820159_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

?I,j
Type of Visit: 0 Com ionce Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: 1Y MudylArrival Time: ]� Departure Time: County: Region:
IF
P'r _�'
Farm Name:uCa1 l „ Owner Email:
Owner Name: a't t rx ►�fX S'►�cq� Phone:
Mailing Address:
Physical Address:
����11G
Facility Contact: *Qe( r_ f� t-anb Title: Phone:
Onsite Representative: i (
Certified Operator: D G,,—e G t,®W''L1
Back-up Operator:
Location of Farm:
Latitude:
Integrator: p✓t�4­0'
Certification Number: L C r
Certification Number:
Longitude:
Design
Capacity
Finish
rN—Feedertto
Current
Pop.
Wet Poultry
Layer
Nan -La er
Dr. P.oultr,
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,o P.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder
W
1E
.4-
Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Turkeys
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
A ❑ NE
[�.Pd?� ❑ NE
❑ Yes
❑ No
E NA
❑ NE
❑ Yes
❑IqZ^
❑ NA
❑ NE
❑ Yes
No
NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: IDate of Inspection:
3yaste Collection & Treatment
4.'is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes[-
.Ale—® NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No QAIA- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?]
Yes
[D-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
[j-1 o _ ❑ NA
(] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ 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
[]-1 o�❑ NA
❑ NE
maintenance or improvement?
Waste Aaniicatfon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [:]'NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes u-N'o❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C t4-)
13, Soil Type(s): AID
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5-'Ko ❑ NA ONE
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 � ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes []~~I 0 NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
Re ufred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes F7j-?16-_M NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F:j- ❑ NA ON E
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �N-5- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a'Na [] NA 0 NE
Page 2 of 3 21412015 Continued

l�acili Number: Date of Inspection: 4-
24.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
15` o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0-1To__­❑ 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(§) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
0 Yes
❑ No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q- o ❑ NA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
1,t0- 30g4 V,
Reviewer/Inspector Name: [ �`
e . -
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes E31No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [E].- o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
�rNNo
U N5;
No
0 NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
li�ages us' necessary)` r
1-7-17
Phone.,16DA33— 3,313L
Dater y
21412015

ill K S 'f�- y 1-[ ) A r7 i� n
• flllP�3� 111fi1fiI1�I ! - Di�i"shin of WateResourc� � �
FaciiMy N3arnbcr ` ® O D�visian ai Sail and Wutcr`Cvnscrvatioir I
E: Q UthAgeney I.
Type of Visit: e'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: Departure Time:lL County: Region: F—
.o
Farm Name: C a"L �I.5 Owner Email:
Owner Name: Z)C V 1GC &'Kjs tk'�w Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
a
Onsite Representative: Integrator: ','-e ¢ -e
r` 8 q.
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
11RINN
Deslgn4
IIk41Mhrt
Swine Capacity
Iltr!!itlmllr` II{Illgrl}{,•
Curr�Yeent
�1 In
P'po.
.�l�13�s
lI' !!!NiIHI +#! !a! lillll !
illt�'
Design Current
I!�fnI r'III a'14001!1H
WatlI'l'auitry Capacity Pop.
[11411A1111!llCiki{Biix' IiL'rya111Nip1111u: Il�lllaEtifi�
I
•.,
yCaMe i
IIIIEIs�f$FStY}!
; '
E! 1,
!�tllfiil!
Design
4€briWl,111
Capacity+
�h!Illnililllllll!{txl
11
!�'1111If !!
Current
I"l
Pop.
lliigi�ell i
Wean to Finish
Layer
I
Dai Cow
Wean to Feeder
100
Non -Layer
Dairy Calf
Feeder to Finish
{'
Design
!
Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
!,
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othc�..
Turke s
Turkey Poults
II
}
p�
'
`
Other"
Other
uri
u:yunun.,n.......
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 E;.--P#� ❑NA ❑NE
❑ Yes
❑ No
[-15A
❑ NE
❑ Yes
[:]No
Q'9A
❑ NE
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR) [—]Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes C7 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FAcility Number: 2- IDate of Ins ection: %
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Ll�'�❑ NA
❑ NF
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ N
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
f�J`No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
1;Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
[3-5o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g3<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
r
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 1�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [7No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o
❑ NA
❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes . No ❑ NA ❑ NE
❑ Yes 2-f4o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [3 o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q N ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [][No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FAcility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [;I ❑ 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)
❑ Yes E No
❑ Yes e'1]0
❑ NA ❑ NE
❑ NA ❑ NF
❑ Yes L'_T< ❑ NA ❑ NE
❑ Yes EE go [] NA ❑ NE
❑ Yes [ No ❑ 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
Reviewer/Inspector Name:
Reviewer/lnspector Signatui
Page 3 of 3
[fNo ❑ NA ❑ NE
to
❑ NA
❑ NE
[�lo
❑ NA
❑ NE
dNo
❑ NA
❑ NE
36%
Phone: 3- 33
Date:
21412015

