820123_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

type of visit: t:Truommpuance inspection V operation Keview V Ntructure Evaivation V i ecnnicai Assistance I
Reason for Visit: a Koutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ���/T County: s �±� Region:
Ftzo
Farm Name: &'e **y Gz- ,, F;-. --L q— 1l Owner Email:
Owner Name: q1 t I,, V`�cc�l�` _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 46IL44 t 1' 8✓�We--? Title: Phone:
Onsite Representative: �Vtvlt Integrator: AvrS
ce—
Certified Operator: Certification Number: l7�
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
f�r, N g9s ,�E, � �' t E,. E'. •€ a . ,iE., : � II p€' �t. � ,: � { �
.1 _
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,, esign , i g g
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w°
t
{ [ g.
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,:rgk ��>rtti8: �A,..flCi/�,tt I'd
_a�,�€ t, pN. r Ipl' �9£iz } y�, tl R `.� ..p IY+ :.< .I[ ¢. .Fi
.,�€�9 9 .,[.rl..,!.- ...,,. �n, P 9 - P k ,
n! €I .�. i =... _ .= i ii i I':,I " Wean to Finish La er i°Wean to Feeder' Non La er �,iFeedert0 FlnlSh �' `N=[{°€E,!EB,,, 1 '�l€ly? lri 1`Farrow to Wean Np ,��p1€i1JPiDesin 'Current �gIR ..€E€EIaIEI a,:'°a A€#:€Fk 21�; iN �! t Farrow to Feeder kE,� dzD �PAnit ��, N,�E,Ca acI PFarrow to Finish[ La ersGilts'c�`
Non -La ers !�=4: Boars Pullets- '- i g '&' 3°A ° ! 8 j �i I" €! k iis 3 € {i h4tY11€ -§ iIii ' �1 Turke S1 +p - ik E ta£c�€.?.�'1 1 Turke POUItS -€ $ 9 e 319 OtherOther�slipi !I�i €wt 41
Discharees and Stream I�cts
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)?
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Caw
❑ Yes 3 l�o ❑ NA ❑ NE
[]Yes
❑No
�NA
❑NE
❑ Yes
❑ No
�NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) Yes ❑ No [� NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2015 Continued

FAcili Number: - 19, Date of inspection:
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �a ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ED"i\TA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):---�-1---
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q-No- ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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 El No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ff 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): G �� S Ctj
13. Soil Type(s): A -0 ©try
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 o ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
[J'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[EfNo
❑ 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 [2'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 21412015 Continued

jFmility Number: JDate of Inspection: ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No
25`. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J- o
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 EINo
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes [:L>6
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?
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes C2-No❑ NA ❑ NE
❑ Yes ❑'l�lo ❑ NA ❑ NE
❑ Yes -lTo ❑ NA ❑ NE
❑ Yes [D"Ko ❑ NA ❑ NE
[-]Yes �o
❑ Yes C�`No
❑ Yes [2'f,10
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments ;(refer to question#): "plaln anyYES.answcrs andlor;any additionaig,recommendations or any"othercomments.
Use dr`iwings of facility to better explaln'situatlons (use addditianal pages, ns;necessary) `:;_•, ` _ r
CA
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
a- 3.3 - P_9,q
Phonel(0- { . 3
Date: �) [
21412015

U;Fyivislon of Water Resources
Facility Number - z„3 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: MEMpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grtoutine, 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i ai a Arrival Time: Departure Time: County: J 7 Region:F_
Farm Name: V­VWe6A eq FC1041 `f _r� Owner Email:
Owner Name: i0%ctt'L �L(i Phone:
Mailing Address:
Physical Address:
Facility Contact: �w: t( cc `� �i�! G✓� Title:
Onsite Representative: t
Certified Operator:
tt
Phone:
Integrator:rnr
Certification Number: 1 ��
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop,
Wean to Finish
Wean to Feeder
Feeder to Finish '~
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
Dry Poultry capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a., Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ER 5o ❑ NA ❑ NE
❑ Yes 0 No [a -NA ❑ NE
O Yes ❑ No �NA ❑ NE
❑ Yes .❑ No
[—]Yes F;mo
❑ Yes dNo
E5'OOONA
❑ N E
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 21412015 Continued
\I

