820131_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua'

I n s a7 _JrvNJ� T18
Type of Visit: (D'Co Hance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (DIC
O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: /�S1 TV Region:
Farm Name: J o A n Owner Email:
Owner Name: `ST) Q� f�j+ � Phone:
Mailing Address:
Physical Address:
Facility Contact: el,, k r'S ��,ti�� ��{ Title: Phone:
1 J
Onsite Representative: Integrator: Iii.
Certified Operator: 4! a �k 0( K09 4't'{ _ Certification Number: 17 IM/ _
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes []-Po ❑ NA ❑ NE
[:]Yes
Design ,Current.. -
E3 -KA
Design
Current
Design Current
Swine
Capacity Pop.
Wet;Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I
jNon-La er
I
Calf
Feeder to Finish
13a jo
iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
:I P,oultr
Ga aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Co-
owTurke
Turkeys
s
O#her
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes []-Po ❑ NA ❑ NE
[:]Yes
[] No
E3 -KA
❑ 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 0-Iqo- ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2141j015 Continued

Facili Number: Date of Ins action:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-N�C ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Jr -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
62 -'Ko- ❑ 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
g o ❑ NA
NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q -N-6- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E iV 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
❑-No- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q-NV—D NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Qo❑ 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 `t 6 if P. Co -4'n `6✓`a 14' S ( r-)
13. Soil Type(s): No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EZ No---] NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑�AFo-`❑ NA ❑ NE
❑ Yes [jNcr- ❑ NA ❑ NE
Re uired Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Blo- 0 NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps [::]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2015 Continued

FacilityCti
Number: - Date of Inspection:- 2
u �c
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E>Kt ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EJ.?do ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes ®No
❑ NA
❑ Non-compliant sludge levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
0 Yes []I -Ivo
❑ NA
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
MN6 ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[*'1q_o_ ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E] -Ne-
❑ 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 - U '''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 ®No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
0 Yes []I -Ivo
❑ NA
❑ NE
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E3<!o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes &N�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yesr3N/o
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

■ Mizion of Water Resources
`Facility Number �� - r3 OO Division of Soii and Water Conservation
© Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: JOrlZoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: S Arrival Time: { 6 Departure Time: pt 0 County: Region: E(ZZc
Farm Name: Ki C
' Owner Email:
Owner Name: ��L1� (;� ��,I Phone:
Mailing Address:
Physical Address:
Facility Contact: Cr.W-ct,� iia."WtWY Title: Phone:
Onsite Representative: � Integrator:
r3� S
Certified Operator: ' J �� Certification Number: 17761
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Current
�. Design
[j NA
Design Current
Design
0 N
Current
Swine,,r Capacity Pop.Wet4PoultryCpacity
Pop.
Capacity Pop.
-
- T4 7ya-y,m
LCa
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish �7
w$t�
Dai Heifer
Farrow to Wean�Destgn
Current
D Cow
Farrow to Feeder
`DrP ultryCa aci
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
1pullets
Beef Brood Cow
5
Turke s
.:..
Other w_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (lf yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E ] No ❑ NA ❑ NE
❑ Yes [a -N-0
❑ Yes [3 --No
❑ Yes [D.No
❑ Yes 0`50
❑ Yes []-Ro
❑ NA ❑ NE
D -NA ❑ NE
Ej__NA
❑ N E
[j NA
❑NE
DNA
0 N
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 2,5t4f
It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. lfyes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z,r%
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
Q-ler•"❑ NA NE
❑ No A ❑ NE
Structure 6
❑ Yes E "1O ❑ NA ❑ NE
[:]Yes E3 -fro DNA ❑ NE
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 Ej-'No
❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes �'o
❑ NA
❑ NE
maintenance or improvement?
[D] No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 1.1�0
❑ NA
[ NE
maintenance or improvement?
acres determination?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ETINo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Heavy Metals (Cu, Zn, etc.)
NA
❑ NE
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ NA
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Required Records & Documents.
12. Crop Type(s): t ,/ rA --'k
13. Soil Type(s):o li`/ 0C GL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F; iso
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 -No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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
[31&o
❑ NA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LJ i4o
D 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 ❑'leo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield E3120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes
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 1 of 3 1/412015 Continued