Type of Visit: (J'Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 2 1to tine 0 Com taint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
a
Date of Visit: Arrival Time: Departure Time: Region:
Farm Name: R Clo - Owner Email:
Owner Name.- tiJax— 63 Ol,y, Phone:
Mailing Address:
Physical Address:
Facility Contact: 17�,111�C +'�'�'c ,pR�ltle: Phone:
OnsiteRepresentative: 4� Integrator: PirgSe
l bCertified Operator: ( Certification Number: I 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
1111
Design
@urrent
Design Current
ltacity
Pap.
Cattlen
to Finish
La er
Dai Cow
n to Feeder
Zip
Nan -La er
Dai Calf
to Finish
Dai Heifer
w to Wean
Design
Current
D Cow
!Feeder
w to Feeder
Di, Poultr
Ca aci
Pa
Non -Dairy
ow to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
sBeef
Brood Caw
Turke s
Turke Poults
r
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?
❑ Yes [3.NT— ❑ NA ❑ NE
❑ Yes []No E�JNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[5"NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E j No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
hio
❑ NA
❑ NE
of the State other than from a discharge?
rd 3
Page 1 of 3 L '
21412015 Continued

FaciII Numh:e:r - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
No
❑ NA
❑ NE
(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
fJ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!I/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[EloNo
[] 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
G3 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a'<o
❑ NA
❑ NE
maintenance or improvement.'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes C�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): () .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [3 Yes [ErN'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes (�6o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
gNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
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 [;3"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
[] NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faclli 'Number: 14)
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 21,90
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
51j�'C
o-a.K
Id
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
V
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes 2<0 ❑ NA ❑ NE
❑ Yes [Q o ❑ NA ❑ NE
❑ Yes [2 o ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: `L]
Date:
21412015

(Type of Visit: QCompliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: _J'kR_outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �� Arrival Time,. Departure Time:County:
Farm Name: [ WAOW 13 t
Owner Email:
Owner Name: a aV 4iw Phone:
Mailing Address:
Physical Address:
Facility Contact: U I
itle: Phone:
Onsite Representative: t i' Integrator: %�L
Certified Operator: Certification Number: 1 G t
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Current El esign Current
Fop. Wet Poultry Capacity Pop.
La er
Cattle
Design Current
Capacity Pop.
Wean to Finish
Dairy Cow
Wean to Feeder
Nan -La er
q
Dai Calf
Feeder to Finish
'4 " " . ' .
Design Current
D Poultry `aci Po
Dai Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
°
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
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
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E�rNA
❑ 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
5 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CET1%
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
- ❑ Yes
;ENo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: NZ - Date of inspection: 1 Ed
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 651To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Eg}4e ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
l �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
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
es
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ -1�in
❑ 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
[Z3, "
❑ 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 [3 Application Outside of Approved Area
12. Crop Type(s): rrc.t� (fit C(4_ Y IUJf py V_(
13. Soil Type(s): ) raw. �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 620<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes No ❑ NA ❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes do
❑ Yes 0<0
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Io
❑ NA
❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ YesF3'N-o
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EoNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facilit Number: jDate of Inspection: U
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R<o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
2<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
<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [5NNo ❑ NA ❑ NE
❑ Yes EEI<o ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes E21 ❑ NA ❑ NE
[]Yes C3 No
[:]Yes 5 *No
❑ Yes U;FNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
x.
ommenO refer to gnestlon . ): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of faeility4o better explain situations (use additional pages as necessary).
T E�_ : r4
e - a ..- Z-0
CU r,c(- owk Lar'A'00"A 641�il
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 3.
Date: UV J
21412014

(Type of Visit: CY;�Ououtlne
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: &C Gyk �4J I s Owner Email:
Owner Name: )Z) a.I �f`sl, o[ s�l(P _ Phone:
i!�
Mailing Address:
Physical Address:
Facility Contact: A-t„ l W 1VbF C�l{!(,�jl oe: Phone:GA-6*I
Onsite Representative: ! �Integrator:
Certified Operator: Certification Number: A
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Currcnt
Design
Current
lq�Design Current
Swine Capacity Pap.
Wct Poultry
Capacity
Pap.
Cattle C.pacity Eop.
Wean to Finish
I JLayer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dt, P,oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [g-1 O ❑ NA ❑ NE
[:]Yes
[]No
[ -1qA_
❑ NE
❑ Yes
❑ No
[;,>K
[] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes CIYo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [;�<o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: Date of Inspection. FE
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ©-<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 J0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z} o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
/
[Z�'NO
❑ NA
❑ NE
waste management or closure plan?
1f 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
[5 lZ
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pertttit?
❑ Yes
r_.4n'q5­
❑ 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
3<01
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN M 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): t/"�l� SOV IettLJ
�^ if A A
13. Soil Type(s): I—mc­C V i U-p— %V,v1�_
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L� "o
❑ 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
[311go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[n No
[] NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
CD-Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C P.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 2No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 do ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

