820177_INSPECTIONS_20171231

NUH I H GAHULINA
Department of Environmental Qual

R
Divi-sion of Water Resources
Fa'c icy Number ®- 7'] 0 Division of Soil and Water Conservation
O+ Other Agency
Type of Visit: IV Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: 210 rh Departure Time: 2h County: TSor
Farm Name: %� ti l'�✓1 +P W S ��^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 1 cmle/ Title: Phone:
if
Onsite Representati19 Integrator:
Certified Operator: QLjCI��Pt., Certification Number: 179-7-2—
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Dealgn Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I JLayer
Daia Cow
Wean to Feeder -304V
30
Non-La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr I;ouItr,
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
LJOther
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:)Yes
[:]No
NA
❑ NE
[:]Yes
tp No
❑ NA
❑ NE
❑ Yes
"No
LZ
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facl�,,LNumber: 7'? Date of Inspection: '7
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 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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 �3 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes [P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
//}},,,, � 12. Crop Type(s): G� laL.i�' ��
13. Soil Type(s): _ 'V
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 4Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Fac11'�.Number: - 1 Z Date of Inspection:
2�Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes `P No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No
❑ Yes No
❑ Yes [� No
❑ Yes No
❑ Yes. ED No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 22-3'W
Date: �' k U
21412015

S NM5*3
Facility Number ® - 0
�"Divlsion of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of visit: eCompliance Inspection 0 Operation Review O Structure Evaluation 'O Technical Assistance
Reason for Visit: �& Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L J Arrival Time: Departure Time : 4S PM County: SO4WS!; L
Farm Name: 11j( ;f_ W&d_r Owner Email:
Owner Name: Minnie- Edwards Phone:
Mailing Address:
Physical Address:
Facility Contact: lommy C-dyvavh Title: Maueff
Onsite Representative: 4 /� n �� �� �q Integrator:
Certified Operator: 76m a r words
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
M-C3
Region: J�Q
Certification Number: ,
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HLa er
Non-LaXer
iNull-L
Pullets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes n No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

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

Facility Number: - —7
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑No ❑NA ❑NE
CR No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
Eg NA
❑ NE
❑Yes
No
❑NA
❑NE
[—]Yes CRNo [DNA [:]NE
[:]Yes
R No
❑ NA
❑ NE
[:]Yes
[>--a No
[DNA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional panes as necessarv).
1). PAID wassl�hio o ��ll C )art w 'er 4nzQ7es —y, An Absoleie- wa-ileanarysfs
Wor VA h �h a. �- a (1, s ns�rd of 1171bs Nl1000�q j), OvPiaUe waJ f o�
1 orb tJ�ss Y
a�q -j-,pi las acre D
so taS Qvafla bye � Plearu
e ate e .shotf t' /r
ter��u-►`lid-1
al,�� aboJe. is �, ,`��q , Please- -Pario Oro- y$&-07o7Pie.
J 1 � fo��d .
/� cal bra�+ch ftx aol a Wos io� y,
aye tie d� rn �� l � � I ,
Nov+ be -(Or , a �I,
0 b a©I ,
st!ud esvty � �`hg � �' b aP�oL . The
Asl�d `Burr I f 9N +o he d+�� �cr a Isv, plus- a so j y w
� aot3
4taola t'soi I war d aye �n �anv4�y
lnrell opn ()d_ reco ds, Re -Us cue i n9onof J f P'
Mch �
,�,ti- 1�l,or)�'✓��- n-aoi�-►�-oaoa}��eaa.l�h�o�},'�t n�rnd�- arei�l aor) .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]Mt fif)
Date: 1- a 3
141l011

Lagoon Nam6, S Air' s llilwa
1
2
3
4
5
6
7,
Design'Freeboiard.]. Last Recorded in
Observed fre6b6aTR-,-.-,,,-,-
Sludge Sur've�- Date
Stud e Depth'
Liquid Trt, Zone
Ratio Sludge to Treiatrnbn :V61ume if> 0.45
Date out of compliance/ POA?
Ew-
I jhI
Soil Test Dat
pH Fields
Lime Needed,
Lime Applied
Cu-1 i Zn-I
Needs S 2 5)
Needs
Undo ilala q, 52 F
Kao O-De WL"O�ftpz-) wl --�Qw
Crop Yield )
Wettable Acres
WUP ✓
Weekly Freeboard'.
1 in lnspections,,,'L,--'
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
I jhI
Soil Test Dat
pH Fields
Lime Needed,
Lime Applied
Cu-1 i Zn-I
Needs S 2 5)
Needs
Undo ilala q, 52 F
Kao O-De WL"O�ftpz-) wl --�Qw
Crop Yield )
Wettable Acres
WUP ✓
Weekly Freeboard'.
1 in lnspections,,,'L,--'
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
1111111j, M-MME77MM..
"
Verify PHONE N ' UMBER&a6d'affiliations
� - - t !
Date last WUP FRO,' FRO or Farm Records
Date last WU'. at farmi �$Icv Lagoon # oveb Y -7
App. Hardwar'p '� 11: ! �.! I i]L• Top Dike , V ;'qf
Stop Pump
Start Pump Oka, a?116- k,
Conversion- Cu-1 3000* 108 lb/ac; Zn-I 3000= 213 Iblac