Facility Number: jDate of Inspection:
`'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q o [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �' o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes fNo ❑ 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
[2rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ ' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C!fNo ❑ 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): 0 "'A "'��'l. ay X & © -
13. Soil Type(s):
E0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes EI'No
[:]Yes ff No
❑ Yes KNo
❑ NA ❑ NE
[]NA ❑NE
[]NA ❑NE
❑ Yes
E!fNo
0 NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes E�rNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;�$qo
❑ 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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - _ Date of inspection: ez
'14. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes R N
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check] Yes ®No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [?Io
Other Issues
29, 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?
C6mm6h'W(refer to question #) Explain}nny#1'ES answersYandlor any ddltional recomme
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
;2&o
❑ NA
❑ NE
❑ Yes
ffoNo
❑ NA
❑ NE
❑ Yes [215o ❑ NA ❑ NE
❑ Yes [30ONo ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[7rNo
❑ NA
❑ NE
❑ Yes
[n"No
❑ NA
❑ NE
/'n /it '21(�
Reviewer/Inspector Name: [ Phone: 3-333
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Division of Water Resources
Facility Number - L{� O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: QMomplionce Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 8'houtine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �`W �n � �%- r Owner Email:
Owner Name: f�►�1`�er. Phone:
Mailing Address:
Physical Address:
Facility Contact: ' [�AV�� 1 ti� ��C`� Title: Phone:
Onsite Representative: t Integrator.
Certified Operator: ( t. Certification Number: 1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design, Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
ro
Pullets
Other
Design Current
Dischames and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region .r_Rd
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes [Zk ❑ NA ❑ NE
[]Yes []No
[3 Yes ❑ No
❑ Yes [:]No
❑ Yes [3l to
❑ Yes [2io
[]'NA ❑ NE
[�NA ❑ NE
[fNA
❑ NE
❑ NA
❑ NE
[] NA
❑ NE
Page I of 3 21412014 Continued

lb
F'acili Number: - Date of In s ection: ems(.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q,l06 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E2,1QA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 22010 ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes []R o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C 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 Rio ❑ 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 (Zf/No ❑ 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): s CL r ,� — LIr , v
-b - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [(Elsfo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2-1�0 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes el'No ❑ NA ❑ NE
❑ Yes j(No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0"No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P(No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

I.
Facilitv Number: - Date of inspection: .
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©'�lo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Erfro ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MIN ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes OONo ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E] No ❑ NA ❑ NE
[:]Yes (2/No ❑ NA ❑ NE
❑ Yes [R'NTo ❑ NA ❑ NE
[:]Yes [�No
❑ Yes Ff(No
❑ Yes dNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any: additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
15 0.' -3.3 P� 67
r
Reviewer/Inspector Name: LL1 Phone:
Reviewer/Inspector Signature: Dater
Page 3 of 3 21412014

®'6ivision of Water Resources
?Facility Number L�d.J - ® Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: p'Cornpiiance Inspection Q) Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: V xoutine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: L.L.I� County: S
Farm Name:_ #P y_�-4V ( Owner Email:
Owner Name: L OV1,4 JA) Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: bNn fZ 4e•'te'61 Title: Phone:
1
Onsite Representative: Integrator:
Certified Operator: i Certification Number: 7 0 o q
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
��- Co
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes rf].Ko ❑ NA ❑ NE
❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ❑ No [Q.Pd'A. ❑ 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 [qo1NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes WNo
I❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

IFacillty Number: - Date of Inspection:
Waste Collection & Treatment —,��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i.,—ZkWo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t ,?I 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
LJ 1V °
❑ 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 ar improvement?
❑ Yes
�b
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E " o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
B_ o
❑ NA
❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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):
Q
13, Soil Type(s): t�
14. Do the receiving crops ' r from those designated in the CAWMP?
❑ Yes
ZJ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z�NV
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
b<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ h10 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes E]'Nio ❑ 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 [ZVo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�/o 0 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 21412014 Continued

