820187_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

���I s •3�- f•l g
fMan of Water Resources
Eaelli f NuMier LTJ - ® O Division of Soil and Water Conservation
� Other Age�ney
Type of visit: &Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (D-fioutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: s P t r Arrival Time: Departure Time: County: S%T
Farm Name: 13 �eyt r0cr.'1 Owner Email:
Owner Name: 6 e' tjG rwl Gft Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct ,1 r! S Title:
L{
Onsite Representative:
Certified Operator: 13 -em, �-)ar U L Uk
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: f f `2 !' C�
Certification Number: T 13 g�-
Certification Number:
Longitude:
Swire
Wean to Finish .
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
Non -La er
[]Yes
❑ No
Dai Calf
❑ NE
Feeder to Finish
l'1n 1
D , I;oult r
Design
Ca aei
Current
P,a �.
Dai Heifer
D Cow.
Non -Dairy
❑ Yes
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ NE
of the State other than from a discharge?
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.
Qther;: -
Other
I I
Turke s
TurkeyPoults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Q 10 ❑ NA ❑ NE
[3 Yes [3 No �A ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Q-iCIA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[]Yes
❑ No
[5"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D4�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Zjll�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: - Date of Ins ection: 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ KA_ ❑ NE
Structure l 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 Q -No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E:Ko
❑ 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
Q'1\10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
0 -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
. ❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10
[DNA
❑ NE
maintenance or improvement?
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!3 o
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3<o
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[' o
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [T 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 n❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C r, VK lLAL rj- U -T-- Ha.y
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 2/4/2011 Continued
13. Soil Type(s): A U_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R'_lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[91 o
[DNA
❑ 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
[3 -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!3 o
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[' o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3'1�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �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 CErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 2/4/2011 Continued

Facili Number:- /�— Date of Ins ection: JS 4pi,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
�] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [D<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 . Do subsurface the 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 ReviewerlInspector fail to discuss review/inspection with an on-site representative?'
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [31N' o ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
❑ Yes C5 No ❑ NA ❑ NE
❑ Yes El -No ❑ NA ❑ NE
❑Yes
Q No ❑ NA ❑ NE
[:]Yes Yes
❑ NA ❑ NE
❑Yeso
rNo
❑NA ❑NE
Comments,(refer to question #): Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings;of fncllity4o better explain situations,(use additional pag'es'as, necessary).
L( qio -3n6�s
Reviewer/Inspector Name:
ReviewerlInspector Signatur
Page 3 of 3
0-3:7 � F- 5.2-
Phone: qtO— q33`
Date: a 5
21412015

[►� S i ��I y s / r� im
r
Division of Water Resources
Fae'tUty Number - 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: OTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: t.Ua Departure Time: l7 County:
Farm Name: FptaWrr Owner Email:
t
Owner Name: t Phone:
Mailing Address:
Region:,Ii
Physical Address:f
Facility Contact: C�t�w1 s jj au -r vt�e& Title: Phone:
Onsite Representative: t t Integrator: PrZ-1-
Certified Operator: V (-j U)&L . Lt & Certification Number: '79,er;,5
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish L
ayer
Wean to Feeder
Feeder to Finish G ' 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current/
Dry Poultry Capacity Po
Layers
Non -Layers
Pullets
Turkeys
Other[Turkey Poults
Other LjOther
Discharees and Stream Imnacts
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
Flo
❑ NA
❑ NB
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[D -NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[51NA
❑ 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
[] N
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ej No
❑ NA
❑ NE
of the State other than from a discharge'?
Page ! of 3 2/4/2015 Continued

Faciii Number: - Date of Ins ection: -.
c
Waste NIlection & 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 D -NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑-1qo_ ❑ 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 [!f 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 orenviro ental threat, notify DWR
7. Do any of the structures need maintenance or improvement? es �va F1 NA ❑ NE
----
13. Soil Type(s): At
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [o]'IVo
❑ NA
[:IN E
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes [3 No
❑ NA
❑ N E
maintenance or improvement?
[3lo
❑ NA
❑ NE
i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [3—No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload . ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ FaiIure to Incorporate
Manure/Sludge into Bare Soil
❑ Yes
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ NA
12. Crop Type(s): -0 e",vk,"A S- 6, g,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'l leo
----
13. Soil Type(s): At
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑'NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ED4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'l leo
❑ 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. ❑ Yeso
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
F-1Rainfall❑Stocking p Crop Yield [__1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes [D-No23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes Q No
© ❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
0 N 0 N
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: g'J"
24. Did tiie 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 2<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F!fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [fl�o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes Q'IQo ❑ NA ❑ NE
❑ Yes [31 o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑i'lio
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ff No
01-m- Q�
Sf� e 5i0k ---17
7 F,filA v,9p}nfi��
Reviewer/Inspector Name:
ReviewerAnspector Signatue
Page 3 of 3
e6ue/, DVI. ✓ L;, [
t- q/o_3v?- lgsj
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone: o r i33-.3331
Date: n -G
21412015