PA I
$4
Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [� oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C ' 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes �No ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
❑ Yes D- o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ] Yes
C -'Ko
❑ 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
[31N�o
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments a� f�,�I
[Jse drawings offacility"' to"betfer`expisin.situntions (use additlonai pages as necessary). ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l -Mlq I a'X
21412014

n IHS -Jv1 u 1a3113
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
uation O Tee
for Visit: Q�Routine 0 Complaint 0 Follow-up 0 Referral 0
Date of Visit: 1911AIL1_1 Arrival Time: Departure Time:
Farm Name B 1+5 Owner Email
Owner Name: bays Q"aw ^_ Phone:
Mailing Address:
y 0 Other 0 Denied Access
County: �_ Region:
Physical Address: ho'Q
v Facility Contact: b(,j1 AMdA0W Title: Qw'110/ Phone:
Onsite Representative: ba%AL ntdriski w Integrator: Pylq $
Certified Operator: Dgvu D&KLhQr' Certification Number: 1(06e?
Back-up Operator: V l yB(QQ.t ha W __ __ __ __ ___ _ _ ___ __ _ Certification Number; (?my0
Location o1 Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder Mid
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
H
La er
Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes ®'No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes O No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

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

Facitity Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®' No
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes d No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
JR NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes 0 No D NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes CR No
❑ Yes JK No
[:]Yes R No
❑NA ❑NE
D. NA ❑ NE
❑ NA ❑ NE
y y s•
Comments:(refer to question #): Explain,any YES answers and/or an additional recommendations or an other comment
Use drawings of facility to better'ex lain. situations, (use additional pages as necessary).
ao'.slvd�ye.sury ex+f;0, N�xtiq a dve_ aor�f,
Reviewer/inspector Name: nda SC BA?4 Phone:
w
Reviewer/Inspector Signature: Date: t
Page 3 of 3 214120111

F
P
F
Date'
OIC
:;.i NPDES (Rainbreaker - PLAT :Annual
Cert Pipe }
711Q r- ®
yIT!!v"1invAIng
u
La o0R Namer
ill-
av
1
2
3.
4
5
6
'T"
Desi n: 'Tree
and11
save e'd in
;
ObseNed'.Ireieb
air
All
SEud a Sdrve
: [)atei,''
i. _
i:1I
• ,
Slud a -De th,
Liquid Trt. Zo
•eft °,; '[
Il. _,
Ratid.SILid "e
o Trig '
e ,
to !dame; if;� 0:45
Date'`oiat o'c
m' li>aiical,
�►?'i?� ; ,;
y- 1ND i q0 `it�lcyy
oil Tes a + '' ` ! I; 'ii :i i Crop Yiefd Transfer Sheets
phi Fields t. � ! it i Wettable Acres ✓ RAIN GAUGE �
Lime Needed �'' ' a '�i I !; . i WUP �T Dead box or incinerator
i ; ' ' �.; �: ! �/,�Neekl Freeboard Mortality Records
Lime Applied i . i,..I;,. l S� Y y
Cu ;Z �I:: •n �'i in Inspections' Check Lists ;
Needs•S� s+`i5' I '� i f! 3j '' 120 min Insp. Storm Water
Needs Pc + ::r + it '`i:� 'i f i !1iI lWeather Coded.
I/T,T,l:1al1VL711v.::tiaumaFJ1P-qW.►_aI?Z'W-"'Fl■W.'41
�I
I �,.
'!' . f.•! it � i'
►'i4i"
l4i rl.rL' � �, L /
®�
_��
�If ;
Verify ;,ItIQN ;N I
Date last WU.?.F
:
,
App:' HardwaDateIas�WU '
Q(Conversion"
-' .1 U�
tl�,aifiliations � I ;�
FRO or Farm Records
Lagoon #
i' Top Dike
Stop Pump
it :i:' Start Pump
Iblac;.Zri-I 3000= 213 Eblac