� Divvision of Water Resources
Facility Number - Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine O Comnlaint O Follow-uu O Referral O Emeraencv O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:'Region:
Farm Name: ppn� 'e Owner Email:
Owner Name: s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Integrator:
Certification Number: /`yQ 2 9--
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
DairyCow -
Wean to Feeder
v
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1)e, I;nult ,
Ga acI
top.
Non-Dal
Farrow to Finish
I
ILayers
I I Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I I Beef Brood Cow
Turkeys
U,ther
Turkey 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:
❑ 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 DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Date of -Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Struc re 6
Identifier:
Spillway?:
Designed Freeboard (in):
t/
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 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes:No
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding [3 Hydraulic Overload [3 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 , [� Evidencqof Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/�
13. Soil Type(s): .Y ( (!
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NO 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
icmNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P§ No
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P 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
[PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
y No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Icili 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ } No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[P No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CPNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
ents :(refer to question;#) Explifi aqy YES'ariswers and/or, any,additional.et' ommendations�or`any other comments . `$
Fu)'S'e7d�rawthgs,'of
facility tp better ezulain situations {use additionai'paees'as riecessarvl.
„
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

4
� Divi"sine of Water Resources
Facility Number - Lf O Division of Soil and Water Conscrvation
Q Other Agency
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 0 Denied Access
Date of Visit: ZO 1 Arrival Time: Departure Time: ; a County: Q! Region: 4_17_p�
Farm Name: 111P Owner Email:
Owner Name: A`y.J e e-4J 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: LJtt
Onsite Representative: h
Certified Operator:
Back-up Operator:1 Ca�,
Location of Farm:
Title: Phone:
Integrator: so,,A0,-e J
Certification Number: 1
Certification Number: / 79 Z�
Latitude: Longitude:
Design Current
Design
Current
Des�ngent
Swine Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle
Cap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
i
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr l:ouit ,
Ca acI
P.a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
IPullets
Beef Brood Cow
Turkeys
Other .
{
Turke P Its
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes rM No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
NA ❑ NE
�NA ❑NE
❑ Yes
❑ No
Z NA
❑ NE
❑Yes
�No
[DNA
❑NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

IFacilky Number: 117 jDate of Inspection: `1/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
St re I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
No NA NA ❑ NE
Structure 6
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 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 n 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 T No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.] Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 1of Wind Drift ❑ Application Outside of Approved Area
U
12. Crop Type(s): � &" ' iz..ilj Q , 6--n�,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [& No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes W No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes r" No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P. No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1�3 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Fac 111ty 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 provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
CM No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑Yes
E�]No
❑NA
❑NE
❑Yes
�No
❑NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
Phone: q o"'f 33, no-O
Date: L2,0k
21412015

'i
i ype of visit: w omptiance inspection V uperanon mevtew V structure bvaluatron V i ecnnicai Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'tom Departure Time: County:,Region: f,C�
or
Farm Name: 017 A ; *2-- W Owner Email:
Owner Name: /" 7 rn n i -= J�Fd( akndj Phone:
Mailing Address:
Physical Address:
Facility Contact: %%r%; r'I�'!t 4al�uQy Title: Bin,—'� Phone:
Onsite Representative: L Aire_ // Integrator: /V 25
Certified Operator: �me!:z �a Certification Number: D /
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Cwo —ac I t­V1
Wean to Finish
Current
0Pop.
Wet Poultry
I Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder c> O
Non -La er
DairyCalf
Feeder to Finish
DailyHeifer
Farrow to Wean
Design
Ca tacit
Current
T;o
D Cow
Farrow to Feeder
Farrow to Finish
D , P,au1t ,
La ers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
C3.ther
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[R.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 173 Date of Inspection:
Waste Collection & Treatment
,y
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
QRNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2 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
El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
54,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
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®-No
[3 NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2.No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs. ❑ 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): _ zlr- p Ltle�
13. Soil Type(s): NDA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tZL No [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ] Yes 0,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E. No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ga No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists r] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - t7 = I Date of Inspection: 6 7 —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes SNo ❑ NA ❑ NE
'. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo [] 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 allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CffNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fo No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: 5/j7—`1'33 ;j50C3
Reviewer/Inspector Signature: Date: ]-- JS'
Page 3 of 3 21412011