V Division of Water Resources /
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: () Routine O Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: 110-,74-10 1 Arrival Time: I1 y Departure Time: County: s Sd4 Region: TILy
Farm Name:y e n 6L �,,,� e, Owner Email:
Owner Name: Ren Azc,,c
n Phone:
Mailing Address: q 441 u !L G MC aZ V 3 2
Physical Address:
Facility Contact: QCn uc, w , c. j{ Title:
Onsite Representative: 9,0, h/e,r; cK
Certified Operator: fig,*
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
'feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: /4/'iesk"4i
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure. ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C31<0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes EErNo
❑ Yes [21No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA E] NE
Page 1 of 3 21412015 Continued

I Hili-Numher: '] 1 Date of IRs ectlon:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?: /20
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[lo
❑ 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
❑'�lo
❑ 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
[3 -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
02Io
❑ 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 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): 449 S 8C/'rh VZ/6 0 Sma 6"- .'n Qver_$ eed
13. Soil Type(s): A-V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3'0 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes OD -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [jNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes E�I<0 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [3STes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? E30i'es ❑ 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.
❑ W+}P ❑C%eokl4,t8 [:)Design ❑ M*M ❑ Lease Agreemems ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑�s�iafl- ❑ ee c y ree ❑ Waste.A w4ysis ❑ SC420[Lldfiysis ❑ Waste-�rs ❑ wrat�
❑'IaiafaU ❑fig ❑-Q9 Minute hnspections ❑ ❑SKdg�e}'
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes io ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ©-AFE
Page 2 of'3 2/4/2015 Continued

acili Number: YQ - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3'<o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2_<0
the appropriate box(es) below.
❑ Faiinre-to comptete ann=`sluttge-srirvey - ❑ u ge Tevels
[� Non -c
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 E10
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA aNE
❑ Yes �fo ❑ NA ❑ NE
❑ Yes Ql o ❑ NA ❑ NE
❑ Yes [DKo ❑ NA ❑ NE
[:]Yes fo ❑ NA ❑ NE
❑ Yes �o
❑ Yes Eq.No
❑ Yes 6:: Ko
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E:] NE
Comments (refer to guestionf#.) Explain any YES answer§:and/or any additional recommendations or any other comments.
[lseadrawinas'facility to; better explaim;situations (use additional pages as necessary),
jy,
�rrs'3a1i'un
`Ur&l*f
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4&j 6tae*)
e (
1 q,
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n 01
re e ,'ve d
am o Aeh/ Cuc
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a copy
o� lAe Lzpaq
D"i'yn,
Reviewer/Inspector Name: / ar I( ,r`G., tarp_, Phone: S 3 GU
Reviewer/Inspector Signature: MM (1,� � y Date: 1U -,7G-16
Page 3 of 3 2/4/2015

/p -&--lam
VOIDivislon of Water Resources
Facility Number ®- ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: (Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: J&<outine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: //`z- Arrival Time: .'s7 Departure Time: .' j' County• Region:f
Farm Name: A__—nn j:F-S 4(A1zgg gJ Far%r'` Owner Email:
Owner Name: Z-24. Phone:
Mailing Address:
Physical Address:
Facility Contact: oe", 6(Jis -' Title: ®Glif?rP/'` Phone: }�-�
Onsite Representative: Siti..•� Integrator: �reT!: r.1r.�.�
Certified Operator:
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:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
gL
a er
Non -Layer
Non -L
Pullets
Other
Poults
Design Current
Discharizes 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?
Page 1 of 3
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Duiry Calf
Dai Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes fig No ❑ NA ❑ NE
[-]Yes ❑No
[]Yes ❑ No
[-]Yes ❑No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ -NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facili Number:- Date of Ins ection: f
❑ Yes
EZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3a
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
KA 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
5g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg 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 l0 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): �repxc e �VGrSYyd
13. Soil Type(s): 21 tt
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 P] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
RLYes
❑ 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 R Design Co 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 [Z 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 2/4/2014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j!` No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®, No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
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-sitc representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
F] NA E] NE
❑NA r-1 NE
❑ Yes E' No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JZ[No ❑ NA ❑ NE
❑ Yes (Z No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes ELNo
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question.#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessa
,G 4.n �iQv wu) scu.) r eL� �-ti .i Wa f �-`-
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eD of I' re4 75
S
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
2/4/2014