FacilityNttmber: jDate of Inspection: 9L5 arc
24•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes DX6 ❑ NA ❑ NE
23. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [to- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes PnlNo [DNA ❑ 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:
❑ Yes E31To ❑ NA ❑ NE
❑ Yes l3'5o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
[j NA
❑NE
[fNo
E] NA
❑NE
[�J'No
❑ 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 ewlain situations (use additional pages as necessarv).
C,X-t-� q (Lo —, — ff -X5-/� y—It — 03. z P— If, z_
II c(0 - -i-,y 4 k5I
Reviewer/Inspector Name: 1% I
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
'T
Date: l
21412015

type of visit: Wcomptiance inspection V Operation Review V structure Evaluation V Technical Assistance I
Reason for Visit: 126outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:=;V Arrival Time: Departure Time: 6 County: v" '.3— Region
Farm Name: f� ` ti �CA-t Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Cjj jt & *A (, Title: Phone:
Onsite Representative: Integrator: Of U
Certified Operator: -It'q yol Certification Number:
'77Qo I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
"� x-2_0 14 6 g:f N d„ 0 2_0 t, PG- 0 (z-?
L
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [gam ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made? [-]Yes ❑No Q'1a'A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No LJ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No [r N ❑ 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 El'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 i 2/412014 Continued
i
Desi n Curreut
g
`� �'
-��� Design Curt•en#
Design Current
Swine r Capacity ,Pop.
Wetll'onitryC p city Pop.
Cattle Capacity Pop.
way
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
, Z.O .SZm
Dai Heifer
Farrow to Wean
w Des gn
D Cow
Farrow to Feeder
.Current
D Poul ,Ca ci PO
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Otter
"
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [gam ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made? [-]Yes ❑No Q'1a'A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No LJ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No [r N ❑ 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 El'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 i 2/412014 Continued
i

.a
FaEili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes Ele- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [E' 1�A ❑ NE
Structure, 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 E No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DVM
7. Do any of the structures need maintenance or improvement? 0 Yes ET<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes W IGo ❑ 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 Qlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;�Xo ❑ 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): ��,/`Fe.c.t.�(G. I/tom 's G o —
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [Z"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 [:fNo
[:]Yes [fNo
❑ NA ❑ NE
❑ 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
dNo
❑ NA
ONE
the appropriate box.
❑1AFUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[-]Yes
dNo
❑ 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
Z1140
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
dNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

IV
Facifity Number: -4 of Ins ection: -4
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes B oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 C30 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[;Ko
❑ 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
u No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R f No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
o
[—]NA
F] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�VNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
W33- 333 Y
9 C-11 I I-6
21412014

cwy ) cFrL
Structure Evaluation Inspection
Facility Number: W- -- 13( Date: _2,3 E,�� 1,6
Time in: Time out:�O c7
Farm Name:- Farm 911 address UCor7 _
Owner Name: J-
ho- Roy _ Phone
Facility Contact: J -A4i-S
Onsite Representative: I tegrator:
Certified Operator: nv� Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No L/
Was non-compliant level reported to DWR ^P_5 POA received
Structure: 1
Identifier:
Spillway?
Designed Freeboard (in.) -
Observed Freeboard (in.):
2 3 4 5 6
Are there any immediate threats to the integrity of any of the structures
observed? Yes No u ----
Do any structures lack adequate markers as required by the permit? Yes_ No
Does any part of the waste management system need repair Yes
Condition of field's Good C-0 UCs" C� 121f Vh
Condition of receiving crop
Comments:

/M s 1 I is .V a Is
of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
m for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: AvI Arrival Time: t( Departure Time: County: =A. Region:
Farm Name: c&j�,.a„� Owner Email:
Owner Name: �GvPhone:
T
Mailing Address:
Physical Address:
Facility Contact: _ S amp_, Title: Phone:
Onsite Representative: Integrator: XII T
Certified Operator: Z
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: Etc-)
Certification Number:
Longitude:
Dischar2es 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑c ,A10— ❑ NA ❑ NE
❑ Yes
Design Current
Met
Design
Curren#
Design C►urrine
[g -XX"
Capacity Pap.
Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
O S31 -b
Non -La er
'
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr.I?oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
Turkey Pouets
Other
Dischar2es 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑c ,A10— ❑ NA ❑ NE
❑ Yes
❑ No
[
❑ NE
[:]Yes
❑No
[g -XX"
❑ NE
[—]Yes
❑ No
ETNA
❑ NE
❑ Yes
[ENo
❑ NA
❑ NE
[:]Yes
[2 -No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: -0 1 Date of Inspection:
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑'NE
4,Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[7rNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
MNo
Identifier:
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
VNo
Spillway?:
❑ NE
the appropriate box.
Designed Freeboard (in):
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
E] Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[l�-leo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[DNA
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?
Page 2 of 3
21412011 Continued
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
❑ K
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q1q_0
❑ 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
[B<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B<o
❑ 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
13 12. Crop Type(s):r./tuu.e5 —S-
13.
l3. Soil Type(s): Wt 4 (A�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q],4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E� o . ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E "'o ❑ 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
[j3l�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
E] 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
[DNA
E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facifi Number: - 1717 jDate of Inspection: TP,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑fid ❑ NA ❑ NE
29. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'o– Q 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �Io [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
E3 -Ko
❑ 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
1:].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
Q -Mo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2,lgo
❑ NA
❑ NE
Comments (refer to gnest1on #) Explain any YES answers and/or any additm
ional-recommendations or any other coments. Y
�.
Use_drawings of. facility46I'Mtetei l in,situations (use additiotial:.pages as=necessary17 - 0 1
).
V-4
5 � �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
If
Phone: 13�` 3�
Date: 1
214/7014

Type of Visit: QL;6,Mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O9 routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ' a4/1 Region:��
Farm Name: 4 P7�- Owner Email:
Owner Name: ,�p�� Phone:
Mailing Address:
Physical Address:
Facility Contact: C �t � s,�y�[ 6 Title: Phone:
Onsite Representative: !f Integrator: _ l�
Certified Operator:LAI
Certification Number: : / 7 [ Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ NA ❑ NE
[:]Yes
[] No
Desigp Carrent
,Design
Current
Design Current
❑A
Swine
-
Ca achy Po
p p.
Wets
£Poultry. Capaciiy
Pop.
Cattle Capacity Pop.
04
Wean to Finish
Wean to Feeder
Feeder to Finish
,.(' a
La er
Layer
Dairy Cow
Dairy Calf
Heifer
Farrow to Wean
Design
Current
—Dairy
Dry Cow
Farrow to Feeder
Dr.; a',oult : Ca aci
P,o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ NA ❑ NE
[:]Yes
[] No
FLN -
❑ NE
❑ Yes
❑ No
❑A
❑ NE
❑ Yes [::]No
❑ Yes �' o
[]Yes [allo
e -ICA ❑ NE
❑ NA ❑ NE
E] NA E] NE
Page I of 3 2/4/2011 Continued

Facili Number: I - Date of Ins ection:
Waste Collection & Treatment
❑ Yes
❑ No
❑ NA
❑ NE
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
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
0 Yes
❑ No
[] NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Designed Freeboard (in):
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑.NT-
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E4n'4-5-
❑ 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
�' 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
E i10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
b
47
[—] 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): Xev-0"� S & [o
13. Soil Type(s): r,.A �L� ILA -�" f
14. Do the receiving crops differ from those designated in the C W MP?
❑ 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?
0 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
❑ 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 2/4/2011 Continued

Facili Number: jDate of lns ection: v
' 4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E >w ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [T11'o'_ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes :Plo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [11-N0^ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes E:'KO ❑ 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)
❑ Yes [n' -No ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
]�No ❑ NA ❑ NE
YJ 'moo ❑ NA ❑ NE
EfNo ❑ NA ❑ NE
�No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