.M
OrDivision of Water Quality
Facility Number ®- 17 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0-Mo"utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7 % 1._ Arrival Time: Departure Time: O; Oa County: 1;2Region:
Farm Name: fyj ; n ; •� �T,igic/ yyL Owner Email:
Owner Name: /yl r1 n r v 15) 111 ,3 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 4Lo_;!914 6"1.f; #nj .-/ Phone:
Onsite Representative: 1 Integrator: Upy�� �LAJ
Certified Operator: �,R,�t,� Certification Number: lL 7D I_
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
LLayer
3 Non -La er
Nan -La
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2 No ❑ NA ❑ NE
[]Yes ❑ No
[:]Yes [:]No
[:]Yes [:]No
[:]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

a+ Facili Number: LT Date of Inspection:
—/ % 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
10 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
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ 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 RNo ❑ 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): Bry" / ee,,tea�
13. Soil Type(s): 7j n71,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CK No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA C] 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
I8. Is there a lack of properly operating waste application equipment? ❑ Yes rM No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available? ❑ Yes (a No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KLNo
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53�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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [3 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: 7 Z I Date of Inspection: --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RNo ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [gNo ❑ 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 [kNo ❑ NA ❑ NE
❑ Yes 2t No ❑ NA ❑ NE
❑ Yes E�-No ❑ NA ❑ NE
[:]Yes ELNo ❑ NA ❑ NE
❑ Yes &No
❑ Yes RNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: 2jp l��3--33Do
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/1011

i
NPI M 01811a`
• Division of Water Quality
Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: ta�Compliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � j Arrival Time: Departure Time: County:
Farm Name: H) In ie Edpw i PUIM Owner Email:
Owner Name: N f nn e Ulya-0 J Phone:
Mailing Address:
Region:
Physical Address: 5 �'� 1 i� �"'fUt ✓e
Facility Contact: 'Tommy ��)bL (�t1" Title: �(J�Ug0- Phone:
Onsite Representative: Integrator:
Certified Operator: TQy,or Certification Number: 1001
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
30go 13
4109d E JNon-Layer
pullets
Other
Poults
Design Current
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DaiEZ Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Er No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): QUO
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[R No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
[5jNo
❑ 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
RrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CffNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below..
❑ Yes
Cg 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+Wind Drift ❑
Outside of Approved Area
wof
,A,ppplication
12. Crop Type(s): C gc!gI �Plil wk- 1' u , SDVIl l6 ✓#sfo �C
flu
13. Soil Type(s): MdoI
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [].Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes n No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes C@ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CRNo ❑ 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. K' Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking'® Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
®'NA ❑ NE
Page 2 of 3 21412011 Continued

Facility umber:
Date of Inspection; S
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes [R No
❑NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Callo ❑ 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 RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CRNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1' 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 duality concern? ❑ Yes ®' No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes CSNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
®' No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Eg No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
❑ Yes
g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ff No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments r
Use drawings of facility to better explain situations (use additional pages as necessary).
-7, %e d o at mo w 1.03S so shot on ),Joan bay ks ,
15, PIS ch&k fb/ 11 �e t�t,1'(e m0i txt� n Qc*,r0 I I iP.l� 5e has Ch ew I��
L, Qj4 Cfo !Pj -Fran 1 ate �. }+Yvon e,S4vP ad
�Q u as N � In p tovs
asp 0 o� e �P '17 ��
la T�' e
e I I rrror `0r07 Aga-. , tleC&du
pIwdosfa ser:1-H
nod year' Coo u). ExOnIf ffl c
ay, PIeaseToC 11017 in a 0I a . Coll cal Lynr) A11WeIJ Qy- cmpAw exiul'o
Saa=?V.
Reviewer/Inspector Name: -„ '� �1j[}�)�- .. _ Phone: 3-3UlAJ
Reviewer/Inspector Signature: Date:
Page 3 of 3 /4/2011

J
Facility No. Farm Name Hie— LdK-a/bTJ Date '51iT
b,
Permit COC OIC_ NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
Gi�J.'lrL�����������
Lagoon Name S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Slud a De th ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
60 VTAMJrqd,%'AT,9 rld'Wq #M1010
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-1 _� Zn-I
Needs S (5-1<25) _D
Crop Yield 0 J
Wettable Acres L• /
WUP
Weekly Freeboard
1 in Inspections
120 min Insp. I `� ,
Transfer Sheets rl r
R GE
W0eaor incinerator
y Records
Check Lists
Storm Water
FEMME ��IG�Fllic�lL7l�1i:�� llllf I11�G7 /�ICf l V, M.. II 01U-41R��
Ell I'm Mam, povl�=111111111R
manly
.Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm 50.xe— Lagoon # (
App. Hardware Top Dike 5),0
Stop Pump4b,7-
Start Pumpg4,0
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lb/ c
1,34-
.Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm 50.xe— Lagoon # (
App. Hardware Top Dike 5),0
Stop Pump4b,7-
Start Pumpg4,0
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lb/ c
1,34-

0 Division of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 'erCompliance 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: , o10 etll County: SH
it
Farm Name: M6,'e- w Owner Email:
Owner Name: nI}i Ed jrpy,(( Phone:
Mailing Address:
Physical Address: 'W 1S W1111 Dn P_
m
Region: M
Facility Contact: G lw Title: Ma", aq qn Phone:
Onsite Representative: Integrator: 0t
Certified Operator: 76)), , ry s Certification Number: 1001
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
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
1)
Pou
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes R 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
C'No
❑ NA
❑ NE
[]Yes
� No
❑ NA
❑ NE
[:]Yes
D'No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Ieacility Number: Date of Ins ection:
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
[DNA
❑ 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CgNo
❑ 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
15a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
CSrNo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f;R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[RNo
❑ 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): L03M'
13. Soil Type(s): ud+2 j SA k L
�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5kNo
❑ NA
❑ NE
y
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;�:No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
❑ Yes
13 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FM 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
�R 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
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
� NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number:Date of Ins ection:
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 153 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 tZ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
[N NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [-No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes R No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ® Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond Other: ns�I
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? [j Yes
E�ZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
J' No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments a
Use drawings of facility to better explain situations use additional pages as necessary).
UR41well �rna,h�,1�c�. �f*n�
y @5;$
YviI n�fk So j I +1°jf r� a b I ! -f-�as sl dye �ho� �+-� 13013.
Reviewer/Inspector Name: 700n SC6?[6_
Reviewer/Inspector Signature: t,- �� _
Phone:
Date:
Page 3 of 3 U 21412011