Facili Number: - Date of Inspection: j5
2�. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg'iw ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes GDXo ❑ 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
QDeNo ❑ NA [3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E]'V1vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
19N0 ❑ 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
[ZA-(o ❑ 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
Qr.No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L.JZo❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
51N' o ❑ NA ❑ NE
Comm,ents,(refer to question #): Explain'any YES answers and/or'�nysdditional_recomimendations'or any oth_'er continents: ,fi,*•'
Use drawlo' as of facility to better explain"situations (use addttianai pales as necessary).`"°
CJ� �b� ' - (S
� _s vv 1i V "�^I - 3 r 31-14-
�.�.�.
Reviewer/Inspector Name:
w
Reviewer/Inspector Signature:
Page 3 of 3
6 - 3 - 0 1 1', -6,ID
Phone:
Date: 3 S
21412014

,43
Facility Number -
O Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (D-e—ompliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
-ItAl 4 1& � (in a
Date of Visit: M MOWArrival Time: Departure Time: County Region:
l
Farm Name: KViA (_ 4')dr44'- — r
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator: rtr'
ka
Certification Number:1-7
�V r
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
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
+_
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
M.XA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[]!XA'❑
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
❑ Na
Eb4A
[3 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
P]eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 6L Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!J"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes e'lgo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
g3-110 ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[R. o [] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9-N-o— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EZ N — ❑ 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 EDI' to ❑ 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��jj ❑ Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): se�!-c,uv��
13. Soil Type(s): �_CAI / (/l rl_ / /,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Faeili umber: jDate of Ins ectio
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
gR[`�o
❑ NA ❑ NE
the appropriate boxes) 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
Z .,No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Fl-Wo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R<o
❑ 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
G2 o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L!d4o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [q o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes CZ Ko ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any Additional recommendations or any other comments k
Use drawings of facility to better exRlain situations (use additional pagesas�necessary). +'4AA
S�o-oSP C�ecla.&oJ
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phong1
-43.3-3-W
Date:
l/4/ZOII
I

'ClDivision of Water Quality
Facility Number ®- /ate 0 Division of Soil and Water Conservation �6 ~ Ca-�JcYI
0 Other Agency
Type of Visit: Compli nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / �3 Arrival Time: ' p o Departure Time: County: Region:
Farm Name � !" w r {-� D .k �Q �/yt. % / Owner Email:
if
Owner Name: % o✓im ) G U) I rYW r_ r- Phone:
Mailing Address:
Physical Address:
Facility Contact: ;Snn n -, v—, w % et-wrr Title: Phone:
Onsite Representative: �,rc� Integrator:
Certified Operator: Certification Number: /`%,g�_Oq
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish 'c V
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
rou
Pullets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
[-]Yes RNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

r
Facility Number: - Date of Inspection: --
-1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
nNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F 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
P�g_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
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _Z��.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F>-2.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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
Yes
[3 No
❑ NA
[3 NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
C�3,No
. ❑ NA
❑ NE
❑ Yes 1061 ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes ;& No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes El No ❑ NA ❑ NE
Yes P No ❑ NA ❑ NE
❑ Yes AQ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes JR No
❑ Yes 21 No
❑ Yes 5�_No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):Explain any YES answers and/or any, additional recommendations or any other comments..
Use'drawings of 2= to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:f���o
Date:
21412011

©Ia1.l% )).a
ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (D'Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Coutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 p . Departure Time: CountyRegion: Ra
Farm Name: (�l= wE,Q[p���R,rr� �i [ Owner Email:
Owner Name: �p y1 t\ 1 L RF.�..1 ER Phone:
Mailing Address:
Physical Address:
Facility Contact: R Q= L -;;�-4 RZW E (Z Title: d w O F—R Phone:
Onsite Representative: _ - S� Ali= Integrator: PR e ,54 i&g .
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Fecdei
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
1)
Non-L
Pullets
Poults
Design Current
Discharees and Stream Impact
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)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [&,No I ❑ NA ❑ NE
❑ Yes
❑ No
q NA
❑ NE
❑ Yes
❑ No
F NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [S No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 4 `a. - kZf2> Date of Ins ection: Jj ilk 1a
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 [a NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —Q—
Observed Freeboard (in): lot,-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[M No
[DNA
❑ 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
[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
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR 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 Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes WNo ❑NA ❑NE
❑ Yes � No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

