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 [,-gNo ❑ 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?
0-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ®-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 - o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes CO 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 [I Application Outside of Area
12. Crop type(s)
a isi �1 �'N fl.��.!
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?
ayes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [:]Yes K No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes [&No ❑ NA ❑ NE
18: Is there a lack of properly operating waste application equipment?
❑ Yes O-No ❑ NA ❑ NE
Comments (refer to question #) n Explain any YESanswers and/or anyrecomn%en dationscor any other comments.
1Jse£drawings �� �.'�
of facility to'bette`r.ex�lain sifivatians:: (use additional; pages'�asenecessary): �'
<��
p+'.=s.
..i .-i-i '£-•'r
Z�YS_lTf+y.::G, Y�.-:
rMfb
by rrr� !v Yrt-
,T.D
�
3�yeviewerllns ector Name
Phone- 3-3 3
eviwSignature:
Date:rllnspector
Page 2 of 3
12/28104 Continued

Facility Number: — Date of Inspection
i' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CR -No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 23—Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
59.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers an irrigation equipment?
❑ Yes
ONO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
RYcs
❑ 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
1 -No
❑ 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
ZNo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5 -No
❑ NA
❑ NE
Additional Comments, and/ar Drawings:
r
T �`/~�%i moi~ + • 4 ' 'V �i12 U/ 1 i r [ i�//i f�Ar / �J 4,'�IUOld
iU07 r t'
Page 3 of 3 12/28/04

11
Type of Visit QkCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outlne O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:// ArrivaI Time: Departure Time: County: 25 Region:
l
Farm Name: i G/d/tt� /-GzCr �GL✓1� Owner Email:
Owner Name: AZL::., ,STI tom' o- r r' Phone:
Mailing Address:
Physical Address:
Facility Contact: 2� %C y- % !2d�r�- Title: -4axtu= Phone No:
Onsite Representative: ., Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =I
=u Longitude: =0=1 0 „
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Design CurrentSwine
❑ NE
Egurrent
C►opapulation
Wet Poultry
Capacity Population
C►at#le C•apaeTy Populatlon
❑ Wean to Finish
10 Layer
❑ Yes
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ NA
❑ Dai Calf
Feeder to Finish D
5?LNo
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poaltry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
❑ Layers
El Beef Stocker
El Gilts
❑Non -La crs
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
El Turkeys
Other. ❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
5?LNo
❑ NA
❑ NE
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 ;E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strncn,rc� I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C9 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 [:INA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? J9Yes [--]No ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J,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 JKNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any'required buffers, setbacks, or compliance alternatives that need ❑ Yes D]Vo ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
�T>J C'Bn/lp l Gcs��al.S t� �F�'� �►�''f� � ''��pu v !�z'.���+'�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
FU Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Eallo
❑ NA
❑ NE
18,
is there a lack of properly operating waste application equipment?
❑ Yes
2 -No
❑ NA
❑ NE
Comaicnts (refer tti'questinn #) Explain any YES3answers andmr any recommendations orYany other comments
Ilse drawings of tacilhy'to better explain situations'(usc atldittanal pages as necessary):
u e— 9h.
�T>J C'Bn/lp l Gcs��al.S t� �F�'� �►�''f� � ''��pu v !�z'.���+'�
Reviewer/Inspector Name _ � -. r n �.�.�• Phone:
Reviewer/inspector Signature: Date:
12/28/04 Continued

S Facility Number; Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [SNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
FX[No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
5No
❑ NA
❑ NE
❑ Yes
f4 No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
J$ No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/28/04

e.
Division of Water Quality'
=Facilityumber O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: :iso Departure Time: ' ( County- Region:
Farm Name: 11 Q Cr Owner Email:
Owner Name: il% �Gi'1 Q to / �� 1 fit✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
r�?/ii I ���'/ G/Title:
Onsite Representative:
Certified Operator: �`7f
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator: YVarw
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =4 = Longitude: =° 0 d =11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: Ej
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IRNo
❑ NA
❑ NE
❑ Yes
[�J­No
❑ NA
❑ NE
12/28/04 Continued