Facility No. Farm
dame �°� �1� _ Date
Permit COC v OIC_ NPDES Rainbreaker PLAT Annual Cert )
,Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge De th ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
COL.. r, v WEW�
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP -- Dead box or incinerator
Lime Needed ��, Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I _,/Zn i '"` �1 120 min Insp.
Needs P Weather Code
r,rnn V;eIA 're n f— ck� n � A e
- • . -
�'lIL'liTl■Q�iR■�ID[1�f�Ti1�.�L']T311�'
:.
..
NOWN ..
f d
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon'# '
Top Dike.
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Iblac
App. Hardware l: I/IdJ�

�61U_j I0141/0
fFacility Number
a
Of ivislon of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit ekCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 24,
al Time: ` De arture Time:niml
County: Region:
Farm Name: rl I nn Ie- f EQ� Owner Email:
Owner Name: innie _EdWQIdf Phone:
Mailing Address:
Physical Address: 1
Facility Contact:Ed- r Title: Mjba * - Phone Nob � 2a � ` l 11 5--
Onsite Representative: _T&J integrator: W
Certified Operator:-Th"a-r EJ WArd-i Operator Certification Number: lta70 j
Back-up Operator:
Location of Farm:
0
Design Current
swine capacity Population
❑ Wean to Finish
Wean to FeederAn
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other --- ---- -- -- --�
Back-up Certification Number:
Latitude: = o = 4 = Longitude: = ° = 1
Design Current
Wet Poultry Capacity Population
❑❑ La er -
Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 0
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 Eallo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
Cl Yes
❑ No
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facitity Number. 'a, — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in): Q0
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [;kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes D�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes NtNo ❑ 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 r%No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U�No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) C e9Aj�17.t1 Hpfm.0Q f-1/1V
13.
Soil type(s) f
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[XNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes
V No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): 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 �', Phone: f
Reviewer/Inspector Signature: Date: aDOM
Page 2 of 3 U IM9104 Continued

Facility Number: "6 —IM I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CgNo ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CKNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[Yes
❑ No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
R NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5f No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZINo
❑ NA
❑ NE
Additional Comments and/or Drawings:
`fi T� I cP i�►� ._' 0-e_ kn oivrj Qn ho j*'), , Ae- nav 1^00
weld m *Wed. -Farm* and oat records
11, WAkA tej caA k doe_ of a -I )??&rA ; n`�trya iS� 3 �i recol"OdRI)
`R
r-S1Vdye_ spot dole- h bec-actin, '4 lied�r �1"��i a mo, 'It d.
�Dw C *01b, e6,p n ao [ o, 6) � nib, evey a pjxr,
We_ rO�On Pa'Ke '17 - sl4es"r ex'6j /bl 9ra1 t4w' a O f3,
Page 3 of 3 12128104

`Facility Nod Farm Name
Permit 00�COC
H1A p ie �Vyd Date f "J'A
OIC NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt, Zone ft
Ratio Sludge to Treatment Volume
MOM
Soil Test Date "�)JY)We `ttable Acres ✓ RAIN GAUG
pH Fields—. WUP �— Dead box cin�rator
Lime Needed d — Ti>-, Weekly Freeboard Mortality Records ✓.
Lime Applied 1 in Inspections
Cu-1 t✓Zn-1 •✓ 120 min Insp. ✓
Needs P Weather Codes ✓
Crop Yield Transfer Sheets
Waste Analysis Date
Pull/Field Soil Crop Acres PAN Window Max Date Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App, Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac
Pull/Field Soil Crop Acres PAN Window Max Date Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App, Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac

1 L,yI 1 opt --t IMS "T- vj
0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 1. County: 10"4101 Region: FRO
Farm Name: 711 &r7o)r 6j2ih,&dr i /i, Owner Email:
e ,
Owner Name: NinnPe. _-- _ Phone:
Mailing Address: %OFt �1j24 t2
Physical Address:
Facility Contact:`1' Title: Phone No: �� a
Onsite Representative: ,,� integrator: &A-1- l3flom)
_thCertified Operator: -QrtQf C r' S Operator Certification Number: 16701
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 f = 1f Longitude: = o = & = 1i
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
--' [I Non -Layer
Other
❑ Other— — -- --- ..
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. Whavis 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 C"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes M�No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
12128104 Continued

r Facility Number) -- l
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JWNo DNA ❑ NE
t
a. If yes, is waste level into the structural freeboard'? ❑ Yes ❑ No ❑ NA ❑ NE
Stnucture I Stnicture 2 Structure 3 Structure.4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):��
Observed Freeboard (in): L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'RrNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ERNo
❑ 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
C'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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste -Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
t5kNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
D'Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding tSHydraulic 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 Drili ❑ Application Outside of Area
12. Crop type(s) Clogib7l gt° u ` 5en
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i ❑ Yes
t'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ITio
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ 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):
w
1W
Reviewer/Inspector Name Phone: 01 4,3,33300
Reviewer/Inspector Signature: R Date: as
4./ I2/7l/fbt< " continued