(Type of Visit: Q'Cmpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: .= Arrival Time: Departure Time: County:, Region: ZrRD
Farm Name:_ 1 t ]�
Owner Name: dCI�N �cx��L
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �ylse
Certified Operator: �p�.�t IR44AL—
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 17190.1
Certification Number:
Longitude:
Dischar es 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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [3No ❑ NA ❑ NE
❑ Yes
Design Current
[SNA
Design
Current
Design Current
Swine
Capacity Pop.
WetlPoultry
Capacity
Pop.
C*attle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
35,40
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , .PouE
Ca aei
I;o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Other
Turkey Poults
Other
I I I
Other
Dischar es 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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [3No ❑ NA ❑ NE
❑ Yes
❑ No
[SNA
❑ NE
❑ Yes
❑ No
[g"N'A
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[]R'No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 52 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 [:]EEvidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i _V'MWIDa ( 'li"A i17RA7V_, ) s , G, O • _
13. Soil Type(s): W p W rob R tut\ -5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
Facility Number: a. - 13 Date of Inspection:
❑ Yes
E2"No
❑ NA
❑ NE
Waste Collection & Treatment
ENo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[\]r "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?
[j 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
Q'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[13"'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 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
[Y]'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 52 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 [:]EEvidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i _V'MWIDa ( 'li"A i17RA7V_, ) s , G, O • _
13. Soil Type(s): W p W rob R tut\ -5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E2"No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[g"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EJ/No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G;(No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p 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
[,<A ❑ NE
Page 2 of 3 .2/412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EEI/No ❑ NA LINE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E3"NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ENo
❑ 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 concem?
❑ Yes E(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 CO/No
❑ NA ❑ NE
permit? {i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
0 Yes MNo
❑ 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 afollow-up visit by the same agency?
❑Yes [j3 No
❑ NA ❑ NE
ents (refer to question, Explain any YES a_M ers�aridlor any additional recommendations or any other comments.
Fi6z
awings.offacility to better explainbsifuations (use additional pages as necessary)".
Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ins \ C3;;) . ") �XTV_"C -S
Phone: rt1D 3pn}
Date: U`
2/4/2011

1"15 7Ij y I n T)q-
Type of Visit: compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for ^Visit: outine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visits Arrival Time: , ���� Departure
Farm Name: �C'tv�l�>v' ""��"�
Owner Name:
Mailing Address:
Time: County: Region: 774%0
Owner Email:
Phone:
Physical Address:
Facility Contact: C(,L��IS(�, Title: Phone:
Onsite Representative: Integrator: M-13
_
Certified Operator: _ Certification Number: 1r7 '70 f
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
`D stgn Current
rx Design Current
Desigtt Current
SwineCapacLtyPop.
Wet Poultiy Capacity Pop.
Cattle Capacity Pop.
❑ Yes
No
❑ NA
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
Feeder to Finish
❑ Yes
Dai Heifer
Farrow to Wean
D sign r"Ciiirrent
D Cow
Farrow to Feeder
D IPault Ca aci :P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
]Beef
Boars
Pullets
Brood Cow
A
Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Other
Turkey Poults
❑ NE
Other
Other
o
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
&<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ 1A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ 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 I of 3 2/4/2011 Continued

Facili Nutnber: jDate of Ins ection:
�--��
4Waste Collection & Treatment
1:1 Yes-
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
H<A ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[ No
Spillway?:
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Designed Freeboard (in):
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[::]Yes
E No
Observed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
❑ NoNA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�Io
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ <O
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
2<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
LId"'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
E2 -<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑t <
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
[g4c,
❑ 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): ..�LL-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes❑
NA
❑ NE.
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ti, filo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[DoKo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g24o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[[]Xo
❑ NA
❑ NE
Required Records & Documents
�--��
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
1:1 Yes-
U"'�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P. ""
❑ 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
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
❑ NoNA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3<o ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENO❑ NA _]NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field D Lagoon/Storage Pond ❑ Other:
[:]Yes Ua-<
❑ Yes ❑ No
❑ Yes io
❑NA E] NE
❑ NA 9 1
❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes HNo ❑ NA ❑ NE
❑ Yes tNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes g3`No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes irio ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes to ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations=or°any. other.comaieats.
Use drawings of facility to.better explain situations (use:additional pages as necessary).
l �S� `- "vim_ -k " �_ &"
L blow► :5y,e"
Reviewer/Inspector
Reviewer/Inspector S
Page 3 of 3
Phone: 47/a r33
Date:
4/201

B_'rms 2-0� - 20/0
ivision of Water Quality
�Fac�lity Number U 2 f 3 / Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine Q Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:-O/��-�O Arrival Time: �•35A*�- Departure Time: fZ• Ss ,,, County:
Farm Name: Aye- /`l 0_ u +, �4 ✓"" Owner Email:
Owner Name: o 4 Phone:
Mailing Address:
Region: died
Physical Address:
Facility Contact: (fl+'LE A&kW GC Title: � • Sae Phone No:
Onsite Representative: Integrator: C29 11 a i I -
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: E10 = 1= u Longitude: =0=1 = u
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
L`J NA
❑ NE
Design Current
DesignCurrent
Design Current
.NA
Swine
Capty Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Yes
❑ Wean to Finish
❑ Laver
�❑l NNg�o
❑ Dairy Cow
El NE
W❑ Wean to Feeder
❑ Non-Layer
❑ NE
El Calf
Feeder to Finish .3
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
❑Turke s
Other
❑ Other
KITurkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
L`J NA
❑ NE
❑ Yes
❑ No
.NA
❑ NE
[EK
ElNE
❑ Yes
❑ Yes
�❑l NNg�o
El NA
El NE
❑ Yes
,L�o
LNo ❑ NA
❑ NE
12/28/04 Continued