tip
1vision of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit:��omm�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ECJ -Routine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: �; 3 Departure Time: ,�Of� County: Region:
Farm Name: xerrer .A ;ra'/1Lz Owner Email:
Owner Name: 7' -eVx 3 e. w4j"4* Phone:
Mailing Address:
Physical Address:
Facility Contact: 132-, (/tlw,&k Title:fir 0" Phone: `%[7 ` 3:3 7 , .34 12-
Onsite
ZOnsite Representative: Integrator:
Certified Operator: 71C.rlrle � 5/j Oql Certification Number: jppG%
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.
Layer
Non -La er
Mets
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
[:]Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[DNA ❑ NE
Page I of 3 2/4/2014 Continued

Facili Number:- Date of Inspection: �aD
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):
Observed Freeboard (in): :b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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
[S No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
® No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Z 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)
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
[] NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
® Yes
❑ No
Waste Aimlication
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[K No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5g 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): ffeemK�tpc f 2Vr✓S7-y►Z
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
® Yes
Er Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
® Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[K No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Dcsign ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [Z Yes ❑ No
® Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []StockingE:] Crop Yield 2<20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes No
❑NA ❑NE
2rWeather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continuer!

Facility Number: - IeZ I Date of Inspection: —
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
w
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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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-compliancc of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes R No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any.YES answers and/or any additional recommendations or: any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
all.
c
l9i?'1!J G DG �rf�`�7F i n rr'CO�S
f, u o1.�r• x-!�/ � Z � r►"s Gvs � virfr •,1l Lf� S �� /¢rip �si �
fl90Gl� `{�w
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �jt7—y3J��
Date:
2/4/2014

D(W JyS g161114
Division of Water Quality
Facility Number ®- Q O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ® Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ®'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: QJm Departure Time: d;, County:
Farm Name:ten a �l�gl J'j]/j� j�, Owner Email:
Owner Name: k'-'1PA Dir/L%j W
Mailing Address:
Phone:
Region: M
Physical Address: 1395- Hnirgw 41 . clp/r6
Facility Contact: _Iffi_ Bladrhow Title: QW Phone:
Onsite Representative: r efh Ply Ox- rl�ryj(� Integrator:
Certified Operator: Il�� �'Q �,!a(�f`jaJy Certification Number:rjp ^
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
C Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
lets
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E�2,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
®' No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes
Eg No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

ti
Facili Number: jDate of Inspection: 00
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:
13. Soil Type(s):
Spillway?:
14. Do the receiving cropsiffcr from those designated in the CAWMP?
❑ Yes
No
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
Observed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
15�No
❑ NA
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.)
IT Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
UR No
❑ NA
❑ NE
waste management or closure plan?
Required Records & Documents
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
5?No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cia 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): dD _6y4- PoAle_. small 0/01 &oiwd
❑WUP ❑Checklists [3 Design [3 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. R 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 CR No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
NA ❑ NE
Page 2 of 3 2/4/2011 Continued
13. Soil Type(s):
14. Do the receiving cropsiffcr 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
15�No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR 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 [3 Design [3 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. R 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 CR No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
NA ❑ NE
Page 2 of 3 2/4/2011 Continued

V
Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E[ 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 P No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CR 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
RNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5a No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
f�[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 necessa
�. Pleaaerno )Qy baw �s a,d. sfwa or a v �aCy ins�c�e ad �w�
6i ki -Jowl) `% ` o� berm � ov`�s;le' banks
Is, �a►e ),fine, 4. add p5�bj 6 -�o yt5-flt-lldr -i f W13 50d ` ejtslw Pl o hft�
Cn )a h curt#,+�), V 4jt ta1'e eY, was rernf s0r ayeet * YvW c&f.10 j AA iod i e_,
y �
Do, p1fte cum9t) rvo,�epla'l - putt 5vygr remmd-,
a I, ISI-,
P& rpUr1,s tar, ho a, e. -- nme. Ioj--w�� 1�
RY" $r acv 01C s J� L�Ur�
Farrn o0 ty-m-d r V n pe W ,rha ewe Of Mid Q hove .
AddiF D,a` nOie, nOf on FAWT(I,
Mo4xl), hells Cie 100 et 01d fhcy1
Reviewer/inspector Name: 3-0 au Soh I* er
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�((}'131 0,2Q f 04
Date:Aw w
2/4/2011