Facility Number: (late of Inspection ark
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? WYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑NNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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 CKNo ❑ NA' ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
[�TfA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
4KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C.5CNA
❑ 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
�SNo
❑ 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
T'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
8No
❑ 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
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
K No
❑ NA
❑ NE
Additional Comments and/or Drawings:
mnSIli SevfasevA* �cfl� �-e- i "nul",n" Pl ,e lip�7 1'hq abo
evidAC� `iS Geselr4
SO1NarfoID SI' ra?�,s hs,Wo'
QPYaje_ Veep Cvrro� O)d C&"tfirakeCa4-ge 0v0i/ahl�
a . Solid Se+ Ivan call b-aht jr1 ?la aooq and sho4c- ha�� be#7 t 7�
�{ 7o 40a cr.
a�OD� e pleae cali�a� ���� }'
h�- r vtt&) - rv� k Ghat 1+ r S`-i11 rvi`h i� w��daw, ,
o a� c y
Ve" y Well malY+ar)14 -0am-) aitt3va �e(wdS,
12128104

,Facility No. � i�� Farm Name "6i ke— Utj?v7 Date I I 0
Permit COC
OIC
NPDES (Rainbreaker PLAT Annual Cert )
besign freeboard
Observed freeboardjin)
Sludge Survey Date
".A.;
------
Sludge r - .
C��--_--
Liquid Trt. -
_
r���������rr�rr�r�■r■rrir�rr■■■irr�
D
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu ✓ Zn—�
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAl UGE
ead b or incinerator
INTO
1/
TO I 11
at
i♦ �:�
�.
1
■_
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
Siva ��IL•}'�'M' �0�
FRO or Farm Records i
Lagoon # A'�ict @007 6
Top Dike Slip
Stop Pump %, 5-
Start Pump 4q,Q

NrI5 Jul 711slq
s
'Division of water Quality
Facility Number a O Division of Soil and Water Conservation
0 Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: WW0411 I Departure Time: I I 0;30AI County: Region:
FarmName:`Norlar Genf-- UrV4�r F32m Owner Email:
Owner Name:. Hlanie 1'+�&k Phone: q10 ^q 45
Mailing Address:
Physical Address: L il lhol NeAh aqrovP_
Facility Contact: Title: Phone No: (Q1q) Qa 1+ (cj
Onsite Representative: Integrator:. B:tA LVMg4L
Certified Operator: —Nemmr G fOperator Certification Number: AwA 167Qr
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 e ❑ 1 ❑ Longitude: = o = 1 =
Design Current Design Current
Capacity Population Wet Poultry Capacity. Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: lil
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 JRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
SrNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:Qa, — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ 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): at�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
12 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
UVo
❑ 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
62"No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D '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
UrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
NrYes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
SPAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) CQjl& i boA111. ( W '.se? of
13. Soil type(s) No -folk I S' - Ng&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EgNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�TNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
XrNo
❑ NA ❑ NE
Reviewer/Inspector Name aoArflS ° 1/Ef E Phone: - 3DOX
Reviewer/Inspector Signature: Date: -7f y
Page 2 of 3 V 12128104 Continued

Facility Number:
�- Date of Inspection L LJL71l1�_1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ Wup ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. jffYes ❑ 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
Wo
❑ NA
❑ NE
❑Yes
❑No
UNA
El NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
59No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
❑ No
&NA
❑ NE
❑ Yes 15?No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes CErNo ❑ NA ❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
Additiohai Comments and7or Drawin s a �g f, s gi ,� k; '`�
-d.6t �':"
Ohe-461 to L exceeded . Pia b y (9w) ID Ks o r) ;1'0/1 oq a 009 d V60 a `oe 6r0"t z1o7oj.
e� P� dw
i, Wakanalyses aoat &o ays,T�os�rar y r►l �aw
G and I a oa, co'_ P '
do 41is
w1fI ne7 +, cdlfifTNI ear,
J
Page 3 of 3 12128104

Facility, No. s°` m Time In !K,30 Time Out
Farm Name INMY �. {�w(�- � Integrator
I
Owner Site Rep.
Operator
Back-up
COC
No.
No. _
Circle: General or NPDES
Date
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test 110 Wettable Acres J
Observed (0161 f2'
Calibration/GPIVIifforlam sljtbb
Waste Transfers tf al
Rain Breaker
PLAT 3 yll IC",� �f7fP �'CJ
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop ✓
Weather Codes 120 min Inspections oW�, y ASO.,?
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
�FYS
ll r�rblo� Isox wasb 1,9 v I, 4rg 4c-