Facility Number: 82— /3/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ElNA [INE
a. If yes, is waste level into the structural freeboard? ElD Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L9'1vo ❑ 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 io ❑ NA
EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 00No ❑ 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 > ]0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:1 Application Outside of Area/
12_ Crop type(s) gc','iK V �� { �� Z; -1'g/ 6 rzi, / r0.5,� �ei✓ �� C lura 3
13. Soil type(s) IIID/f cwk-go Kat.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ YesNo NA
El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes lK'No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q<01 ❑ NA
❑ NE
Comments (refer to,gteestion #): ...Explain any YESanswersiand/or anv<recomnendations. or_iiny otlie� comments il
y.... r ° r
dr_'at�angs
Use of facility to. better explain situations. (use addthonal pages:as necessary): _
w: = a
Reviewerlinspector Namei � Phone:j!D , Ss 33. 33LU I
Reviewer/Inspector Signature: tet-_ Date:
12/28/04 Continued

Facility Number: — 3 Date of Inspection
Required Records & Documents ,,..,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes EKo ❑ 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. El Yes Ej o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L7ivo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B1or ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EI NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L�i<
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,L-�,'�No�❑
O NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,Ej11o'
El No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, ,�
!�_., Ko ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CI lvo ❑ 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
©�❑ 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
,�
D neo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,.,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
L�oo ElNA
E-1NE
33. Does facility require a follow-up visit by same agency?
El yes
D<o ❑ NA
❑ NE
AddrtionaltGoinmerib and/or Dravvin f ` -
12/28104
12/28104

t
��K,cS 10-OS—�aog
015ivision of Water Quality
rFEFacy Number 182 % 31 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 9to­mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ']"/ p-0? Arrival Time: Departure Time: County: Region:
Farm Name: AIG AI" ery Owner Email:
Owner Name: ��'y' `i Q Phone:
Mailing Address:
Physical Address:
T
Facility Contact: ���+�s ��t�' �< <-� Title: / 5�r"�^ Phone No:
Onsite Representative: r_ZA Wrfl-Integrator: Co
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =' =" Longitude: = o ❑ ' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ Layer I j==]
❑ Wean to Feeder I IE]Non-Layer
Feeder to Finish 13520 3 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
to 1
Cattle Capacity PopUlatio�t;;;_
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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?
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L"rNo ❑ NA ❑ NE
❑ Yes
❑ No
[3 NA
❑ NE
❑ Yes
❑ No
[�A
❑ NE
L_T�A
F-1NE
❑ Yes
No
[:1 Yes
�❑
[ No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
11/18104 Continued

Facility Number: SZ -L3] Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,,,, No ❑ NA [3 NE
a. If yes, is waste level into the structural freeboard? [I Yes Bg�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
l.J, Ngo
Spillway?:
El NE
15. Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in):
o
❑ NA
Observed Freeboard (in): .3
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[_3<
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ErN.
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Ej
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
io
❑ NA ❑ NE
through a waste management or closure plan?
❑ 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
D o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [I Yes
�/
LTNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE
Yes
�,_�
TNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,�
Leo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6 e v -M" Jc_ i 5;,, ! I C vii, N (U, S,� a. rs•� K �G ., .
13. Soil type(s) /i/o 4 LVa V . Ko --
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l.J, Ngo
[:1 NA
El NE
15. Does the receiving crop and/or land application site need improvement?
ElE Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[_3<
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
01No
❑ NA
❑ NE
mComments (referjtolqueshon.#) �Explama y�ls* � ndations or any other comments.
} �..FY n YES°answers and/or apn gromme
Use drawm afgfaciL #o betteF$X lantasitnahons (use addittonalt a es as necessary):
aiiL ': ., i.. : "-.. '....._ A ,_-,..:> x _T. r`f, .4..S'-- • x 4,. -+P'1i'i`.413':T..r:7
1W
Reviewer/Inspector Name Phone: '7/0, q33 . 333V
Reviewer/Inspector Signature: Date: 9p-/ g"
Page 2 of 3 12/28/04 Continued