Facility No. 43t-1$2 Farm Name A/) 61 df Date
Permit --I"' COC L/ OIC -j,/ NPDES (Rainbreaker PLAT
Annual Cert Daily Pipe)
3J
�3
Lagoon Name S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard ,
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Soil Test Date
le IQb-toi`'(
pH Fields
.5-S
Lime Needed
Y--eS
Actual Flow
Cu -1 ✓
Zn�
Needs S (S-1<25)
Needs P
Soil Test Date
le IQb-toi`'(
pH Fields
.5-S
Lime Needed
Y--eS
Lime Applied
Cu -1 ✓
Zn�
Needs S (S-1<25)
Needs P
,I
Crop Yield r Ai
Wettable Acres
WUP ✓
Weekly -Freeboard ✓
1 in Inspections
120 min Insp. ✓"
Weather Cndes
Tr sfer heats
RAIN GAUGE
Dead box or incinerator `
Mortality Records
Check Lists
Storm Water
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
Ll
g D.vre -K
73T ' i7v7 .
Verify PHONE= NUMBERS and affiliations 72kcab.0' -Ii/hwabD
Date last WUP FRO %NOy FRO or Farm Recordsa,
Date last WUP at farm Qjd�[1N Lagoon # ��`��4'yprr
(P,7�8
App. Hardware, Top Dike �a Ind ir3
Stop Pump
Start Pumps
Conversion- Cu -I 3000= 108 lb/ac; Zn -1 3000= 213 lb/ac a, 01 f

II Facility Number
Cly Division of Water Quality
4 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: @F Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Com laint O Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: 1 I o� Arrival Time: Departure Time: .3 County: Region:
Farm Name: n );�vobs �,Arw Owner Email:
Owner Name: inn S Q , (zrA oS h �� Phone:
Mailing Address:
Physical Address:
Facility Contact: C %_-� IN RK14)5 kAw Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:'
'
Location of Farm:
""", I-°` Swine
Wean to Finish
Wean to Feeder
Feeder to Finish y $
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
� M
S,, VVS %
u
r'�.ti
Latitude:
Integrator: Fe
Certification. Number:
-AkCertification Number:
Longitude:
Design Current • ° Design Current
Capaeity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer ,
Other
Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other '
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?
Design Current
Cattle Capacity Pop.
Dairy Cbw
Dairy Calf y
—Dairy Heifer ,
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
'd" ❑ Yes'❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
• b. Did the discharge reach waters of the State? (If yes, notify DWQ)
•
❑ Yes
❑ No
❑ NA,
❑ NE
i
c. What is the estimated volume that reached waters of the State (gallons)?
5
d. Does the discharge bypass the wasie management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE �.
3. Were there a4 observable adverse impacts or potential adverse impacts to the waters�
❑ Yes
❑ No
��] NA
F:
❑ NE ,
of the State othenthan from a discharge?
- Page Lq 3 ii
} 2/4/2011 Continu d ,
�1y'_. 'l:+.1�_.. f 1_'�I. ,`��•jr. _y �.. �1-: �:1 .. ,.i is .. . 1 ... �.: ..i... w. it iLM.�u.a�i ...... .a fin. .�:.- _ •j..'..•�+.
-... . +.i
-I,. o(�a�
_. .i�
,..- . . .. ,;�

•-� w. ,:�.., �;,r,�,•'fVeFr".'v'F.'i�'#h'�.'i" AwrT,•tnr�.w+., � -... ,�- _.., .. .. ,..- -' ... ...n.
.,,T,},,,....�.. ....m.--1�3Y.
^tea r•. ,w;.. �.-....,..
i
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CErNo
Facili Number: I "J Date of inspection: R
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
E
Waste Collection & Treatment
,❑ NE
dNo
[RI Yes
❑ No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
17. Does the facility lack adequate acreage for land application?
❑ 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
E(No
r
E
Identifier;, �•
Pag2 of 3
•
' Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
[ONo
❑ 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 [244o ❑ 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 [g'5o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?; ❑ Yes ry'SVo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes []?Ko ❑ NA ❑ NE
maintenance or improvement? `a
4. t
Waste Application L
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [v"No ❑ NA ❑ NE
maintenance or improvement?
'F 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑'f o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
'.r,. ' ❑ 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
r `'
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
S3"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3] -Ko
[]NA
,❑ NE
acres determination?
[RI Yes
❑ No
,
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑.Soil Analysis
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g -No
❑ NA
❑ NE
Required_ Records & Documents
,. 19. Did the facility fail to have the Certificate of Coverage & Permit readily available?❑
Yes
[�No
4.
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?'If yes, check1 ,
❑ Yes
(No
E]NA ❑ NE
the appropriate box. N
'
❑WUP ❑Checklists ❑Design ❑Maps ❑ LeaseAgreements
❑Ot�r:
,
21. D es record keeping need improvement? If yes, check the appropriate box below. '
[RI Yes
❑ No
. ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑.Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and I" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ""
❑ Yes
[k�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 1
❑ Yes
E(No
❑ NA . ❑ NE 1'1
Pag2 of 3
2/4/2011 Continued;

