820122_INSPECTIONS_20171231

NUHTH CAHULINA
Department of Environmental Qual

lyAl;�1,...nDIVIS14n of�.WatEr•ResonrcCS ,.,, i . 6! , ' i
, 1QIDlvislon of Soil and MaterRonservationi �, E
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: p Arrival Time: �d0 Departure Time: County: 5af!teSo4 Region:
Farm Name: t Owner Email:
Owner Name: r,-YY'tQS — ���•( t4i Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: , N
t.r
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Disebarizes and Stream lmnacts
Title:
Latitude:
!
Design Cu
,iip �� !i 1,1, �j�
�t Poultry Capacity P
11
-4�F•rn4, 'a=Ar
1
1s ,Dry.,PoulftydI
Layers
Non -Layers
Pullets
Turkeys
iTurkey Poults
Other
Phone: /
Integrator: JIGI r�
Certification Number: 200y
Certification Number:
.Design'; Current,,,.'
Ca aci '1'..:' Pop.;
:,,.
Longitude:
Design Current
Cattle Capac€ty Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
❑ No
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 l of 3 21412015 Continued

,[Facile Number: - "tZ_ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
'Structure 6
Identifier:_
Spi l I way?:
Designed Freeboard (in):
Observed Freeboard (in): LJ.{ + 7 X
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�,,No
❑ NA
❑ NE
waste management or closure plan?
TT"'
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDUCHHOn
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes gpNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. C] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Win rift
� ❑(tApplliicattio`n Outside of Approv d Area
12. Crop Type(s): 4,__1 /�S��i1�+'1� L
13. Soil Type(s): [r.—
14.
Do the receiving crops differ from those desig ated in t e CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?.
[] Yes
No
[] NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
P No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
t�i 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 1�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 214,12015 Continued

Fncili Number: - Date of Ins ection: 'J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �5 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
[64No ❑ 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
1�No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
No ❑ NA
❑ NE
Comments (reter'to'g°uestion #): Explain any YES answers and/or any additlonai reeommendatilons,ar,any, nthercomments
i,. :, �•. ;..�. A li ,: �(¢ .•tE:. €.-. Yt'. N+„ •.l i .�!'.li t; o s-;n.: rr ,tsk'�. `y ,SIL:,.t1 d�, n.l.,�5t!!i r3=„ � ti i ,1- lr- :I'1` i- Eil.;,. , i,. ,t+,44... i.,tSr
�1 ija 1.9w
13.i. �F 4sw4li� i 9fl�'., tl�j• 11 �.F • ��1 Alit itF' ,.' �6f. i,�1 4i�v ! f{�: i�lj� �� �.. 9€ iR � 31. 1St�fi� •I:l�lil �i,l�l 1143 It;'• � i. 1 :51 "� �`
Use,,dreings�to
'
of�fncili bettcr,explain siluations;(usc�udditionul ages=as; nei essary). ;
Reviewer/Inspector Name:
Phone: �/�•-33.�
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412015

it
ivision of Water Resources
Faellity Number - 22z- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: J)oWmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QJMf'tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I W 6 lapArrival Time: 006arture Time: ounty: Region: ' rD
Farm Name: -G.4 Owner Email:
Owner Name: E&W_ Phone:
Mailing Address:
Physical Address:
Facility Contact: rV0FX* -4 UQUU Title: Phone:
Onsite Representative: N
Certified Operator: t
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
Integrator: K&`&
Certification Number: WU Y� 4,
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultrj Capacity Pop.
Layers
Non -La crs
Pullets
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-DaiLy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes VNo DNA ❑ NE
❑ Yes
❑ No
-&3"NA
[ NE
❑ Yes
❑ No
C i"r`
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence oi'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
420<A
❑ NE
❑ Yes
j2No
❑ NA
❑ NE
❑ Yes
O;ro
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: r Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ulflo ❑?NA
❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Sytr ye 2 Stru u Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in): � V"D p2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�1 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2 1Vo ❑ 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 &� lVo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FR<o [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require ❑ Yes & o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2lo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land. application? If yes, check the appropriate box below, ❑ Yes �No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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
E;'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rV'No
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&rN—o
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[[20No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
<0
❑ 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
[4o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
j(NA ❑ NE
Page 2 of 3
21412015 Continued