:J ►
[Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any{addltional°recommendatlons or any,other, com°ments,.`,;
Use drawings of facility to better explain situations(use additional pages a's necessary).;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q i 0.30$ 'i aP I
Date: a
2/4/2011

ci
ivision of Water Quality
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompl ante Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LJ Arrival Time: p p Departure Time: O County: rCy,�1 �^'�— Region:
Farm Name: -�;: l/� T7'0 y P dorm\' �]� 4 j Owner Email:
tl
Owner Name: / `� v!ylQ K.J . Lf`e U-)r-/ Phone:
Mailing Address:
Physical Address:
Facility Contact: An ,? e jj /'eau Title: k9 &, d� Phone:
Onsite Representative:
Certified Operator: ei
Integrator: /
Certification Number:
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.
Laver
Non -La er
You
Pullets
Poults
Design Current
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [jNo ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes � Na
❑ Yes EZ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - DInspection:
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): �e
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2LNo
❑ 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
fj] 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
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window I ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) �� u� ,fT�rmK �� /0"e'g—rj
13. Soil TYpe(s): k,6r_ / �r4t1 ll�%1 ,/Dr?
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 allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes ®No ❑ NA ❑ NE
❑ Yes 0—No ❑ NA ❑ ' NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E. No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1 .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

Facill Number: - Date of Inspection: —_7 > —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [Z-No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 5�[ No ❑ NA ❑ NE
[:]Yes No
[:]Yes ® No
[:]Yes CS -No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commentsia;;r;"�
Use drowings:'offacility to better explain situations (use additional pag"es-as ,necessary).:,.'',
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit s�ompH nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit _$Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ? O 0 Departure Time: � ,' � County:
Farm Name: A==16r'A2ry- ' " U rrri- 2z i Owner Email:
Owner,Name:. ortIII test. T]trek"'ep „.,_,_„,.........., Phone:
Mailing Address:
Physical Address:
Facility Contact: TYl i&2flru -) ol�"f- Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: P)
Latitude: [=0 06 Longitude: =° ❑, =
Design Current
Swine C•ap +city Population
Design C►urrent
Wet Poultry C►apacity Population
Design
C►attle Capacity
Csurrent
Population
❑ Wean to Finish
JEI Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Feeder
❑Beef Brood Cow .
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ 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)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M-No
❑ NA
❑ NE
❑ Yes
C3 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: &E2f Date of Inspection
ri Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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 �R 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 91 No ❑ NA ❑ NE
through a waste management or closure plan?
0
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 K 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 .MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes §allo ❑ NA ❑ NE
maintenance/improvement?
I I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Eio ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) / C(/Q.���
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers` and/or ay recommendations or any other�comments� rk�
Use drawings of facilityto better explain situations, (use`Additional a es as necessar a t f
�-
Reviewer/Ins ector Name Ott - { ` { ` oD
P f -- d x Vt, t, Phone: �d` S.S
Reviewer/Inspector Signature: Date:
Page 2 of 3 «1l61U4 uonrinueu

Facility Number: — / Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ 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
RNo
❑ 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
E3 No'
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JRJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,1
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,[No
Cl NA
❑ NE
Additional. Comments -and/or Drawing's: , y� Y
4
A tki. o s i
.:NY'v�?-
Page 3 of 3 12128104