DIMS J1 y )ph),
Division of Water Quality
Facility Number - 5 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ('Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ill ls. Owner Email:
Owner Name: b(1 J`r i7 fib[' r hQ hl Phone:
Mailing Address:
Region:
1
Physical Address: at) ION �em I JI 1 9 'R(}t boro
Facility Contact: 00/;& fiod rhatl Title: Phone:
Onsite Representative: DQ'; Ld l how Integrator: ` dfyt�s
Certified Operator: _I. oy uld thaw Certification Number:
Sack -up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Foultry
Canneity
Pon.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Poults
Other
Discharges and _Stream _Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ®' No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

acilit Number: e0A - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I Cl
Observed Freeboard (in): 3y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes C2 No
❑ NA
❑ NE
$. Do any ofthe structures lack adequate markers as required by the permit?
❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part orthe waste management system other than the waste structures require
❑ Yes tS No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[]Yes Ca No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Z.n, 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): A)
13, Soil Type(s): 'F(rCLf UP -A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
[R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ 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.
0 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
No
❑ NA
❑ NE
3. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E'NA
❑ NE
Page 2 of 3
21412011 Continued

facility Number: CIL - i qq I I Date of Insueetion:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[a No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
fa No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
rZ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
fo NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z 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
CffNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
-06
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
® Yes
*No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [30the • fir I - aM ,, -,
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
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo
❑ NA
❑ NE
Comments (refer to %question #) Explain any..YES answers°and/ar any 1.addtttdnal recommendations or Any other comments.
f � i _._R M -,f;
....°,�.r?., F: C.....l.ti',i...l..,�t:..�.� �..., 1. .: `1 .........,.......,\ .. ... a. ,'d<I
air ole0jee'-A
vae Call`braied_ �e t -r s- fra mcozlr, , Lo,)t call b►-aKzh was r �o
c�� Cafr�ok be*e 4 $yea
�S. Sl,d j2 S v ve y eilG9► P07 (,1'_�I oi01(f,
5-e0ac%11 road. MII be w4 �y`�ohacto b�-��,`�l k76�be- s t - ►vr h ri�� , �r��a�'la6�e
qbr WMe On wkdt wHVJ.
Wex� r 10HO No wr s ays doge fa 'Pall.
h► 0 �e (gyp SoilC�a I13 h 1� G '�s�1i
re( crd� ior y,, alC ,� corte��i�,�;�� -�� Kati.
�FjroII Ja Cl)rfig 60(w;c4 or. 4Yvo)k fla, mod IGCA'o.1 Qf4o discwllo� it fm 4 er,].
n V P
LAbo,,,?. no�j n Ut G� rOdvce- ] �vC� ins) V 1N r '+twe oil GIB loe- tial/Ove,
C
sla.�� No*._ TY�
Reviewer/Inspector Name: ,(� Schn�ei �` T Phone: l 33-- .3 302
Reviewer/inspector Signature: Date: s ' Q
Page 3 of 3 21412011

Facility No. - i Farm Name rQ.1 ' Date al
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge_Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA7
Soil Test Date ak
pH Fields
Lime Needed 0
Lime Applied
Cu-1 ✓ Zn-1
Needs S (S-1<25)
Crop Yield ✓
Wettable Acres
WUP ✓
Weekly Freeboard
1 in Inspections
120 min Insq. 77'_
-. iCodes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
..
..EFTMEMM
r
Verify PHONE NUMBERS and affiliations
-� `-pIkio (ram 676194- UIYCWY4 /%
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon # -t-flp krl
App. Hardware Top Dike 51.0 DOS -
Stop Pump, j
Stark Pump _� 1 arrU9i6ek
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac

'GkD]vision of Water Quality
Facility Number ®- L1�J O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: '&Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: (;Routine 0 Complaint O Follow-up O Referral O Emergency C) Other O Denied Access
Date of Visit: y� Arrival Time: :Q7 Departure Time: County: =� Region: PC
Farm Name: c c L� , * Owner Email:
Owner Name: NI k B(ad S A a w Phone:
Mailing Address:
Physical Address:
Nu4�lu
Facility Contact: , v} LL2(_ [b(Ij, Title: }yj'j P,n Phone:
Onsite Representative: ba-Pei Bod&w Integrator: 1)UrV>�
Certified Operator: D4-. L 1)rodSht iy Certification Number: 1662 j
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Nan-L
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

' Facility Number: $'a - 122 Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FNo
❑ 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
allo
❑ 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
C' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CRNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
S[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Com , Wheal- Soy
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
®'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
12 No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
[!5[ No
❑ NA
❑ NE
Re4uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
❑ 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. 0 Yes [R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
aNA ❑ NE
Page 2 of 3 21412011 Continued