Facili 'Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes e'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes [., 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 provide documentation of an actively certified operator in charge? ❑ Yes o❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes G;JO " ❑ 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 to ❑ NA ❑ NE
❑ Yes 53 N ❑ NA ❑ NE
❑ Yes eNNo ❑ NA [3 NE
—F] Yes [?'�o ❑ NA ❑ NE
❑ Yes
&2 No
[] NA
[] NE
❑ Yes
E;?No
[DNA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
(Comments.(referjo question #) Explain any.YES answers and/or any additional recommendations or any other comments., , I
Use drawings of,facillVio°better` explain situations"(use additional pages as necessary).
A Aj
%W�V4 f�Vy�t M.,__ �
(bW `*ty� -24
t c je
)],ease, OLd
Reviewer/Inspector Namc: [y'tL.r i.o -
Reviewer/Inspector Signat 0;42 �'
Page 3 of 3
Phone: /16jfi
--,,�
Date:
2 �01

S
Division of Water Quality
Facility Number ®- -j2Z O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 10 Compliance inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:® Departure Time: D : GR[i w. County: S NL W Region:
Farm Name: Fc pl'es Owner Email:
Owner Name: �r6,K 19 d w[ Phone:
Mailing Address:
Physical Address:
Facility Contact: S L.OrLtTitle:
Onsite Representative: H
4
Certified Operator:
Phone:
Integrator: �iti✓��✓h
Certification Number: Z400 7
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[ILaXer
Non -Layer
Design Current
Dry Poultry CanaeitV Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharaes 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 61;Icity Pop.
Dairy Cow'
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
�,0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 � � 21412011 Continued
W

1.
Facili Number: Z - Z2 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �,Sr. 2 *7 3 Q N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes n No ❑ NA ❑ NE
(i.6., large trees, severe erosion, seepage, etc.) "R
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [4 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
T_
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
❑ Yes
❑ Yes
® No
�a No
No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes % No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes `P No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

d Faclli Number: jDate of Inspection: 3 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes TV No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �@ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Yes
❑ No
❑ NA ❑ NE
g] 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
E�j No
F] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any,other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9,&— 3 3
Date: 31,17
21412011

Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation '
0 Other Agency
Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Q Q Departure Time: County: 5' S Region: EgQ
t
Farm Name: _1�ri1 _ ? :— Owner Email:
Owner Name: �rnes4- /4, OG1tLcm Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: j?
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:
1 Integrator: hd 1'L)h
Certification Number:'���
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
JHLayer
Non -Layer
Pullets
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes FLNo ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
[] Yes ❑ No
[:]Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

F cilit lumber: - Date of Inspection- ID
2-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f9CINo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ENo
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �� J, $MIJ j %es�
6'---
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z3 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 4-5 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
�Outside of Approved Area
12. Crop Type(s): Coos-W 8?.,ra �s�+ /:-Sf1t�.� d t [��-,r'r►. tt' , , f
13. Soil Type(s):
14. Do the receiving crops differ from those desighated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination`?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
_Required Records &_Documents
19. Did the facility fail to have the' Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Z3 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes 49 No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Y] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fp No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

FacilityNumber: Z_ - / Z Date of Inspection: jo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge
levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 55 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes fp No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail tq 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 rMNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
l
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers;andlor any additional;:recommen dations or any other cammerits. �' 'gip
Use drawings of facility to better explain situations (use additional pages as necessary).
w.,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910"yw—Bly
Date:..,. 10/12
L12,
21412011

i
or v

Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: -- r� Departure Time: D� County: A�uAl Region:
Farm Name: ram' Q 4' CV01 , ci- s Owner Email:
Owner Name: 43
Mailing Address:
Physical Address:
Phone:
Facility Contact: 5� I OJO^ Title: Phone:
Onsite Representative: Integrator: coy__ L LC'
Certified Operator: Certification Number: z4o ,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Desi n
C*apacfty
I
C•urrent
Pop.
Design C«urrent
Cattle Capacity Pop,
Dairy Cow
Wean to Feeder
Non -La er
I
El
Dairy Calf
Feeder to Finish
Dr, P,oultr,
Design
Ca aci
C►urrent
Pop.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Giits
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
`T No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ElApplication Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
§g NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
jZ No
T�
❑ 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 21412011 Continued

Facility Number: PT - Date of inspection:
0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
1,
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
[] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
r 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
`T � No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fl No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Window Evidence of Wind Drift ❑ Application Outside of Approved Area
+Crop
12. Crop Type(s): l ilk JJ<+,. L1�'�� t�
Q/k4y
s
13. Soil Type(s): LPe-i a A/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
( No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�Ij] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
No
0 NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design [3 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �9 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Fa ilit N mber: - 5 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? t
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
r
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
tR No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
Ej5 Yes
[] No
❑ NA
❑ NE
FApplication 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 add itional=reeoretrnendatinns ar anytvther comments; `� .
Use drawings of facility to better explain situations (use Adilitioniil pagesas necessa ) .��
Reviewer/Inspector Name:
Phone:
Reviewer/]nspector Signature:
Date:
Page 3 of 3
21412011