Type of Visit 0 Compliance inspection 0 Operation Review (91tructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency her ❑ Denied Access
Date of Visit: � Arrival Time: �O Departure Time: /�; �� County: w Region:
Farm Name: � I�u�is' ame� Owner Email:
Owner Name: 30AJ.1- r l�[OJ�r�G[Jrd ' Phone:
Mailing Address:
Physical Address:
Facility Contact: k7 'r or- Title: %2>H r Phone No:
Onsite Representative: �� Integrator: � ��
Certified Operator:Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ c = ` = Longitude:
0 1-1 I r---
Design Current
Design Current Design C►ur-re nt
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capes ity Population
El Wean to Finish
❑ Layer
El Dairy Cow
El Wean to Feeder
❑ Non -Layer
El Dairy Calf
Feeder to Finish
El Dairy Heifer
El Farrow to We
Dry Poultry El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
Gilts
❑Non -La Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Cow
❑ Turke s
FE]Boars
Qther
❑ Turke Poults
❑ Other 1
10 Other I umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA'
❑ NE
❑ Yes
❑ No
.❑ NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M0
❑ NA
❑ NE
❑ Yes
&,No
❑ NA
❑ NE
Page I of 3 12128104 Continued

' Facility Number: — Date of Inspection
,ii
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6—,2
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
ONo
❑ NA
❑ NE
Ge/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
KNo
❑ 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
ENo
❑ 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
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I&No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Fr�z4C
13. Soil type(s) 6_-�X/ fZ A)-,Q1-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? []Yes M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?'
18. Is there a lack of properly operating waste application equipment?
❑ Yes ULNo ❑ NA ❑ NE
❑ Yes R[No ❑ NA ❑ NE
Comments (refer to.question #): Explain any YES answers and/ur any recommendafions on any othe"r co tntttents _
Use drawings of facility, to better explain Situations.. {use; additional page"' pecessary}:��� i
Reviewer/Inspector Namer-—'''° Phone: �--r
Reviewer/Inspector Signature: Date:-/�—p7lU
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection /t7
J 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 LRNo ❑ NA ❑ NE
the appropriate box. ❑ WGp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis . ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
fgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E[No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JO 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
BNo
❑ 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
91 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
AdditlonaFC,ommenfs�andlor,Drnwings .a r •,.t. g ti a
ate- 3
Page 3 of 3 12178104

--�f~vision of Water Quality ,�
=NumrXerldn]USIOn of Soil and Water Conservation
-- G Other Agency
Type of Visit
Inspection
0 Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
,Commpliance
0 Koutine 0 Complaint
Q Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: 0 :I Departure Time: t-Dn County rw— Region:
Farm Name: 6Pr_iu�0`gr-nn 1 C Owner Email:
Owner Name: _ Q XL Y\ : — r e u) , eL Phone:
Mailing Address:
Physical Address:
Facility Contact: 4 U in r, 14 f rj� r1 rxr— Title: i �' Phone No:
Onsite Representative: S''= �—� _ Integrator:
Certified Operator: `� Operator Certification Number:
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
Longitude: = o = 6 =
Design
Current
Design Current
Design Current
Swine Cy
apacitopulati
P onWet
Poultry C►►apacity Population
C►a ttIe Capacity Population
❑ Wean to Finish
1110 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
1
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
1 10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
JRNo
❑ NA
❑ 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? ❑ Yes R[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): / C%
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(iel 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
91 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
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) S Cu
,,�
t 3. Soil type(s) I� &— / l •J----
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J2 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
F�l No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Comrtients (refer to question`#)Explain any YES -answers and/or any re�omm ndatians or�any other comments.
Use drawings of facility to better explain situations:' (use addrtional pages as necessary):!�� v . `;
Reviewer/inspector Namef`..`; ;� f,j�Phone•
Reviewer/inspector Signature: Date: y �d
I Z/40i Ulf 4Ulriintev"

EU
` Facility Number: — Date of Inspection
r�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Mo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5iNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tZ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
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
(&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
A�`dditi al Co menu and/or Qrawlr�gs:
w
12/28/04

sion of Water Quail ty >I. c%
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time�:� .` � Departure Time: '�%L% County: Region:
Farm Name: .h�frwr-d #29.2 r - C� Owner Email:
Owner Name:.._ .Ed j2r» `r e— UJ Ir"eL,u e- Phone:
Mailing Address:
Physical Address:
Facility Contact: �Dh i 4'_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: �1
Operator Certification Number: /,'g92 1
Back-up Certification Number:
Latitude: = a =1 = Longitude: = ° = & = «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
.K No
❑ NA
❑ NE
12128104 Continued