` Division of Water Quality
1 Facility Number Division of Soil and Water Conservation`
' � �]
O Other Agency a
L
f Visit 0 Compliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
n for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency )% Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region -`
Farm Name: \otY1t>�S QAu UV Owner Email:
Owner Name: Y-, n t. TEA 1A�( Is Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: c r
Onsite Representative: Integrator: M m ­-.1 d-�
Certified Operator:
Back-up Operator.:
Location of Farm:
Design Current
Swine Capacity Population
�❑ Wean to Finish I
. Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
Other
❑ Other
I
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Layers
Non-L,
Poults
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: = ° = 6 =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t4No ❑ NA ❑ NE
❑ Yes ❑ No
ElNE
ElYes
NA
ElNo;NA
❑ NE
❑ No J&NA
❑ NE
[:]Yes
El Yes
'MNo El NA
❑NE
❑ Yes
❑ No m NA
❑ NE
12128104 Continued

Facility` Number: —j"jDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E2 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 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 [I 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 h0E
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
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
NE
{Not applicable to roofed pits, dry stacks and/or wet stacks}
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:]No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �] NE
maintenancelimprovement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA V NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ❑ No ❑ NA
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
PNE
NE
PQ NE
NE
4 NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i�%6c�d
dw V i—
Reviewer/Inspector Name 'Tlmz� lam .
0 Phone:
Reviewer/Inspector Signature:
Date:16
12128104 1 Continued

FaciEity Number:Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [RNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA :P NE
the appropirate box. ❑ WUP El Checklists [I Design ❑Maps ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
JXNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
1)0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
'K' NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
P9 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
n 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
i� 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
❑ No
❑ NA
J�NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
0 NE
Additional Comments and/or Drawings:
12128104

T
Date of Visit:
Farm Name:
Owner Email:
Owner Name: ` Y L . W, f1i t. Phone:
Mailing Address: + (]
Physical Address: w.a—m - 1n - �id t d
Facility Contact: 1 '
Onsite Representati
Certified Operator:
Back-up Operator:
track -up certification Number:
Region• V_,]
Location of Farm: Latitude: = o = 6 =16 Longitude: = 0 0 ` ❑ `d
Design Cnrrent Design Current Design Current
Swine
Capacity PopulatiR1 Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer ❑ Dairy Cow
❑ Non -Layer ❑ Dairy Calf
❑ DaiEy Heifer
can to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Dray Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non-DaiTy
❑ Farrow to Finish
❑ La err
❑ Beef Stocker
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
❑ Gilts
❑u
Boars
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharges & 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 DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
5 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

V
Facility Number: — Date of Inspection [� d
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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 No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) I A
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �.No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 111
9. Does any part of the waste management system other than the waste structures require ❑ Yes JqNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
f
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes10 ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ',No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) No
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )ANo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes �KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes 4 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes o
tNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
ElYes
❑ 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 J1 N Phone:
Reviewer/Inspector Signature: Date: !ti 0
12 4 Continued

facility Number: — Date of Inspection0_01011
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. ❑ VTUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J%No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
&A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
/
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�PNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYesZo
o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ 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
[INE
General Permit? (ic/ discharge, freeboard problems, over application)
F
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[IYestNo
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
P
MZ
t�� 1
o Q� � W LfS,
Page 3 of 3 I2/28/04

Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
f ,;Facility No. Time In P30 Time Out Date
Farm Name . � r�T,4,%r .,, '� _ _ Integrator
Owner S Site Rep
Operator No. LVIQ
Back-up No.
COC
517
Circle: General or NPDES
Des' n
Current
Design
Current
Wean -� Feed
I
Farrow - Feed
Wean---F—inish
Farrow - Finish
Feed.- Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Desi
0i'u'ge 0
'u dey • �'
Crop Yield
Rain Gauge
PLAT-----�
Daily Rainfall
120 min Inspections
Observed
Calibratior!GPKI
Waste Transfers
Rain Breaker'��
Wettable Acres
1-in Inspections

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County. Y1 ' JRegion:
Farm Name:
Owner Name: S Phone: 1191 QZj (45 On) Tor•nM.Y
Mailing Address: u l 1 I dam l �J,.a�►f0 [L «Cp
Physical Address: CKXPY1 Q_
Facility Contact: ��rnrn F—V Title: M I ' 1 Phone No: �1
Onsite Representative: lOr''\rnk'h' Integrator:' -pre- i i v+r'1v s"j&'
Certified Operator: Ai s Operator Certification Number: � �0 , 1 �
�f i� 1
Back-up Operator:
Hack -up Certification Number:
Location of Farm: Latitude: [--] e =' [--]" Longitude: 0 e 0 ' "6
�I,JN S� CaS �v4c-►�. N� C'ZroYe. C� 3 m� � Z- tsh W ����0.w. 12��v�o
Arn; (t
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
d S ❑ Nan -La et
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
[I Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El 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
[IDai Cow
El Dairy Calf
❑ Dai Heifei
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
�A
❑ NE
❑ Yes
❑ No
WA
❑ NE
❑ Yes
❑ No *JX NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
"Wo
❑ NA
El NE
12128ll10�'4``
Continued