l ype of visit: W Uompliance inspection U Operation Keview U structure evaluation U I eennical assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [p� r Arrival Time: i p Departure Time: County: a0N
Farm Name: �__ OCLO rA �C 5/ Owner Email:
Owner Name: f- A,I Q._, Oc�r-, Phone:
Mailing Address:
Physical Address:
Facility Contact: fnD�, Title:
Onsite Representative: H
Certified Operator:
Region: 00
Phone:
integrator: J ' if�f �W' G✓✓I l �.+<-�
Certification Number: .7_i )oqq
Back-up Operator: Certification Number;
Location of Farm:
Latitude:
Longitude:
Design Current
Design
C►urrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Fop.
C+attle Capacity Pop.
ean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eder to Finish
Dairy Heifer
arrow to Wean
Design
Current
D Cow
Farrow to Feeder
FaP_�rPox14%C•_a
aei.
P,o ,
Non-DairyFarrow
to Finish
rs
Beef Stocker
Gilts
Beef Feeder
Boars
—.Non-Layers
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:
❑ Yes ,NNo ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes.
[]No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[]Yes
[-]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
_ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili umber: - "a 'a- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
NA ❑ NE
StructureStructure 2 Structure 3 Structure 4
Structure 5
Structure 6
``I
Identifier: _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): $
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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 T 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
[5;No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsidej f Approved
Area
12. Crop Type(s): s-L( . L ) , . - �
se-
13. Soil Type(s): 1 "a-r4a [ L__—o'5. WGteirC�„� -
14. Do the receiving crops differ from those designated m the CAWM
� P�
Yes
No
�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
T� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jp No
TT
❑ NA
❑ NE
Repuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
t No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�j No
❑ NA
❑ NE
the appropriate box.
TT''��
❑WUP [--]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 [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

JFac11Lq\ Number: - jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
T
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
FApplication 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?
P Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations-.orA any other comments
Use drawings of facility to better explain situations. (use additional pages as:neeessary). "; r
AkA I m V�h -�1-�K 1��;b-u Dj44 l�StvC �'�►S d
5-13f / l l r �/�� I
_ v " SSW C
• �p �- ,D r.�Q A-
I V`� �" 5 '7 _
5oc- �r,d Jt4
pcJ� YVAR, re_— fje►— CC�s� �ftCt�) DeC— 20//
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %D3 31V
Date: 6 AL�/
21412011

ij
Facility Number F�MI
i Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I�q 1170 Arrival Time., Departure Time: 1. Qti I County:
Farm Name: _ f!f►�LJtsthm _�I� ' _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: f
Facility Contact: 74A 0661 Title: Phone No:
Onsite Representative: Integrator:
u
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
,Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Latitude: ED
0
Back-up Certification Number:
Region:
0" Longitude: = o = ' = "
0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other_.--
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [j]
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes '�;No ❑ NA ❑ NE
❑ Yes
❑ No
[ iNA
ElNl `'-
❑ Yes
El No
( NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
'MNo
/11
❑ NA
❑ NE
❑ Yes
t§No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

j Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No PNA ❑ NE
S ructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:LIM.-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zsu 2,4 U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JU No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes
6No
❑ 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
Q No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�No
El NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
t
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
),!�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence offWind ❑ Applicati n.Outside of Area
Crop
�Drift
1 �t3�r�t"
%��
aqsod
12. type(s) K
G
� `""�,�
13. Soil type(s) f%4k_/Vb
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
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
RNo
❑ NA
❑ NE
Comments(refer to question.#t) .Explain any YES answers andlar anytrecammcndatians or any other eommentss�) f
Use drawings of facility to', etter explain s..ituatlons:°(use, additional page es�necessary):* - r � � �,, ^ ��
ReviewcrlInspector Name ft`'fl Phone: �J OD
ReviewerAnspector Signature Date:
Page 2 of 3 12,128104 Continued

Facility Number: — Date of Inspection
ftwired_Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20., Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �1] No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j�$No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document .
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
t}No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes
❑ No ,,B NA
❑ NE
❑ Yes
§allo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[PNo
`�
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
AdditlonaYCotnments audli►r' Drawin s:x
,,. .. g.
Page 3 of 3 12128104