• Facili Number: - { Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes CR No
❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
CNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �R No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes CRNo
❑ 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 Callo
❑ 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
K Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[Yes ❑ No ❑ NA ❑ NE
❑ Yes RNo
[]Yes ® No
❑ Yes CffNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: ^ ao
Page 3 of 3 21412011

f
Facility No q3a—t5q Farm Name L� �� Date
Permit ✓COC '� OIC� NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design Current F5 Rrops
Design freeboard
,-Observed freeboard (in)
..iJ�7'------
rir1rn . ..W.. li7iTr1L•S1
on~.arti
Soil Test Date � Crop Yield 120 min Inspections
pH Fields Wettable Acres _ Weather Codes -�
Lime Needed 1 WUP Transfer Sheets
Lime Applied Weekly Freeboard RAIN GAUGEy
Cu ZnwoeT Rainfall >1" Dead box or incinerator
Needs 0P 1 bJA ,n I n pa ctions Tyr, - FLO r
r, Cv r i�sgc
Waste Analysis Date 12111
to
- 60 Da
+ 60 Da
N Amt (lb11000 Gal) a,-�, r
Pull/Field Soil Crop RYE PAN Window Max Rate Max Arnt
canla v
Verify PHONE NUMBERS and affiliations f
Date last WUP FRO Date last P farm a J'a
��% App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump z600
Start Pump y
�� 0►r r o5� �a�c his mel olS 1,vt wrn n zif fN�1 f a D� G(+
OA h p� re c
er ,1 rn > �, Br also d`4 A�see c � y e(�V.,
dro�le- �
„ I act Ch

SB�;kfS 2 - 0S- ZO/O
ivision of Water Quality
i Facility .Number Z �S� O Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Foilow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / 22—/6 Arrival Time: /z : /r nr Departure Time: Z; County: IZ Al
Farm Name: 8ae,0A1 ►`3-S Owner Email:
Owner Name: bavl J ;3M45.4a-w Phone:
Mailing Address:
Region: f/
Physical Address: /
Facility Contact: q V4,-.S '�>a t'W � C K Title: G Phone No:
Onsite Representative: efz, /75 .0 'wl_�, integrator: r_,oA,1P;'e S
Certified Operator: ---yam 4V'' d _ B rn2lt5d�11) Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
LITWean to Feeder l3rZoo IC1
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other �_�------- — - -__�
Back-up Certification Number:
Latitude: 0 n 0 f = Longitude: ❑° 0'=
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I T=3
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other_,
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Apphcation Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow,
❑ Dairy Calf
❑ Dairy heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Ell
d. Does discharge bypass the waste management system? (Ifyes, 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 01� ❑ NA ❑ NE
❑ Yes
❑ No
N<�A
❑ NE
Yes
ElElL
No
,3
_fNA
❑ NE
❑Yes
[]No
1_7NA
[I NE
❑ YesBN
o❑
NA
El NE
ElYes
2-K.w❑ NA
❑ NE
12128104
Continued

s
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
Structure 4
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 O NNo ❑ NA ❑ NE
❑ Yes 0 o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EI No ❑ NA ❑ NE
❑ Yes No ❑ NA (:1 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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? El 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 D'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. Crop type(s) t� KA! — LJ• C4- �- — 3 e-4 At S
13, Soil type(s) /CSC evj' Il L Nob A
- -
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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Er'No ElNA ❑ NE
17. Does the facility lack adequate acreage for land application? ElYes 2<" El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9<0 ❑ NA ❑ NE
( ) ,. ''�yjy
r w s fV 4 IL 'I. .� bw. d� * �•A ,d y`}
Comments refer to t�uc5tton;:# i xplam any YES ansHers andlor any recommendations or tiny other comments t � � �� . �
Use drtiwingc,irf factl:ty to better explain sttuahonst {use'tddititinal pages as necessary):; 1�4' {
:, ,1 " :._ r 1. i,.I;: . ,� ! .� i!. — i.r� R�JV�i'! eft' 4t
ReviewerAnspector Name Phone: 9/�• }3.3� 3.301D
Reviewer/Inspector Signature: / Date: /-ZZ - 2 a10
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other ,�,/
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [El 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
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
o NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes:�N�[03
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1 Vo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;/No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q<oo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
2'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
EJNo
❑ 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
EKo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2<o
❑ NA
❑ NE
12128104