Facility Number: 9— 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): % 9
Observed Freeboard (in): oQ 41,
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 [RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN [:IPAN > 10% or ] 0 ]bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [IApplication Outside of Area
2. Crop type(s) XQ Z
W.a.5 ��LY— S AZQ 75
3. Soil type(s) f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes X No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RLNo ❑ NA ❑ NE
Reviewer/Inspector Name tAPhone:
Reviewer/Inspector Signature: Date: / v;DZ)
,rage 6 Uf ) nion"ru

Facility Number: — Date of Inspection Leg
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
(3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IN 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
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ER 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
onal Comments and/or Drawl
12128104

Type of Visit 40"Co'mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 1180 routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: /��D Arrival Time: a Departure Time: County: Region: �
Farm Name: ;, full CIS' H9 a�_ 5l ezn 2—Z i Owner Email:
IV
g10- Cy ,,.--
Owner Name: a.% _��%L[i� Y— Phone: � �l
Mailing Address:
Physical Address:
Facility Contact: 2r2.1 t~ w-„-ZCEc.tlr- itle: Phone No:
Onsite Representative: Integrator:,' z—_ -
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0' =" Longitude: = ° =' =
iMDQS,n" ,yr>,g,Currents Design C-urrent Design Current
` 'rS� �Ca aci Po ulation
11CapacttyiPopulation Wet �PJ�oultry Capacity Popula ions= Cattle p ty p �71inei ".`d�`u.'..m ..1o'TN1� e «r '_. , -i R
✓.mnnm d 7m. `� »•, rs?.: r i �'. i^e _�c.�caasca _s .*ion,,,,
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder & ❑ Non -La et El Dairy Calf
j ❑Hcifei
Effeeder Finish Dai
❑ Farrow to Wean �,; ` El D Cow
�Dry,�P°°�t�Y � �
❑ Farrow to Feeder �� ��: ; Non -Dairy
❑ Farrow to Finish❑ Beef Stocker
h
El Gilts❑Beef Feeder
❑ Boars ❑ Beef Brood Cow
Turkeys
Other ' ��
ems.
❑ Other d �� � Number of Struct1111111
❑ Layers
❑ Non -Layers
❑ Pullets
❑
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IQ 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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
yu No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
( No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

a. Facility Number: — Date of Inspection
.� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ff No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J&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 95-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
19 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
[8 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
II. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drrifl ❑ Application Outside of Area
12. Crop type(s) r,-si'a ZE'VczS�-
13. Soil type(s) ,ZA Z"X Z8—a �f�/-%� Z f iy
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
A No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[8 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
C&No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNO
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
JAWNo
ElNA ElNE
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):
l..s�
u7L`' *ar Aleg)
Reviewer/inspector Name Phone: 633-33a o
Reviewer/inspector Signature: — Date: /L
12128104 Continued

Facility Number: Date of Inspection ;/� %
.j _
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 29No ❑ 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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9 Yes WNo ❑ 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?
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? (iel 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?
Additional Comments and/or Drawings:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
I.No
❑ NA
❑ NE
❑ Yes
C3 No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
52 No
❑ NA
❑ NE
❑ Yes
1Z No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
Cj�No
❑ NA
❑ NE
12128104