I
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / O Arrival Time: 5 Departure Time: ��� County:
Farm Name: �rrfesuvr� Owner Email:
Owner Name: l_QP4 Phone:
Mailing Address:
Physical Address: ,� /
Facility Contact: f'"� /� �4&y t-t-7f?t"` _ Title:
Onsite Representative:
u
Certified Operator:
Back-up Operator:
Location of Farm:
Region: f--' —O
A^ Phone No:
Integrator: -'t3Mwr
Ft LLC-
Operator Certification Number: v100Ti4
Back-up Certification Number:
Latitude: 0 c =' 0 " Longitude: = ° =' = "
MENIesign Current Design
Gnrrent JILCM.n
Current
Capacity Populatioq Wet Poultry Capacity
Population Cattle
❑ Dai Cow
p=ty
Population
Finish
ir
❑ La er
Fceder
❑ Non -La er
❑ Dai Calf
Finish Oa Z
El Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
El Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Cow
❑ Turke s
Other. 111 ❑Turke Foults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at:. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
C!�NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No 5bNA
❑ NE
❑ Yes
'�No
El NA
❑ NE
❑ Yes
t?No
❑ NA
❑ NE
12128104 Continuer!

Facility Number: — p?a- Date of Inspection �Q
Waste Collection & `Freatnient
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No RbNA ❑ NE
Stnteture I Structure 2 Structure :3 Sttucture 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): - -
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes {A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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? El Yes r] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EpNo ❑ 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 0 Yes [�No ❑ NA El NE
maintenance or improvement?
Waste Auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O§No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes DVNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence ��of Wind Drifl [:]Application �_/Outside of Area j /
12. Crop type(s) COczS�u� n�uda VYYiS S lrl�i�� st'' `" 41 'K, Xi ; laP 1'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YYNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Wo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�5No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Q,y Phone:
Reviewer/Inspector Signature: fV41tw Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes JpNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O�No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %LNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 1� No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes '3 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IoNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_PNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
io
❑ NA
❑ NE
Other Issues
vv
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
*o
❑ 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
[5�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
Wo
❑ 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
Q, No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2p�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 40 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Tfine: Departure Time: � County: 34-y%-,PSGVJ Region: _-
Farm Name: ftt_n ...ilr, Owner Email:
Owner Name: Prv_k_C�-_A'__ cau r"A Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: to
Back-up Operator:
Location of Farm:
Phone No:
Integrator: / f
Operator Certification Number: °� `f
Back-up Certification Number:
Latitude: 0 e= 1= a Longitude: 00= f=
Design Current
Design C►urrent Design Current
Swine C•apucity E'apulation
Wet Poultry C*apaeity 1'opulatian Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish A 5
❑ Dairy Heifer
Farrow to Wean
Dry Paultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Beef Brood Cow
❑El
Turke s
i�ther
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Dischnrees & 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 [N No ❑ NA ❑ NE
❑ Yes
❑ No
1p NA
❑ NE
❑ Yes
❑ No
Q3NA
❑ NE
�TNA
❑ NE
❑ Yes
❑ No
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Gate of Inspection t"f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes T�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2NA ❑ NE
Stru turc I Stnicture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
h �
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LF 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? 0 Yes 'un 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 El NE
maintenance or improvement?
Waste Auullcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EoNo ❑ NA ❑ NE
ntaintenancelimprovement7
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 Ibs ❑ 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) t jL.Ik � :S�' -5
13. Soil type(s)
L I W e%
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ 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
No
❑ NA
❑ NE
,Comments (refer to question #)t 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):
1W
Reviewer/Inspector Name e7l Jn Phone:
Reviewer/Inspector Signature: Date: /

6. 4
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes {$No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA [:1 NE
the appropirate box. ElWUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? IDyes, check the appropriate box below. ❑ Yes )E] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V)No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27..
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Rlo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[5jNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
10 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
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:, r< d ,.
Page 3 of 3 12128104

r Division of Water Quality
Facility Number O Division of Soil and Water Conservation
D Other Agency
Type of Visit @ Com liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit tine O Complaint O Follow u O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 4 Arrival Time: 50 -1- d Departure Time: County: � "'7-� �� Region: 1450-0
Farm Name: _ Orn(IlL &&O ' Owner Email: Owner Name: ^ On eq� Al2� Phone: 610
Mailing Address:
Physical Address:
Facility Contact: ZAA''J Title: Phone No:
N
Onsite Representative: Integrator: ,Nlt1'rD &yct)
Certified Operator: u Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = 1 = Longitude: = o = i =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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?
Page 1 of 3
❑ Yes ❑ No ❑ NA �NE
❑ Yes
❑ No
❑ NA
E
ElYes
ElNo
ElNA
E
❑ NA
to'NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
T�LNE
❑ Yes
❑ No
❑ NA
9 NE
12128104
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):
❑ Yes ❑ No ❑ NA 1P NE
❑ Yes ❑ No ❑ NA [PNE
Structure 5 Structure 6
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
❑ 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 P NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA [*NE
maintenance/improvement?
`t
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA 7 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
THE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
P 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
[PNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
CommentsI �
I'Viawaa(refer toquestion #)ExplainanyrYcES,answers ands/ar any "recammendatinns ar any other comments.
i]scdawings�affacility to` hotterexplain sttuatians(use a[Iditionai pagepsf#as necessary):
"I
Reviewer/Inspector Name - I phone:V33
Reviewer/Inspector Signature: Date: S
Page 2 of 3 12128104 Continued