'BX7A(.S I o- a 7- zo-o i
Type of Visit erCompliance 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: /Jr 9 Arrival Time: / = 34 Departure Time: 2,�DS' County: �►r+DSe/ Region:
.
Farm Name: �ClCUN+�+-S Owner Email:
JV r` C- fQc�S I,.Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: u �'_ +,S �t`j r C' fC Title: �� `� �i��r--� Phone No:
On site Representative: t"><rS �c.`M4J a �C Integrator: �"D rt� f c1L,,ttits
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Vixan to Finish
20'Wean to Feeder .320t7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude:
p
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPouets
❑ 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?
Longitude: =0=1
Design Current I
Cattle Capacity Population
❑
Dairy Cow
[:]_Dairy
Calf
❑
Dairy Fleifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
i
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 ycs, 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 03< ❑ NA ❑ NE
❑ Yes
❑ No
3-9A
❑ NE
❑ Yes
❑ No
LTNA
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
0_,<oo
❑ NA
❑ NE
El Yes
L'to
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 2<0 ❑ NA ❑ NE
❑ Yes [` <o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 3<o' ❑ NA ❑ NE
❑ Yes Ej o ❑ 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? El Yes Cgl<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 91q'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 ElYes 3'go ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑�o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes id'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ID -rift ❑ Application Outside of Area
12. Crop type(s) n !-/J — 1..1 t, 0_i` 4-- se>', 10 —, _�
13, Soil type(s) F-a, e p v i t i,. . No A
14. Do the receiving crops differ from those designated in the CAWMP?
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
&1� o
❑NA
El NE
L�,'N�o
❑ NA
El I,[
o
El NA
❑NE
0'No ❑ NA ❑ NE
Comments (refer to question #!): Explain any YES answers andlor any reedfift ations or any other comments.
Use drawings of facility to b�tfer explain situaons. (use additional pages as necessary):
a
w
F `d. lVi '..�T_r��, i�� � ��� I-
Reviewer/Inspector Name ►GI-��""' erU+� ;., 'i Phone: �I/C�,'f33 . 333
Reviewer/Inspector Signature: Date: S— zaa 9
Page 2 of 3 12128104 Continued

. 1 y
Facility Number: 2 — /S Date of Inspection =1 -D
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 appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
2-
❑ NA
❑ NE
❑ Yes
D<
❑ NA
❑ NE
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 El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Er<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
1 JN'o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3<o
[1 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?
El Yes
�,
Q11"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
�,
lyJ '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
D<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
•
12128104

epos 6/z9/o0 R4
z H /59
Type of Vislt
ompllance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
0 Routine Q Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: i9-12—o0l Arrival Time: Departure Time: County: S0�4 ey Region: l;'67
Farm Name: BQ GO,�1 RI/S Owner Email:
Owner Name: J)avl.cl FP-&C1Sx0,a Phone:
Mailing Address:
Physical Address:
Facility Contact:
// Title: Phone No:
OnsitcRepresentative: Cc1I^t_iSyW�IC integrator: d7Yl� �-YM
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Latitude: n°
Back-up Certification Number:
0 Longitude: 0 ° 0 s = t#
Ua
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[3Layer
$02 ❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
ElPullets
ElTurkeys
El urkey Puults
❑ Other
Design Current
Cattle Capacity Population
El Daia Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cow
Number of Structures:, ED I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
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'? (1f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
Design Current
Cattle Capacity Population
El Daia Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cow
Number of Structures:, ED I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
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'? (1f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
Number of Structures:, ED I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
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'? (1f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
C] No
El NSA'
El NE
❑ Yes
El No
E3 A
❑ NE
B*9'X
❑ NE
❑ Yes
❑ No
❑ Yes
[D No/❑
NA
❑ NE
❑ Yes
L�'No ❑ NA
❑ NE
12128104 Continued

all ►
Facility Number:
Date of Inspection 8-/2-6
—97
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): 23
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
❑ Yes L7 No
Structure 5
[I NA ❑NE
❑NA El NE
Structure 6
❑ Yes L7 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 Ko ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B'�o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) Ergo'
9. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvemcnt?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes v No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) C©rAJ, W4 ec.,�' , So y�G� nJ
13. Soil type(s) �c-a 4 o 4
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E5<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [?rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[3"�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�o
❑ NA
❑ NE
Reviewer/Inspector Name ]h �, r +'` �-- t , �4. °� " '„ h��„ ?/0 �3 3334
»o ,w . .G+t1 ...,,�.:i a..,. t..� r.��. Phone:
Reviewer/Inspector Signature: Date: ?-/Z -Za0 $
Page 2 of 3 1212AV04 Continued

Facility Number: $2 -/,15'9 Date of Inspection 8 iZ-O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes 30o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E] No []NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes B o ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3' o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3,5o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Elgo—
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�
L7 tvo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3io
❑ 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
['fo
❑ 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
[:'<
❑ 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
D-IG
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
BITo-
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