1 66
Facility Number: 1?2 -- 131 Date of Inspection y'1 S-c7y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design EJ Maps ❑ Other
❑ Yes No . ❑ NA ❑ NE
❑ Yes CrNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather
Cade
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
toNA
[__1 NE
❑ NA
❑ NE
r❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
B
a&_0 ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L��1, Ngo ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L��7,, Ng�o [__1 NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LTNo ❑ NA
[3NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Digo' ❑ NA
❑ NE
Other Issues
�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[3M Yes
o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L -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
EffNo
❑ 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
ElL1Yes
�,
"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?
El Yes
I�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D-1q'o
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

I
Type of Visit &tompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance i
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access I
Date of Visit: %q`D g Arrival Time: I foo* pA., I Departure Time: /: SS County: Region: 0"--
.--t- i /- C%
Farm Name: -� aL`N 1AfC l' Owner Email:
Owner Name: -3,b 4 n1 ,10 y t1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ctl r 7 + s r+�i Title: ! ` { S F��- Phone No:
Onsite Representative: Cu►'�` s Integrator: Cpkort C- Fr-,, c-
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [::] o [—] ' 0 Longitude: = OE::]' = u
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
51
Design ;' Current'
Design Current Design Current
Swine
Capacity_1PoVulation Wet Poultry
Capacity Pop�u�lation Cattie Capacity Population
❑ Wean to Finish
; ❑ Layer
r: ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer F [] Dairy Calf
❑ Feeder to Finish 13520
1 3 7I3
❑ Dairy Heifer
❑ Farrow to Wean?
�DFy Poultry
w<=" ❑ D Cow
El Farrow to Feeder°
No
E] Non -Dai
ElLa
Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑ Beef Feeder
❑ Boars
El Pullets
w ::::: ❑ Turkeys
❑ Beef Brood Cow
Other
❑Other
❑ Turkey Poults
❑ Other
Number of Structures: j
❑ Yes
3<o
s
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[�5 NA
N
ElE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
ElEDL�
No
'1vA
❑ 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
E A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
3<o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ER<o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:Z J31
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:
❑ Yes ,Eff "NNo El NA El NE
El Yes 37No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0'1 o
❑ NA ❑ NE
Designed Freeboard (in):
Reviewer/Inspector Signature: Date: g- P9+ Z 0416
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Observed Freeboard (in): 2
❑ Outside of Acceptable Crop ❑ Evidence of Wind
❑r Applications Outside of Area
12.
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.)
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�o
❑ NA ❑ NE
15.
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
,�
B o
❑ NA
❑ NE
through a waste management or closure plan?
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
o
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
ONoo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2*90
❑ 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
B o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�
B No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0'1 o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date: g- P9+ Z 0416
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind
❑r Applications Outside of Area
12.
jWindow rDrift
j� l
Crop type(s) - i� per � r� r gNr dam- l G ; �J S Lia L� 6..0 N
13.
Soil type(s) Np
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�o
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
o
El NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,2
l 7<o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
o
❑ NA El NE
18.
Is there a lack of properly operating waste application equipment? El yes
,E3
L'_Ko
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name i C ky ;i�e.V e'15 Phone: 9/0,(/33.333 a
Reviewer/Inspector Signature: Date: g- P9+ Z 0416
12128104 Continued

� a
Facility Number: $2, — j 3 f 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 [3 o ❑ 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
�o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2�<o
❑ NA
[__1NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[,<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,��
L1/No
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
D-INo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�,/
L� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 1Vo
❑ 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
[ 1V o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
[:1 NA
[__1 NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,�,
L7NNo ❑ NA
❑ NE
Additional Comments and/orDrawings.-
Page
rawings:
Page 3 of 3 12/28/04

r
® Division of Water Quality
Facility Number Z /3 f 0 Division of Soil and 'Vater Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /0'Oj - O Arrival Time: /2:50 Departure Time: County: Sam Region:
Farm Name: /C Owner Email:
Owner Name: —J aLLu Phone:
Mailing Address:
Physical Address:
Facility Contact: J G �^1 0. Title: 9k1nrC— _ Phone No:
Onsite Representative: C:WA-s Integrator: Co %PLV -t c__ �v.... S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 = [=4 Longitude: ❑ o ❑ E__1 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder JE1 Non -La et
Feeder to Finish 520 1 2 --"?q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
L 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 PopuEation'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Fleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 [10 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
[;R No
❑ NA
❑ NE
❑ Yes
m No
❑ NA
❑ NE
12/28/04 Continued