R` Facility Number: — Date of Inspection — —a
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):
Observed Freeboard (in):
❑ Yes [,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cg -No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
'
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
®.No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Da any of the structures need maintenance or improvement?Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
3 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
EgNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9 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) c f�jCi`yyLt i� 115VeCSt—!'J
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?
9 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
17. Does the facility lack adequate acreage for land application?
❑ Yes
JM No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
12,No
❑ NA
❑ NE
Comments (refer to questions#) Explain any Y>a5 answers and/or any recommendatlans or xny other comments.
.Use drawings of facility tohetter explain situations.'(use°additional pages as nccessary):
/ f x �D",GQ�G�G� �Y i^ 4�'✓�� �"� ���' �..`3•� ��Y'f� � �u �f.� r� �G! / V ��1�rr✓
�
�/'t�3��- ! k�5 C!J � ��r✓� �J%/� ��Uf� �` tet- �..�-'-u�
®1 7-0 Arc ovn.s
GC ` vte
1owl
Reviewer/Inspector Name x _ Phone: 9JP�`�—��1�
Reviewer/Inspector Signature: Date: xq
Page 2 of 3 12/28/04 Continued

_1 Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JU No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
54 -Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No [:INA ❑ 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
9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
eh -
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2RNo
❑ 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
[9 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
ENNo
❑ 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
[ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,Yes
�o ❑ NA
❑ NE
F S
AdditlontihComrtt,'entsand/or Drawings
rL�s , r���c� ��'�5�r; �► �.s fir; n
v
eh -
Page 3 of 3 12/28/04

iv.
sion of Water Quality,
Facility Number 0Division of Soil and Water Conservation
0 Other Agency r 5
I
Type of Visit &compliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit (34;�utine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: O County• S �`� Region:
Farm Name: , w Owner Email:
Owner Name: L tf'-o r Phone:
Mailing Address:
Physical Address:
Facility Contact: Lt✓Title:
Onsite Representative: Sim�_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: Iwol<
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=6
Q Longitude: = ° = d =a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
-- ❑ Layer
: I ❑ Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design. Current a
Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heife►
❑ gry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
PINo
❑ NA
❑ NE
12/28/04 Continued

T
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
K.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 9
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
[I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement`?
® Yes
❑ 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
W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
& No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CR 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 DrifE ❑ Application Outside of Area
12. Crop type(s) Ax t� /[ ,��gJrlt /1,� /✓�
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
17. Does the facility lack adequate acreage for land application?
❑ Yes
k] No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
&No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better_ explain situations. (use additional pages as necessary):
E? U,le W e r
Reviewer/Inspector Name w
Phone: 9'YD if .33-33 d<:)
Reviewer/Inspector Signature:
Date: /D 2-Z 07
12/28/04
Continued

R
i Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0—Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JMNo ❑ 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
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PLNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J@ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�LNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2!�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
EgNo
❑ 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
Z -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
P[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
al Comments and/or Drawings:
12/28/04

O
l
Type of Visit compliance Inspection O,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: Q Departure Time: ,� County' Region:/—g=
Farm Name: Y L j!f01'hrr' fir/ a0-2_ Owner Email:
Owner Name: %%%.' ` a e [- _ Cmc �Ir Phone:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: T _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=I
= Longitude: =0=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes jo No ❑ NA ❑ NE
❑ Yes
(rNo
El NA
EINE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
' No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
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?
a, If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3��J
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [@ No ❑ NA ❑ NE
❑ Yes Z No [:INA ❑ NE
Structure 5 Structure 6
[:]Yes ,K No ❑ NA ❑ NE
❑ Yes W 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? X 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)
❑ Yes
rZ,,No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require❑yes
❑ Yes
Mf No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
❑ Yes
WNo
❑ NA
❑ NE
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
k, -,,,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 D
rift ❑ Application Outside of Area
12. Crop type(s) &�i(.es�dl�"az�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ea No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rZ,,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
�-
Reviewer/Inspector Name �'{ T �/ i"a Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: — l Date of Inspection ®-v
4 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q& -No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [__1 Maps I--] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 13KYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 5Li 20 Minute Inspections ,SMonthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
'RNo
❑ NA
❑ NE
23.
If selected, did the facility fait to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
§4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
01No❑
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
M No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
EK 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
4No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector 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
s F
Additional Cannments and/0,Drawings. :.. * ' d. �; ; �,e� k; � ► °. ,>ti
.�rl �� �� �®� i'�a � �Z. z�vr�r s i'" yrr�r pL �✓�d� /gyp ryi ;-�
12128/04

Date of Visit: Time:
Facility Number //
Q Not Operational Q Below Threshold
93'Permitted M Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ....................
Farm Name: .......m.: 7a1 �........C�r fe_ .....Farr;;, ................................ County:........�.�c �'.��.'�........................ ...�R.......
OwnerName: .... ....... n% ., . za....... ......... C.0.c.±.a.&..................................... Phone No:.......................................................................................
MailingAddress: ........................................................................................... ......................... ..................................................................................... ............. ............
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative:......I .i4� .......(za.! Qr........................................... Integrator:.....rn! lc.j�?Lt ........... rowu................
Certified Operator:..............0................ Qag�7j..%L...................... Operator Certification Number: ..... J.7go� �...............
Location of Farm:
(1 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 9 41
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes [M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes `$j No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............�................................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