�,v�+rrcd 9- 2 9- 0 7 k2 Q
i/
Type of Visit @P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit @F Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:-27-0 7 Arrival Time: �.` 30 �rl Departure Time: County: Region:
Farm Name: g 0,C-0N Q 4S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Bav lG Title: GNU, IVV Phone No:
V
Onsite Representative: C�Y�' �' � �'� integrator: Cot�.O"v- ► <_ �-aYwN,S
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
1-
Latitude: = o = 6 Longitude: = o = d
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
IN Wean to Feeder 21 3*6
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
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
Cattle Capacity Population'::;:
❑
Daia Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocke<
❑
Beef Feeder
l
F
❑
Beef Brood Cow
I
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)
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 W No ❑ NA ❑ NE
❑ Yes
jNo
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[� No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
[;a No
❑ NA
❑ NE
12128104 Continued

I Facility dumber: $Z- /S g. Date of Inspection 9-27 07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[� No
[I NA
El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[;9 No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[I No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[19 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ 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?
I
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
f
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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 Drifi ❑ Application Outside of Area
12. Croptype(s) tOriJ 1,.] c�_ p,, ID-CkAls
13.
Soil type(s) F- _ ' /`t b A r
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
f9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[P 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):
Reviewer/Inspector Name }�; c %Ze.v c.� Phone: 9/0, 4t33. 33OD
Reviewer/Inspector Signature: Date: 9 — 27— Zoo 7
12126/174 Continued

Facility Number: T2 —/51 Date of Inspection -Z7-07
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes i 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ 7] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis C1 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ t20 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'No
❑ NA
❑ NE
Other Issues
((
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[I)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
W No
❑ NA
❑ NE
E
12128104

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 O Emergency O Other ❑ Denied Access
Date of Visit: DS-O/-D(o Arrival Time: /; 25 Departure Time: County: 'tea^/ Region: /L:,�
Farm Name: &d c 6z Owner Email:
7 I
Owner (Same: b<%y q1 _d a of Phone:
Mailing Address:
Physical Address:
Facility Contact: _�✓ 1//!111 a� ,Qjna_d_sZLaldL Titic:
Onsite Representative: "jI-.,_k
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator �� �/L 1,:=q-V/�S
Operator Certification Number:
Back-up Certification Number:
❑o =i �11 =0 � 1 1{
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
® Wean to Feeder 2d0 IEJ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non-L,
Pullets
Pouets
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heilei
❑
Dry Cow
❑
Nan-Dai
❑
Been Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: FT
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 M No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[K No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
19 No
❑ Yes
® No
❑ NA
❑ NE
❑Yes
®No
El NA
[I NE
12128104 Continued

acility Number: :E— / S17 Date of Inspection OS-Ql-D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ig No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[9 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 ��
Observed Freeboard (in): 3 f?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[1 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
E No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 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
KI No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C b F^N fie ` i SOT Lae-a^j S
13. Soil type(s) Fa- b No A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination to Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
L2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
UK No
❑ NA
❑ NE
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone: 69L0�154e/
Date: OS• O/- z 490 to
12128104 Continued

Facility Number: Date of Inspection bay -di- p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility rail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D9 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`?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
El Yes C&No ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
Add�ttonul Comments;and*..Ora'wings F y aW ;
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a ZI0.r Arrival Time: Departure Time: County: 5,a v� p__,� cj-) Region:
Farm Name: 130 e r7 &I n s Owner Email:
Owner Name: - _ Q V 1 A jar'a, cat I'> kc-Lt Phone:
Mailing Address: Zara �3P12
fe rr Ir q /� Jr
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Ann &ck i Imo („2 Z r:j j.J d4rk),_1'C1L Integrator: CO � 4 0' le
Certified Operator: 1)aj i oC P • G �ra-4Skow Operator Certification Number: id J� G ?,1
Back-up Operator:
Location of Farm:
Back-up Certification Number -
Latitude: =1 g =o=, =u
Latitude: Longitude;
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 3200 3,10c,
I
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
i
❑ Boars
Other
❑ Other
❑ Layer
❑ Nan -La er
Dry Poultry
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Pouets
❑
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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf'
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number, of Structures:
b. Did the discharge reach waters of the State'? (lfyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(R No
❑ NA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[6 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .2,9
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 N 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 fy No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes q No ❑ NA ❑ NE
maintenance/improvement?
1 1 . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No El NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) G` m r ., 1 w �� . s-
13. Soil type(s)
Ea B }�
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
C$ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`s❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Reviewer/Inspector Name.;ajl'r^�Ra'?,
Phone: �'!o �p�G /SV
Reviewer/Inspector Signature: Date: CLS--
12/28/04 Continued