'_ =�]
Facility Number �
0"13 vision of Water•Quality. , 's
Division of Soiland Water Conservation
0. Other Agee cy.
t:.
Type of Visit
ecompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
01outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 a Departure Time: County: Region: J!�ZD
Farm Name: Hz) Owner Email:
67
Owner Name: ]RLLi7; rf _ I-'PaI cX­ ,CPhone;
Mailing Address: ,/92 / � � �. xld L� ; A - - Ale -
Physical Address:
Facility Contact: ZPA711; L- Title: I Phone No:
Onsite Representative: Integrator: —
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number: 471�VY
Back-up Certification Number:
Latitude: = o= 1 = Longitude: = 0 0 i
Design Current.. 1
Swine Capacity: Population Wet'Poultry C
❑ Wean to Finish El Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish t to o Ii
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
n' 'Current 'Design; Cu re�nt�
ity..Population Cattle :.Capacity Population
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ 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 Structure
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 (Q No ❑ NA ❑ NE
❑ Yes
[Q No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
* No
❑ NA
❑ NE
❑ Yes
(P No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
§Q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
M No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ANo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
(ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) y
13. Soil type(s) — _ Jlf�er-%3 t -L� / AZZ
14• Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes RNo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes r"Mi No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo
❑ Yes J4 No
[I NA ❑NE
El NA [I NE
El NA El NE
El NA ❑NE
QA
Reviewer/Inspector Name „ ` .�. °° ,� �„ , Phone. 7:�2
Reviewer/Inspector Signature: Date: / oa
12128104 Continued

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 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes lay] No ElNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2qNo
❑ 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
4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
rrO \
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JzNo
❑ 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
Ej No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R[No
❑ NA
❑ NE
Additional Comments andlor Drawings:
12128104

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 Co/.21/ Arrival Time: Departure Time:County: _Sarn�rah Region: FXo
Farm Name: r e-� Cy.�'� 4�a rvv., S ~ 1 Owner Email: I��
151 qo -G 2
Owner Name: R oM., A �- _�t�e.r.�re +� Phone: g s a 5 33 - 3f7p
Mailing Address: ___-_% O 1 e2_n_ ." 1r. iqga. ' jQ P N C D 93q(
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: on e-
.3 re1-34-e
Certified Operator: _AWe,. o C G2__4 ti
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: e. r. ^+e-i c.
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = 4 Longitude: = e = g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I +
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
SL
G
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ 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 Heifei
❑ Dry Cow
❑ Non-DairL
❑ Beef Stocke►
❑ 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?
❑ Yes [11 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5d No
❑ NA
❑ NE
❑ Yes
79 No
❑ NA
❑ NE
12128104 Continued

f ac� ility'Number: S.2 — ,�a3 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): /f
Observed Freeboard (in): cave
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 [7 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [I No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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 ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [)fl No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [:]Application Outside of Area
12.
Crop Z
�s Cu G rP
13.
Soil type(s) /Vr �T� f�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
M No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
50 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[A No
❑ NA
❑ NE
Reviewer/Ipns ector Name
Phone:
Reviewer/inspector Signature: Date: % i ZD,S"

facility' umber: $.2 —/,?3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 50 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
.2. a, .2 . $, Ae
❑ Waste Application [I Weekly Freeboard El 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
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ [ 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
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
© No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[A 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? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[E No
❑ NA
❑ NE
itional Comments and/ar;Drew>ings
12128104
12128104

el.
( ! EiI i I
3 "g• ESIE1 � f�I �. ,3 I f E� � ��: 4 E6B 38 I 3}i;§Y 'i . ,9 g �i ! ..,.. � 1 f p i� a s s.r { a ion. j i
# k:t�f ! , t7=},i ;� I i � 1,1! ; � I�, Q'Divisionlflf Soil and Water Conservatzflitl�E j�,'9 : r � , g i c j , ¢ V. ! ,-'d I� •i` ! ;I 1 tr< E i'4 -,€ I �! I; € ! a - 3
In!.�, €i ti a1ItI ,y 1� sk a}y41� Ed ;It } III if f I
i,3.7?;Q Other AgeEncy.;. !.I . I •17_rrEC�
�a �t i Sih I�� d g - k i •hd -: ..
7
sw r,. r- .. .P.. if E. ,r< €� 1 4... �, � 9:7a'. 3'., .. �, i!, .0 ,.rl �$t in P, a .i..-• � n�7 ��- ...a. ,..{'I . ,�, ,.
Type of Visit 0<ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Ine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: O O� Time:
rO Not Operational C Below Threshold
rmitted MR66iiffied [3 Conditionally Certified 0 Registered
Q Date Last Operated or Above Threshold: .........................
Farm Name: ....... !` r Wep'S....�.'.`)....Farw,........2..11............................................... County:..... . °'"................. .................. .....................
.,
Owner Name: .....°n'�', G W &rr'"t Phone No• 90 �33 71
..................................................................................................... •............................................................I........................
MailingAddress: .... If � �........�`!............................................cicS...... �C. . �83.�1.................................................... ............ ..........................
Facility Contact: .... �'".i.e........ �!Y".'�� .............................. Title: ........... Phone No: !.............................................1
pp
Onsite Representative:.....�`""*e...... Bv.?:se-24 ............................................................. Integrator :..... .i..re-0.�..............................................................'
Certified Operator: ,........A24",,Ir.....�r ,-,R.......................................................... Operator Certification Number:..../ r s ..................
... ................ .........
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• OFF
Discharges , Stream IImpacts
1. Is any discharge observed from any part of the operation?
❑ Yes B-i�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CTWO­
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes L}Nw,
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 ❑-Nx
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [ 9-19-6
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 01*u--
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier...................................................................................................................................................................................................................
Freeboard (inches): 2Q.
12112103 Continued