• Facility Number: 22 79 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA qZNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA JM NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA FINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
lbdNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
PNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ 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
❑ No
❑ NA
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
1t
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
MNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
E�NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
ENE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
1�NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
ONE
33.
Does facility require a follow-up visit by same agency?
ElYes
[INo
NA
[I,
Ib NE
Additional Cott rnintsandloir Drawings '` y _'� x
�;2q. co ; t?S �- C.li46ra-��
7 � �
�ece_1t'- vQ_,d -P,,o►M
Page 3 of 3 12128104

Division of Water Quality
Facility Number 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 ❑ Denied Access
J
Date of Visit: 7 Arrival Time: l Departure Time: County: S4r1 Region: EILD - -_
Farm Name: Ernes 0:1urv, Owner Email:
Owner Name: ErrA-e5 ~t �
A . uw, Phone:
Mailing Address:
Physical Address: j
Facility Contact: AW 4.,, fbu 0+ _ Title:
Onsite Representative: `4
Certified Operator:
Phone No:
Integrator:
Operator Certification Number: 'Loogq
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [---] 0 0 ' 0 Longitude: 0 e 0 ' 0 «
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ 13oars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
FRa er
on-Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry 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?
Page I of 3
❑ Yes ;'W"No ❑ NA ❑ NE
❑ Yes [--]No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes P?No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: SA 1
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?
Str cture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 41 Q
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 ❑ No NA ❑ NE
Structure 5 Structure 6
❑ Yes R No ❑ NA ❑ NE
❑ Yes JE 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? A Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures 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 &No ❑ NA ❑ NE
maintenance or improvement?
Waste Apl2lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes P No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes $@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of
Acceptable Crop Window El Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) i l�si Li"a5 ) Gnu\m
13. Soil type(s) lk—`tOA I A20A
T'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes tO No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5PNo
❑ NA
❑ NE
�Comments�(refer ta`�q estion�#),1~bxpinin nny Y+E�S answers and/or uny recommendations or any other comments.
Ilse drawin s of facili tolbetterfex lain si.tuationa. (use ndditlonal pages as necessary
7� Mow 1Q5oow qtVk euxd s/ems 'qs s-oon as
Reviewer/Inspector Name Phone: 3 33�
Reviewer/Inspector Signature: Date: y 0
Page 2 of 3 12128104 Continued

a . 'L
Facility Number: 14 Date of Inspection '% 0
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ri, No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
®Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
19 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
?No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
' No
ElNA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;jPNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
.0
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
MNo
❑ 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
M-No
❑ NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
Additional Comm',nfs,and/or � w€ngs:
Dra H
a(f/�
a
, A
Page 3 of 3 12128104

.Division of Water Quality
=Facilityumber, Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason far Visit Routine 0 Complaint O Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 9 I Arrival Time: Departure Time: County: �M Region:ZWO
Farm Name: Cen& _ xm l __— Owner Email:
Owner Name: _ E'rr1 eS �- Ojut" Phone:
Mailing Address:
Physical Address:
Facility Contact: k 44.4i' jk m Title:
Onsite Representative: 14
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish UD0 A 'b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = 0
Phone No:
Integrator:"tU�✓Ya�h ��L� t7
Operator Certification Number:
Back-up Certification Number:
i « �O❑' ❑"
Longitude.
Design Current
Wet .Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Imnacts
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
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: FTI
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 TNo ❑ NA ❑ NE
❑ Yes ❑ No [P NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No 0 NA
❑ NE
❑ Yes Ep No ❑ NA
❑ NE
❑ Yes �RNo ❑ NA
❑ NE
12128104 Continued

acility Number ,.
_ Date of Inspection
Waste Collection & Treatment
4. - Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
19 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P9 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
E 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 RNo ❑ 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 C5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CH No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA FINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lb ❑ 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) 440". Pas -v- e) , A. Op--erSr-ad . Cat, a,/l�► S®'h �eaHs
13. Soil type(s) 4,94,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
No
❑ NA
❑ NE
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
09No
❑ 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):
i
T
Reviewer/Inspector Name Phone: p `{
Reviewerllnspector Signature: Date: 47
12128104 Continued

rFacility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [IYes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 hNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
6 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
29No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes
K?No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IS No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
n No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
)CbNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R1 No
❑ NA
❑ NE
al Comments and/or
12128104