Facility Dumber:
Date of Inspection i0 a3 d7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): $ �
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
EN No
❑ NA
EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
FINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
f�] No
El NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (TNo ❑ 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. Croptype(s) - �G:rta.4t��.o� l tSVV//
13. Soil type(s) IV0,4 Rai, AinS
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 ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CM No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): 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):
AL
Reviewer/Inspector Dame ��` 2e V q,� S Phone: 9/0, el_m M 00
Reviewerllnspector Signature: Date: /0 — 03 - 2-60 "]
72/28/04 Continued

Facility Number: $Z — /3 f Date of Inspection /6'-G31
Required Records & Documents
19. Did the facility fail to have 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 [21No ❑ 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[J9 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Na No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EM 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
[39 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Qj No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
❑ NA
❑ NE
General Pernvt? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Comments and/or Drawings:
12/78/04

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:-� -C? Arrival Time: %irJ yr Departure Time: County:
Farm Name: / `Cc di -1114 /J�q j' Owner Email:
Owner Name: IQ e %.j C _ _ Phone:
;Nailing Address:
Physical Address:
Facilitv Contact: S O L KI 0 r tCk Title:
Onsite Representative: ► s o . til r c K
Certified Operator:
Back-up Operator:
Location of Farm:
:Swine `,
Region: fE7
Phone No:
Integrator: CO Gly "it—
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=,
❑ Longitude: =o=,
o=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La ec
Feeder to Finish S'r '1L 34f/4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke y Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation''
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity,PFopulktion
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket'
❑ Beef Feeder
❑ Beef Brood Cow
h. 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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V No ❑ NA ❑ NE
❑ Yes
[2fNo
❑ NA
❑ NE
❑ Yes
[;4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
(3No
❑ NA
❑ NE
❑ Yes
i1 No
❑ NA
❑ NE
12/28/04 Continued

ti
f
Facility Number:Date.of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes *o [INA ❑ NE
:.Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�J
No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
T'
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
IV No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
{� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
1A 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 Driii ❑ Application Outside of Area
12. Crop type(s) z e�i�d i;! �s 1 i i'✓
13. Soil type(s) %�=- 1.k� �/r� w/it/S
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JV No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
[J No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature: i Date: e" (�
/2/28/04 Continued

r
Facility Number: �{? — /A�� 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 EINE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code .
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JO No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/f No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PEAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewedInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
21 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
[:]Yes
0 No
❑ NA
❑ NE
Aigonal�Comtnents:`and/o'riDrawiigs: �-f_' �' �
12/28/04

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: Arrival Time: vd Departure Time: County: 5a u.- a—, o0 Region: Flu)
Farm Name: _ _ ✓`� ��wr Pn r ri^ _ Owner Email:
Owner Name: __ -o.� _ _o�4.T Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: _ Z cl n _ 12. �4 r. i
Back-up Operator:
Location of Farm:
Swine
Phone No:
r
Integrator: C o o '*'% C
Operator Certification Number: 1-7-101
Back-up Certification Number:
Latitude: =0
=1 Longitude: 0 c [� A =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder on-Layet
® Feeder to Finish 2-rd,S00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Po#lation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej ;..
❑ Dry Cow E
❑ Non -Dai
❑ Beef Stocker I
❑ Beef Feeder
❑ Beef Brood Cow h
Number of Structures: I ! I 1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ®No [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
O No
[INA
❑ NE
12/28/04 Continued

Facil�L ty Number: �,Z — /3) Date of Inspection o�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 00No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Y� Yes ❑ No ❑ NA ❑ NE
❑ Waste Application [� Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® 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
M 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
Z)No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[X No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 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
[;JNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
t No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
12/28/04