IF cility lumber: f'a — f Date of Inspection 27 d
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan? .
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ® Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes j No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ej No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN J� /I Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &rMV764cx /T4N / Zi""I C="j Z Co" TWk t,-+ � So
13. Do the receiving crops differ with those designated in the Certified Anima! Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [ No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ® Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes R No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
�ammenrs trezer�ry quesuon �� rapuan any,, � ra;answers anarvr any recou�menaauvm�vr,u_ny�w�er cvmmenrs .!•',,+ ,�:�: �
Use€ draw�ngs'tofv<�c�iiity�ta iietter.explain a�titatious:,(use`ipadditionsi,pages as necessary}�, Field Copy ❑Final Notes
i:, � tit } L�.+�: +i' � ' s��'�E��F F fry; �N3 � $ "� � �� 4`i' �' �':�lr tr ,f�;� ��3'" �'�'"�'i+'����€����M.r`_ `=.!a ��:'�� �,`!�t' : � �r?.wL:'""°�._�".��'.^` u`.`�`"!�;:�'�`+�'-,:; �,,,�•"�"-" �
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Reviewer/Inspector Name V0,0
Reviewer/Inspector Signature:
12112/03
Y, e- o✓e- jP055 )D\e_ CLVrn . w.aLS,
Date:
Continued

Placility ]'Number: ga — //4 1 Date of Inspection If 1�7 d
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
® Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Pian readily available?
7 !A' 1 oN ' a • g off- I� � � � s � �� �.:,-k-.
�1 /14• I �`r - a'� 31 1(��r, Ca���.. had s',�,,� arm b� or.
!1 % 10!03 2 '..,.� d \t cr,�:yc�-4;oA eve-tj+s.
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
23. Does record keeping need improvement? If yes, check the appropriate box below.
9 -Yes
❑ No
[Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C@ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
M No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additivaal problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) M Yes ❑ No
31, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ® Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ® No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
0"1'20 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during oris visit You will receive no further correspondence about this vi5s�iL
_ '� 1Q ., 4Y K'l 1 3 �i34aRV IC� { P e § = d����: Pil3i3i f �i t silo '. G'41Cci^ft d i g f# Y P:t f fit d t�'993z F ,L B �f(i� Lry;a F in' Ki f
ddltlonal Caiiim+cuts:attd/or�iawrngs
i 2,0043. '� - Pe
7 !A' 1 oN ' a • g off- I� � � � s � �� �.:,-k-.
�1 /14• I �`r - a'� 31 1(��r, Ca���.. had s',�,,� arm b� or.
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r►
12112173