LAGOON FREEBOARD-'�kYD,, iVAILABLE STORAGE-.:C PACITY#LOG �L r
'ruut �fumbar. �z� 4g F� �(arna: �F„[�2y ZM4,MY,
Vw'ne�:: � Ir� � � {.. sl.� , -' .. ;r , . '� . •`'-V'umbcr ofla�oons at�
ry' ...�,_
�:o
pemtoc is Respoasible'.Char0Ckflcaie Manber I `
If there is more than one`ia800%iz'at' this facility, please describe is w'ords.oe by"dr4wi which Iagoon 4 idendfied aa` ' r
1 oon number, 1, oon number ?, etc, aidnote ast�c 0} which 1 oohs, if 81a ,'have desi ed illwa s. ,
PI
hee
r . � Comnllanco I.ovel 2Uslnches
. 1 • XM1.,, tiww.tiRr.gy,nl'�.1•. u1riVN+mR TF4 ST'f••�' - •• , ' 1
x . . � - � � __ �... w.�......., _,m. _....�,.., +..r.;:., .� ... :-. - . •i .. " 24 lnehos - - a
Ii +'F 30 inchEf 3.
U' l� •�M�� r �-' �{'F�1 ({I�'�i" ,� ,'.Ts ry{'sj�� i - � _^ S 4 + 4
�zMrU �; f � �'� +r�lt -0. . 3 i w r'�€ti r• �36 giches
Z=41, inches .
Id
�vRcsrsned freAhnarr•I nin.a atistilahlr#.etnrnnA rtnnaritvwPalrly in inr:hes. . • - ..<.<; :.,, +-,, �.` ti
mom
,1. Freeboard plus available storage capacity is the difference between the lowest point of, a. lagoon, embankment and I,
the Ievel or liquid. y
"For Iagoons with spi way; tnz difference between the level of liqui$'and-thclbottom of the spilltitiay should be'
k, mcorded.; E K

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 ❑ Denied Access
Date of Visit: I I Ob Arrival Time: . SOq Departure Time: -�4i� County: �g,�.SOh Region: �10
Farm Name: IM Owner Email:
Er C9roJa-ba3g
Owner Name: __ _ _n�S�_ � _Dr�t,i,vrl Phone:
Mailing Address: _qq4 _ PDSS " 4w
Physical Address: Facility Contact: w
e" ©�� Title:
Onsite Representative: c l
Certified Operator:
It
Back-up Operator:
Phone No:
Integrator: rAwky i,11,,�
Operator Certification Number: _o`t._�l7`i__
Back-up Certification Number:
Location of Farm: Latitude: [�o [� I [� 46 Longitude: =° =; ❑ 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer '
❑ Non --Layer
Other
❑ Other !
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
DairyCalf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dal
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a,
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?
�ti7 G
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
[:]Yes
[]No
55NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes C yNo ❑ NA ❑ NE
❑ Yes -� No El NA ❑ NE
12128104 Continued

1
Facility Number: + Date of Inspection l ( 3 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ®-NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,No ❑ NA
ElNE
(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. Do any of the structures need maintenance or improvement? ❑ Yes t�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes r$KNo ❑ 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? IT
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
ANo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) LDAS�t na u a S ma (t Cimeo-.n
13.•
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
PNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
M No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
allo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
allo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[�a No
❑ NA
❑ NE
Commentts�{�ref�er�totques�tion�#) t Ex�plain�nny YsESanswers.�nd�or�eny recomn�en�d�atians or an other comments.
Ilse drawings�of facility�ta�better�explain�situutlons^?(use�add,itional'pages as necessa,rsy):
r'id .� y.:`� �,re .:x � Yu.`:•i . ,s:,,,;,, _ � .u-r r � b'�.r°.��x,.l+�#5 rE:a
Reviewer/inspector Name �3
,.., Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

j . 4
M Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes] No ElNA ElNE
❑ Waste Application ElWeekly 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes §9 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ii
NkNo
❑ NA
[I 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
10 No
❑ NA
❑ NE
Other Issues
rd
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
55 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
OlNo
❑ 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
E&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
E�jNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
Ad ditional'Comments and/or Drawiq s r g^' 1'`r x ��
a " .. %.:� 4..iav vwea��!»r��n ' � E�� �
O.S. 5 l udye plain Dc A-c`o (,, v\P_ads 4,D h•e �orw ,
12128104