Facility Number: fri — /r=3 Date of .Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes t:o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Ergo
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
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes moo/
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ff V
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
DLle--
1 I . is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Q3b1)---
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 05C vY qt. reN cl� Swr.l! rj{* � ►•
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
EJN io
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[}-tom-'
b) Does the facility need a wettable acre determination?
❑ Yes
EKo
c) This facility is pended for a wettable acre determination?
❑ Yes
B-90
15. Does the receiving crop need improvement? ❑ Yes S-Ko
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor Issues
17, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes 31q-o—
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [3-N6--
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes mar`
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.
', .SI U 'F alai 1 « i ht na�f,t �; 7t t.. �. , si- s 4dComments (refer to quest of #) ,�Exp >a a"r"•y f� YES ja' swhF e--..i:.s. an-4Fan—
mm� o�> wady'
��. ; yy;
.�er�c�omme�`:'f
lUse dravi7igs of faiciLty�tobetter ezplarn situati"ons:'{use addihorial pages as rnecessary). >Ield Copy ❑Final Notes
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Reviewer/Inspector Name 91,I ? ,} ,fir ,• aHA. ,E ..1.4 , �; �'. I. _. , ,1. F ie? "° E !E �,c = „rr .z ,-"i, 6 i = E ' ::R , �a^a�
Reviewer/Inspector Signature: Date: o D
12112103 f nnt�nued

Facility Number: ,� — a,'� Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
❑ Yes C7 <o
❑ Yes [j-No
[:]Yes Q4dT--
❑ Yes 014
❑ Yes 9-No
❑ Yes 5-Ko
❑ Yes M-No
❑ Yes [4]W
❑ Yes [9-W
des ❑ No
❑ Yes [3-N6`
❑ Yes E'Ko
❑ Yes ❑-No
❑ Yes S-Wo
❑ Yes f 9-w
12112103

Site Requires Immediate Auption:
Facility No. 4- IZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:_,_,
Mailing Address: C,
County:
Integrator: 71
On Site Representative:
Physical Address/Locat
DATE: L 3 flu �� , 1995
c�
Gnu SAL.
711u r U
Time: -3,
Phone:
Type of Operation: Swine Poultry . Cattle
Design Capacity: '-��� —'Number of Animals on Site: 3� �
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude: °
Circle Yes or No
Does the Animal Waste Lagoon , sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yet or No Freeboard:—L—Ft. ,Inches
Was any seepage observed from the lagoon(s)? Yes o * Was any erosion observed? Yes o
Is adequate land availabIc fo spray? Yes or No Is the cover crop adequ te? Yes or No '
Crop(s) being utilized:-Z) fr�k.1 �'--�� ��; �;
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli Yes'or No
100 Feet from Wells?'
Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? �es_ortee: Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Yes or �o
Is animal waste discharged into water of pesate by man-made ditch, flushing system, or other
similar man-made devices? Yes or +o l If Yes, Please Explain.
Does the facility maintain adequate wastemanagement racpnk4volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) Yes qir No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.