Facility Number: —/ 9 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 ❑ No ❑ NA ❑ NE
❑ Waste Application m 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
6D No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5� NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
M NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN 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
[9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� 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
7 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?,
❑ Yes
[p No
❑ NA
❑ NE
..
AV
eae w'_C_U k e_"uc_-A jre-co f.
12128104

ii .
Type of Visit d Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility• Number 3-O
Dute of Visit: Time: _ 113 y 5
?dot O erational 0 Below Threshold
G'Permitted certified Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: sd
Owner Name: 0111. Bra�S� Phone No: `ICU SlG7 G�G0 (home
Mailing Address: c% ��O Fe�r1m, R� QSekurt�_/Ut`
II �arrti�
Facility Contact. ny C/ draAL-1 Title: Phone No:
Onsite Representative: '�'o,4; '6 - lnterrator: �pj'e Fpl0M S
Certified Operator: �GyiJ QdS Ajy Operator Certification lumber: 16 6PI
Location of Farm:
9-Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' � �" Longitude ` 1 •6
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca ackv Population
can to Feeder 370 3 jo 10 Laver ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver ❑ Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
❑ No Liquid Waste Management Svstem
Discharges 8 St,_ rram Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 3
Freeboard (inches):
Field
❑ Yes Mo
❑ Yes Q No
❑ Yes ❑9'o
❑ Yes M19-0
❑ Yes D4o
❑ Yes M-Wo
❑ Yes 9<o
Structure 6
05103101
Continued

N
Facility Number: ga —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
0 Yes I_tvo
❑ Yes 52^K-0
❑ Yes D<0
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Ull<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Elwo
W-aste-A.pplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes E;
11. Is there evidence of over application? ❑ Excessive
Pondingl ❑ PAN ❑ Hydraulic Overload ❑ Yes Eav0
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes�[r]--No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes [t}Rlo
b) Does the facility need a wettable acre determination? ❑ Yes 2NO
c) This facility is pended for a wettable acre determination? ❑ Yes E*o
15, Does the receiving crop need improvement? ❑ Yes I�-
16, Is there a lack of adequate waste application equipment? ❑ Yes ©'NO
Reguired
Records Decumentj
17,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M-No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
U�No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
03-wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
UNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9-No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
S-No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[DXo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
al-Ki
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
L.E. N6-
U-No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
p�. -� : ,. • . ,
Cow (refer tokyuestion #f),w `Explain any YES# nswers and/or, any recommendations or any:�other;,comnietlts
�t
.. se' drawings of facility to,nettertexplain,sltuations tq!T Fddltlonal�pages as necessary) 0 F�
eld Copv ❑ Final Notes
�
parer, lwkr, g owt and lQec oeal are well A011-
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101
Continued

REGISTRATION FORM FOR ANIMAL F=EDLOT OPERATIONS
Department of Environment, health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must he filled out and :nailed
by December 31, 1993 pursuant to 15A NCAC 24.0217 (c) in order to be
deemed permitted by OEM. ?lease print clearly.
Farm Name:
Mailing Address:
County:
ox 2SL� go
Z=
Phone No.
'�A o
Owner (s) Name: [mlii�o_
Manager (s) Name: S'/9 /h t _ ..
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) _ R JX_ e5T of CZiN TQ.<J
Latitude/Longit'ade if known:
Design capacity of animal waste management system (Number and type
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Year Production Began: 19 � 3 ASCS Tract No.: V / , L
Type of Waste Management. System Used: :'0RR i g t3
Acres Available for Land Application of Waste;_ i 1,
Owner (s) Signature (s) '.
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Site Requires Immediate Attention: NA
Facility No. 82. • I sit
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
`Mailing Address:,
County: 5�n
Integrator: C-0 V.
On Site Representative:_
Physical Address/Location:
DATE: I I It' , 1995
C_
Time:
V wrs
Oparo NC. Z83Qj e-
Phone: sg z - o 1c>s
_ Phone:
� :3 r•...�� s �. l�� SEE 4-L �
Type of Operation: Swine Poultry Cattle
Design Capacity: 3t Number of Animals on Site: 3z-aa
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hMes
ufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)r No ual Freeboard: : Ft. Inches
Was any seepage observed from them
n(s)? Yes o NJ Was any erosion o edNo ? Yes or
Is adequate land available for sprayorNo Is the cover crop adequate. Ye or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwe11i 9pes r No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or rine:
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Yes o No
Is animal waste discharged into water o tstate by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management r (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: -z 1% t ok
r4-d
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.