-- - --- � Division of Water Quali
Facility Number $a /� JIMSitiiiston-To-f#SgilFa—ndLW-Tt-e-r Conservation
Qer Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -OS Arrival Time: 00 Departure Time: County: pson Region: Fi'?a
Farm Name: F--nesk odkM_ Owner Email:
Owner Name: Er'7na� Phone: %2 17�2 ~ 6.23g
Mailing Address:
Physical Address:
Facility Contact:Title:
Onsite Representative: I /9alel ' Oea/d
Certified Operator: 1444 e A 03
Back-up Operator:
i
Phone No:
Integrator: Qrow o� C /7vr J
Operator Certification Number: �ooyt/
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 1 = « Longitude: = 0 0 d =
it
Swine
Wean to Finish
Wean to Feeder
L l Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ 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 Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: I'
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 LINO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
20N'o
❑ NA
❑ NE
12128104 Continued

Facility Number: g.� — /a
Date of Inspection S- o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Ko
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: - I
Spillway?: �o
Designed Freeboard (in): oZ q
Observed Freeboard (in): C "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0"No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El 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
❑<o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
01�o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
(I' qo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QlJo
❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q1Ko
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acce table Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
60
�o /,g yo
12. Crop type(s) ,6er, ,e rc_ Pus .re► , .5., nII Gra:eve,-s".1, 6." ; 414,a
Wig,, 4-a—
/_20
5
13. Soil type(s) Nud_.__.._.:,--•---:.--•---.,_—,.,._
14. Do the receiving crops differ from those designated in the CAWMP?
G3 es
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
EKes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:❑ Yes
Q o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA CITE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9to
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answer s,andlordany recommenda" nkm,', any other comments.
Elsedrawin s of faeilit ta�bettor ex lain sitptions. (use additionald' s esxasecessary
g Y. P. P g
I P11-uSL I ti Ile &v ./A 100n Ile a4,f 4 vs,'n9 Ae
N /al�rS GiCCprL�ir�g TO >! woj/&1O/Pn, SO� rtvr'rwr� �'Gllr 6u
y v o � GD e�aj' S 6a fore• ernr/ sr�J�y 5 arhp lea AL�.1�ie•,
Reviewer/Ins ector Name /� `
P /dark ,:,, ,.. :. �, Phone: 91O-'�A! 'ls�i�erf 7�0
Reviewer/Inspector Signature: Date: 5--
12/28/04 Continued

j . .
o d'^ l
Facility Number: R.:Z= (late of Inspection T _pS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
t!d'Yes ❑ No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
B"Yes
❑ No
❑ NA
❑ NE
the appropirate box. ❑ W�❑ C fists 2*6esign ❑ Mja� 01iet*
21.
Does record keeping need improvement? If yes, heck the appropriate x below. �• 1
'"r/,y /0_41� I& 1 5
❑ Yes
[-1Go
❑ NA
❑ NE
❑ Wast�A }ieatierr ❑ We�kl ee oard ❑ i astO,4a.akysis ❑ psi& ❑
❑
❑ R ' all ❑ 5t mg ❑ Cropx e`fd ❑ ❑ Monthlyand-l�`•Rm nspections ❑ Weather Godc
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
G?I1go
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D-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
Rio
❑ NA
❑ NE
Other issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[-lQo
❑ 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
�o
❑ 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
C3,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
2No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3"No
❑ NA
❑ NE
AdditloualCo/mments and/or Drawings::
lleeaC /o o%a►ce �o9dvn �K9� ��, Tp�,,r reton4�s Znl�sc�ir w'// sr.�c� a royy
ale
.L vJ I
nas
Covera y e G
4 i. Pleas e
! 6+ I ease
S& je
kelp CeP�, a� Gaf'�ra�un Gta1!a Wildurrn ecorc/5
/'erriov8 /l �ji /O✓erSee//c� Gr'U�p 7�rd/+� �ei'rr,-v�4 /C;c�Gt �,S�A,
1212&04