Facility Number: fr22 — ja! Date of Inspection
® No
❑ NA
❑ NE
i
�(] No
❑ NA
❑ NE
Waste Collection & Treatment
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LN 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: 1-114 Y-1
Spillway?.
Designed Freeboard (in): ' '20'V
Observed Freeboard (in): 3 If f'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 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
[P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[4No
[INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
[0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) GcrP-S ,L_�_ 14c4 , se"c(( 4.-nI,- nJ. Qtr-P"kcer'-
PaafccrC_
13. Soil type(s) _ ,4 drR1, 14ko _ Wrw'aw... )��1u_...,,�-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�(] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name �,� ; fi e Phone: 110 A(-4
Reviewer/Inspector Signature: Date: a
i 12/28/04 Continued

Type of Visit Qr'Compliance Inspection Q Operation Review O Lagoon Evaluation
for Visit (NIoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
date of Visit: 5 �D o Time:
Facility Number X� �'3
0 Not Operational 0 Below Threshold
[34ermitted 13 Certified © Conditionally Certified E3 Registered pate Last Operated or Above Threshold: .........................
Farm Name: _.....
Owner Name: . Phone No:
a.
Mating Address:....�--3---..._..........................--�II-----........ R�_...._ 1
N t - _L_ ..a a ...
_.........._.........�.
Facility Contact:7.....�_. PhoneNo:
Onsite Representative: . .
Integrator: �... ah'4 t........ .................... --- W_..
Certified Operator._ lqo�a�_ ......... ........... Operator Certification Number:_______
Location of Farm:
Q�wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 u Longitude • ° 0�
Dish & Stream lmpac_ts
I. Is any discharge observed from any part of the operation?
❑Yes &Tlo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 591No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freehoard (inches):
12112103
Structure I
4
Structure 2
Structure 3
Structure 4 Structure 5
❑ Yes U!(No
Structure 6
Continued

Facility Number: Jia — 3 Date of Inspection �
Of
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [3to
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 2No
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 QNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes [ o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ENO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [rNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes dNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground El Copper and/or Zinc
12. Crop type J%lre, ..
, z#.. S`i� � Pk,.jn las` i, j
t / Sr // r o-reYrd (^-A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?� ❑ Yes YNo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a Iack of adequate waste application equipment?
Odor lcsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ( + No
❑ Yes QNo
❑ Yes [jrNo
❑ Yes [ErNo
❑ Yes U(No
❑ Yes Bf4o
❑ Yes Q No
❑ Yes [140
❑ Yes ["No
`its (refer to gnes5an) Explaiaaay YES s vers and/oran i�ecummendattaiLs br any other comiaeartts. =,.
,Use drawings of fac�ty to�better explain srtuatioas. (use addth6nal pages as ne�rY) teld COPY [3 Final Notes
Reviewer/Inspector Name
S
Reviewer/Inspector Signature: Date: p
11/12/03 V Continued

FaeiliM, ,Number: Y.Z — Date of inspection I VX/y
ddittoaal Comrnonis`and/&'Dra% rings f-
r'
k"e ji anw-str aval alis lcvzl5 ��•��
Required Records & Document~
-All r46 dS lba,t
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[jrNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Pian readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
B"No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[Q'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Eallo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
QNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
[9'No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
B14o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 1' Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0'No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes QTNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [fNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [7No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [140
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddittoaal Comrnonis`and/&'Dra% rings f-
k"e ji anw-str aval alis lcvzl5 ��•��
-All r46 dS lba,t
H,
12112103

Site Requires Immediate Attention: Ah .�
Facility No. aZ 133
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 95, 1995
Time: 13 40
Farm Name/Owner:
-Mailing Address: K L i fk6x 153 _CV.At�r, 10C_ (coo) 65-J0 --
County:
Integrator:=Ws. �sx:cls Phone: L4 �o 5 �i a o t ql On Site Representative: "c6ss%. G,.tokla f:�flA Phone: r coa) -X ^s $1
Physical Address/Location:.k i s e L s I
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: _'_So?O
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:3.5 ° �' Longitude: -7a °,�"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (&or No Actual Freeboard:--U—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or 49 Was any erosion observed? Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? lgii)or No
100 Feet from Wells? 44 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(O
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or i� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No L­5c,�- %-o t co.
r. s+r
Additional Comments: ?rc1-to
T4.;S n
Inspector Name Signature
Sm; t<_ 711 Wo c"v4L Qtd,
r Y `Liec.:[ie NC 28301
cc: Facility Assessment Unit Use Attachments if Needed.