Facility Number:- 1-71 Date of Inspection
r '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes '�*o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
�MNA
❑ 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�,[
❑ Yes ZNo
❑ 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 "INo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yeso ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) -04,,�_ &,v�'-Saa ,r `i/Cl. n G
J V
13. Soil type(s) No A _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes IgNo
❑ 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,
El Yes No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes '�(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes )M No
❑ NA
❑ NE
94e Lo-rn UY-1k 0W ICsey "I va.,nkut Q&Ct 4b
f o
�i, �iu�� "°, Phone: Otto q35 MW
Reviewer/Inspector Name 1Q,ls'Tli.1� a F t,.
Reviewer/inspector Signature: 111c+ Date: U'-J�e
12128104 Continued

Facility Number: Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VN. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No "KNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�SNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
*VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[--]No
XNA
❑ NE
Other Issues
29,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2(1�4,0
❑ 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
El
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
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
16 No
❑ NA
❑ NE
Additional Comments and/or Drawings:''
Ll
12128104

'4
:::Y'{Y,$['SniF.w°S�=':S4ih:Sl$[Ns�:`f�T".�iSiK14.z�+Y��"YIw!'Ty}.<ef_....a:eeT.y'2ti'$aB7r�w;.Y.:'-_.wLui:i:�LsY,.3,N1�rr�.reveLiewln !'..'. rb<:�.,'. �+hu-•r Y-`JY ''1:tA+.r Vf:ei��'e+u#:']P"'rMo.'1 fi'.".i (••,:. t'*"d'1: �'�'rr:i-., i3.. :.[<a�+.< ,-<<:i... ... r-':b -r "�`§'.,.� ..
-it t�� {t^'"N4 Ik� Y ; � 3r �s �� �,... '1'� O `Qttl:r !n !4 7�� 'n..': �,,9d�. �^ �.:�� .i' ' '� i 1,• a ' .n�„� F �'r � 3 ��'i �rt ' t., �� y {
.��.YA'=L�.:`�a,.��N ......�T,�.�p y��•�'^i �... �`us��3��h ��1��....���M�tl'.a. Ir.L r Xi=.. r... b�,r .L a, _�.i � _ ... �...,. .., �. �_ �. .,.. .o-.�.�..u��..... ... _ _ � �.
Type of Visit (V'Com;Aance Inspection 0 Operation Review `0 Lagoon Evaluation
Reason for Visit (VRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
r rr Mw n�i�i.rr..
Date of Visit: Time: 5. 0 O
Facility Number 'i
�� rO Not Operational Below Threshold
e Permitted E3 Certified ©Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: _ l w .r- f "S&I County:
Owner Name: f�f Kr� S Phone No: _5_4� — ta; +
11Mailing.Address: ����w111�a�.. � ~''�1�d• __ K
Facility Contact: Title: Phone No:
Onsite Representative: iS U_iDTiZoy� Integrator: NSF
Certified Operator: I''
�jf_1 �tl�� Operator Certification Number: NOW
Location of Farm:
92'wine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' 04I�u Longitude • ` •6
Design Current Design Current Design Current
Swi - Ca acitY Po ulation Poultry Callacitv Population Cattle Ca $city Population
Wean to Feeder C 1 10 Laver I 1 ❑ Dairy
❑ Feeder to Finish JEJ Non -Layer I I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons r' ❑ Subsurface Drains Present 110 i s 4odArea ❑ S r'av�Field Area
`Holding Ponds / Solid Traps '" " ❑ No Liquid Waste Mana emenf System
Discharges S tream IMpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray 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 S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): %'? iwd-sS
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facility Number: — 7 Date of Inspection 10 3 O o
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑<
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 91-l�o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9f4o
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0 0
12. Crop type cem"J& AOS
13. Do the receiving crops differ with those des' nated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [! 1Ko
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
0-<0
b) Does the facility need a wettable acre determination?
❑ Yes
U-No
c) This facility is pended for a wettable acre determination?
❑ Yes
E21TO
15. Does the receiving crop need improvement?
❑ Yes
&Ko
16. Is there a lack of adequate waste application equipment?
❑ Yes
Q-Ko
Required RecoLds & Documents
17. Pail to have Certificate of Coverage & Generai Permit or other Permit readily available?
❑ Yes
ErNo
19, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,_ /'
(ie/ WUP, checklists, design, maps, etc.)
El Yes
2
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P N" o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Eitfo_
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0240
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
, �,
(iel discharge, freeboard problems, over application)
ElI3 Yes
No
23. Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
❑ Yes
2115o
24. Does facility require a follow-up visit by same agency?
❑ Yes
Eg o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®1qo
Er No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commenf�`�(�efcr to'uestion #� ��.x. lain an Y�bYAnswers andbr•'anreciiinin°endations�ir,an otherx omments.� � Y;; �
drawing
� , ��
11se of facility to better explain sltuatiotts., (use additionalyypug�(e4s as necessary) ;' teld Copv ❑Final
•. .a .. d.�, .w..._.+Ilb of M6i��%u. §.` .It �1 .. ,„_..YVNa3�iVryYP'@i .. X..J .. n.i .".. E-!�Y!
Notes
r
%t }vt MC Hel Att5 y is C f W►1 iA 5,t 4 C7e41+'i pots
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 03
05103101 Continued