Itoutinc O Com laint O Follow -u of DW ins cction O Fallow -u of [)SWC review O Other
Date of Inspection
Facility Numberi 6 Time of Inspection [a= 24 hr. (hh:mm)
U Registered © Certified © Applied for Permit 0 Permitted 113 Not OperatiogaA Date Last Operated: .,,•.,..,,,•,,,,
l/ IYPIYPPI ,••..•.•••
Farm Name:.......!lrit.(.... County:..........,A' x�............................................
r..../ .....................................................
0Owvner Name:.........!i .��Pf.IEC Phone No,/B�. ��— ..�%2.,�.............
FacilityContact:........I.,�! h(.....e �.... Title:-, ............................................................. Phone No:.................................................
MailingAddress: ....... AF.01...... el ....AC..... zze.......................................1. ..........................
Onsite Representative: ............. ............... I ....... Integrator:... �.................
Certified Operator ............. 14(17 .. ,, . —/ !........................... I ............... I...... ' Operator Certification Number ,....... %..79.,Z:l...........
ocation of Farm;1001
................... ........................... ..........
........ ................... ,�.................................................................... ..................................................................
t...l��rTr ...:� ? R ............�.... !!!! :...Q ! .,. „cr'lr.����1^ .r .............................................. r
Latitude • ' �6 Longitude • 0' "
❑ Wean to Feeder
Feeder to Finish Jor7,2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
..
,Design
n PoalfryCapacity
Cattle 10
u r.ayer I I I du uairy
❑ Non -Layer I I 1 10 Non -Dairy
❑ Other',
i" Total Design Capaeity
G k ,•:. .. -
Tota1 SSM
Nurnbet pf I.aggons Holdin$Ponds '� l �' 10 Subsurface Drains Present J10 Lagoon Area J❑ Spray Field Area �E
10.
5 ❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface.. Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga]Imin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than ]agoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125197
❑ Yes 9 No
❑ Yes 19 No
[:]Yes No
❑ Yes No
❑ Yes ;9 No
❑ Yes to No
❑ Yes 4 No
❑ Yes P( No
❑ Yes KNo
❑ Yes ;4 No
Continued on back
,
Division of Soil and Water Conservation
❑ Other Agency`
'
Division of Water ualitY
�
�,
�
{�,'°t`.
^'.`�s+-`'r,._^_'N.�.."":.:....�.�.'.,."p�.^."x�M.:e' _S.s.°`!�x—�—w.xi�i';. x-�n••,��...yr...u...,.w.
e, a`�ess."""�w.::.:•'�4M..""".u..;;k W��� R t YJk..
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a.`k(
�..`i�.s.z
..:
Itoutinc O Com laint O Follow -u of DW ins cction O Fallow -u of [)SWC review O Other
Date of Inspection
Facility Numberi 6 Time of Inspection [a= 24 hr. (hh:mm)
U Registered © Certified © Applied for Permit 0 Permitted 113 Not OperatiogaA Date Last Operated: .,,•.,..,,,•,,,,
l/ IYPIYPPI ,••..•.•••
Farm Name:.......!lrit.(.... County:..........,A' x�............................................
r..../ .....................................................
0Owvner Name:.........!i .��Pf.IEC Phone No,/B�. ��— ..�%2.,�.............
FacilityContact:........I.,�! h(.....e �.... Title:-, ............................................................. Phone No:.................................................
MailingAddress: ....... AF.01...... el ....AC..... zze.......................................1. ..........................
Onsite Representative: ............. ............... I ....... Integrator:... �.................
Certified Operator ............. 14(17 .. ,, . —/ !........................... I ............... I...... ' Operator Certification Number ,....... %..79.,Z:l...........
ocation of Farm;1001
................... ........................... ..........
........ ................... ,�.................................................................... ..................................................................
t...l��rTr ...:� ? R ............�.... !!!! :...Q ! .,. „cr'lr.����1^ .r .............................................. r
Latitude • ' �6 Longitude • 0' "
❑ Wean to Feeder
Feeder to Finish Jor7,2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
..
,Design
n PoalfryCapacity
Cattle 10
u r.ayer I I I du uairy
❑ Non -Layer I I 1 10 Non -Dairy
❑ Other',
i" Total Design Capaeity
G k ,•:. .. -
Tota1 SSM
Nurnbet pf I.aggons Holdin$Ponds '� l �' 10 Subsurface Drains Present J10 Lagoon Area J❑ Spray Field Area �E
10.
5 ❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface.. Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga]Imin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than ]agoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125197
❑ Yes 9 No
❑ Yes 19 No
[:]Yes No
❑ Yes No
❑ Yes ;9 No
❑ Yes to No
❑ Yes 4 No
❑ Yes P( No
❑ Yes KNo
❑ Yes ;4 No
Continued on back

0
Facility Number:,?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,l-folding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stntcture. I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (Ft): ......... ....... ..................................... *.................. ..... ................ ....... ................ ..........
......,......,...
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ll No
[:]Yes
,1 No
Structure 5 Structure 6
❑ Yes
R9 No
Pa'Yes
❑ No
❑ Yes
$No
15. Crop type !¢ ....CO........................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP).
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Ce ille or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily. available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
El Yes �] No
❑ Yes No
? 19 Yes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes I�No
PrYes ❑ No
❑ Yes C9 No
❑ Yes R No
❑ Yes I@ No
0' No.vio'latlons'oC deficiencies. were: n6ted-du' ling this.visit.,.Y.ou.will receive ni 6tdrther: ;
0frO9Pbndenee Ah:out this°,visit.:
,11• ^C. ,sys�-:• �v �,��.-� .Ea.�•�+✓ a!✓�' y�G� �p�r,�a.�+�.�aas�s"J +
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zz..�. 4.14 ww-w& r6
7125197
Reviewer/Inspector Name
Reviewer/Inspector Signature: �w���, _ Date: Q'
0' No.vio'latlons'oC deficiencies. were: n6ted-du' ling this.visit.,.Y.ou.will receive ni 6tdrther: ;
0frO9Pbndenee Ah:out this°,visit.:
,11• ^C. ,sys�-:• �v �,��.-� .Ea.�•�+✓ a!✓�' y�G� �p�r,�a.�+�.�aas�s"J +
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zz..�. 4.14 ww-w& r6
7125197
Reviewer/Inspector Name
Reviewer/Inspector Signature: �w���, _ Date: Q'