4
Facility Number aZ Date of Visit: ' 7 ,_1Y Time: : /0 M
of O�� Operational Below Threshold
��M"Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: Ltn #I County:
Owner Name: r­r^es-� 0o6►. I Phone No: o
Mailing Address: rr+74/0 4o.Stid,o H%a 4+ue.. Al .7838�
Facility Contact: AEX 140 4AE-4m Title: Phone No:
Onsite Representative: AJ4 i� Dr/r,„, Integrator: Aardhx
Certified Operator: /7S4le-z Operator Certification Number: y�.
Location of Farm:
L7 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �• �u Longitude 0 •
I
:Swrne
,Design Ct-jrrent Design Current Design- Current ..
Ca' aclty `E Population. :-�i. Pouh;Cs acitY '�"Population ;Cattle Capacity,,: . Population
Wean to Feeder
eeder to Finish
1,36no
3 G C
€El Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
1Ej Gilts
❑ Boars
❑ Layer ;'i' ❑ Dairy
❑ Non -Layer I I€ Non-Dai '
❑
Other
Total Design Capacity
.. Tota1SSLW
a Number of Lagoons t i E ❑ subsurface Drains Present 10 Ligoon Area JQ S rav Field Area
�Yf`
�" FloI ing'-Pondsal Solidx)[raps .zj,..No Li uid Waste Management System )
ffisgbaEaes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B-5o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes O-<o
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 E5110,
2, Is there evidence of past discharge from any part of the operation? ❑ Yes [ -1<0
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-Ko
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EiNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): 7
05103101 Continued

Fasrility Number: Date of Inspection'" 7'
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [}'Ko-
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes G-K-o
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 P'Ko-
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes B<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2-No-
elevation markings?
Waste Aonlication
10, Are there any buffers that need maintenance/improvement? ❑ Yes [<o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes G-Kd
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &.1maja . s„"/� Gam.,:., . 6A . 14A .1. Sa„ Lk'. S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes S-M
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
EP90
b) Does the facility need a wettable acre determination?
❑ Yes
2No
c) This facility is pended for a wettable acre determination?
❑ Yes
gNo
15. Does the receiving crop need improvement?
❑ Yes
j, No
16. Is there a lack of adequate waste application equipment?
❑ Yes
2-Mo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid, level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
91�0
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
&�Ko
Air Quality representative immediately.
19t! ifiU �& l "Y-'t' ;•' 3 99PlkuA�st€' 3 �e €�� R¢�;'q'�'t Si"(e{,{..•h E a a i Yit€y9 =, ,: =iil...J 'S'ct �4e i 3€ t 5! - `&€,. § i'.ik .R 6 -�F"' - s f {,£. - -' s � 7 r e � w. �C°meritsitrefer to'queµsanxplsn ariy YES answers and/oTny recommearlalions onany otliei comments ,
LTse_drayvtngs of faciLty{to.,bEtter explatn setuatioase(nse aFddihanal pages as Enecessary): }{ < Meld Copy ❑Final Notes �} y i5 4 l! i
� �i'{ ' if„ If e�j.n s ,�•.: i �E � Cal . �Ijj��gg 3 l 1!3 V 19� } iI .4 'Si E9 li. r t § � �, i � � 4 IS }�-�f�i"; �k � 3 1 �q ..}�1 .,Y---..-.x....,.r,�.�.�-.r...—....�..'-��.r•Z•-.....--wa.�-./
...i:3,.:{�141tb.�:.'.lY.6Rt�rii•�.:'r,L . sriixle:�s� [1�R.:&x.• � ..ii..a.t�.�t�:�s
' T
Reviewer/Inspector NameA,
Reviewerampector Signature: A1.0t,Q Date: 7 %-Oy
IVIVU.f L;onanuea

Fkcility Number: ea — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0
22. Does the f Hit fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
0-Ido
(ie/� fists, d , etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B o
❑ V&as a ion ❑ Frebeerd—'❑ Waste-2rn'alysis ❑ pling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
S-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
9-Kii
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
©-W
28. Does facility require a follow-up visit by same agency?
❑ Yes
Pilro
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
©N6
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gj-No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0R40,
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
K}16'_
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
B'90—
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
Eo
❑•Stecking- -wm rop Yield Form [ "
12112103

Site Requires Immediate Attention:
Facility No. A-R - /z z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: E%
Mailing Address:_
County: tvAXo, !
Integrator: E Sirl�T,6�
On Site Representative: A
Physical Address/Location:
Type of Operation: Swin
Design Capacity: G bba,a
DEM Certification Number:
Latitude: °
DATE: f -1 , 1995
ACE
Longitude:
Time: �Z•' =��
DEM Certification Number: ACNEW
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + �S year 24 hour storm event
(approximately 1 Foot + 7 inches)®or No Actual Freeboard: 7 �YFt. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes o�
Is adequate land available for sprays? Yes or No Is the cover crop adequate? Yes or Noe'
Crop(s) being utilized: 0 -A.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(IR or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes o(E
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate was"re management records (volume o manure, land applied,
spray irrigated on specific acreage with c ver crop)? Yes or No C7
Additional Comments: Ar-4 -rn /S 7 Ji, � Z #e-. _
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.