i.
Facility Number:
Date of Inspection
t-dOr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a pbrmanent/temporary cover?
❑ Yes,io
❑ Yes [D-No
❑ Yes (D-No
❑ Yes Io
❑ Yes Ea1lo
❑ Yes 9-KO'
El[ Yes No
Additional Comments and/or Drawings;C. ti, ,,Y:' , ; r , _ •t. �_..:
AL
44% I i45, ig dr►c "fiat 514hAJJ joe a+,
GCS+.. rya -ro Dtf tiLr s . /� tc t r1act ,
05103101

Site Requires Irntnediate Attention:
Facility No. - t'7�
DIVISION OF ENVIRONUENTAL MANAGEMENT
ANIMA,, FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2 t , 1995
Time. tea
Farm Namm/Owner: TO N4 103 j G 4a E F-b U.) r`rd S
Mailing Address: 9�00 �� �
ash np_uj�uri Gy-ovj. - nc a
County:m _
Integrator: IDM &f .s, Phone: �g tl-off
On Site Representative: Phone: 510-z-g-02115
Physical Add:em/L.ocation: _� _�� _ wet �cs ,���- v� can+. G wv e
Type of Operation: Swine nur Poultry battle �.
Design Capacity: v Number of Animals on Site:
DELI Certification Number: ACE DEM Certification Nwnber. ACNEW__ -
LatitudV 39 - J' L_' ,g_" Longitudw_78 ` 11 ' -1 1
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ye or No Actual Freeboard: —Ft. _ Inches
Was any seepage observed from the nYe
n(i)? Yes orFyas any erosion observed? Yes or No
ua
Is adequate land available for spray?or NoIs the cover crop adequate? Y or No
Crop(s) being utilized: Loa-c d-t b� rrk..r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin 7 ke�lor No
100 Feet from Wells. Y' Y or No
Is the animal waste stockpiled within 100 Feat of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the stage by man-made ditch, flushing system, or other
similar man-made devices? Yes 06D If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No N4V �%J c,..�.accn '�.c
Additional Comments: Z. T+^?►i s
in pector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

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to the` Vr /ivisi69• �+ri�e�rtea! �as�e�rt ' ati"
69 `
Mid •e�..:.f �N '.1�.: !,Ju• �S� �.�r'.�.y ��'....
Phone No . ; 21��546-ruc� - - --
County •
Farm location: Latitude .and Longitude 1�-lb ?j /7$ UL �, (required). Also,
Please attach a copy of a county road map with location identified.
Type of operation (swine, layer. dairy. etc.) : SME NURSERY
--
Design capacity (number of animals):
Average size of operation*(12 month population avg.): Juqu
Average acreage needed for land application of waste (acres)i
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Teaha;Laal fpecialist Castificatiao M..
As a technical specialist designated by, the North Carolina Soil and Water-
Conserdation Commission pursuant to 15A NCAC 6? .0005•. I certify that the rfew or:
expanded animal waste management system as - installed for the farm -named above RF-
has an animal waste management plan that meets the design. construction:::.-
operation and maintenance standards and. speC3ficatians.af the: -.Division of..,.�:- _..
Environmental Management and the USDA -Soil Conservation Service and/or the North - -
Carolina Soil and Water Conservation Commission pursuant to ISA NCAC 2H.0217 and
ISA NCAC 67 .0001-.000S. The following elements and their corresponding mini
criteria-hsverbeen verified by me or other designated technical specialists. -and
are included in the plan as applicable: minimum s-aparations-
equivalent for lagoons or waste storage ponds; waste storage capacityr­adequate _
quantity and amount of land for waste utilization (or use of third party); access
or ownership of proper waste application equip Bent; schedule•- for --timing of• - _
applications; application rates; loading rates; and the control of the discharge._
of pollutants from stormwater runoff events less severe than the 23-yea►t.- 26-hour- $
storm. 1741 e . .... .
Vane of sevheiaal
Atfiliation:.
Address (Avency):.
(Please Print)
L6 Phan* No
Z�_
Signature. , - Date:
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o+aser/]tanager Agreemeat
I (we) understand the operation an maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion, to the existing
design capacity of the waste treatment and storage syxzam or construction of now
facilities will require a new certification to be submitted to the Division of
Environmental Man.agemoAt before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this systan -to.
surface Waters of the state either through a man-made conveyance or through
runoff from a sz?.*= event less severe than the 2S-year, 24-hour storm. 'The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Lazd owner (Please Print) : x:,ya Ed,., a 4:d-
Signature:_ 4&h i6 Date: IZ.- /4 9 4 -
!Tame of Manaaar, it different from owner (Please print) :
Signature: _ l�1.Q�- - - �. - - - ' Date -
Moe& : A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Divilion of
Environmental Management within 60 days of a title transfer.
OM4 USE OW,.,Y:AC:rZW#