L Vllllll4lll0 kl G1G1 EG'{#U1L04lV �1 M).'L'%V1nJlll[lay' 5 ..l:l1.]-"ARM"Gl'3 Ql1Nl Vf. lLl■ 44""i[i VllRl [F4V[lllll\.11\[p41V ll� Vl&.Ri[f V{llMl,�lrGr1l1H41111�p, �,.,',�.f,. ,38'„vV
'° ;'= ---aa ...z:: ..»� as � �'.���'r ��i...�r:
Use clrawin¢s;of=faciliiv'to better eKnlatn-sltuationsFiuse.additiohalMUffes'as necessarvl. � . � ,� _ `:_,.� tv. � w�� . _�� 1ROK :_ - �
•�� ;.. �o tlpvJ � AS'f � � �-�.Izz.�,.�vr p1A,R ps_.(Z��r��-zr� � o �..bs . ,N �pe.� A�R� .
ReviewerlInspector Name:
Reviewer/Inspector Signature: 56kg
:
Page of 3
Phone: �4C)•$'%1
Date:
2/4/2011
Facili Number: Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [3"'No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [7,'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 Q -'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT") certification?
❑ Yes [5 No
❑ NA ❑ NE
Other issues 0
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E5*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 Cg*"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 �o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
�R
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 allo
❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
❑ Yes Q'No
❑ NA ❑ NE
` "34. Does the facility require a follow-up visit by the same agency?
❑ Yes ff No
❑ NA ❑ NE
L Vllllll4lll0 kl G1G1 EG'{#U1L04lV �1 M).'L'%V1nJlll[lay' 5 ..l:l1.]-"ARM"Gl'3 Ql1Nl Vf. lLl■ 44""i[i VllRl [F4V[lllll\.11\[p41V ll� Vl&.Ri[f V{llMl,�lrGr1l1H41111�p, �,.,',�.f,. ,38'„vV
'° ;'= ---aa ...z:: ..»� as � �'.���'r ��i...�r:
Use clrawin¢s;of=faciliiv'to better eKnlatn-sltuationsFiuse.additiohalMUffes'as necessarvl. � . � ,� _ `:_,.� tv. � w�� . _�� 1ROK :_ - �
•�� ;.. �o tlpvJ � AS'f � � �-�.Izz.�,.�vr p1A,R ps_.(Z��r��-zr� � o �..bs . ,N �pe.� A�R� .
ReviewerlInspector Name:
Reviewer/Inspector Signature: 56kg
:
Page of 3
Phone: �4C)•$'%1
Date:
2/4/2011

'vision of Watcr Quality l''
Facility Number ®- Division of Soii and Water Conservation b
Other Agency
type of Visit: &=plinnee Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
teason for Visit: tine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /17 Departure Time: �I ,'�Q County: <a g!-,,.-� Region: Z f D
Farm Name: t7hr ,3�-a�S1,aw �Q/rs-�� Owner Email: '�`-"�-
Owner Name: Ke de- e '2 ;9 i'R�5l f u/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Ae-plHvYlL 2;*Ix&&4v / Title: Phone:
Onsite Representative:
Certified Operator:
}
Back-up Operator:,
Location of Farm:
Integrator: /r—
Certification Number:
Certification Number:
Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
gLNo
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C►opacity
op.
Wean to Finish
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Layer
❑ No
❑ NA
Dai Cow
Wean to Feeder
11
INon-Layer__A_Dai
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Calf
eeder to Finish
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dairy Heifer
Farrow to Wean
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Design
Current
Dry Cow
Farrow to Feeder
of the State other than from a discharge?
Dr, P,oultr,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
gLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/1011 Continued

lFacility Number: - Date of Inspection:
Waste Collection & Treatment
1' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Sd7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2,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
[RNo
❑ 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
4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E&No
❑ NA
FINE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [! - o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Zn,- ►'iNA1,*_
l
13. Soil Type(s): Am
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 [Z 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 53 No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - 7 Date of Inspection: <1
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 FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 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 (retcr to question #): Explain any. YES answers and/or any add itional'recommendations or any�other comments ► {` ;
Use'drawings of facility to better explain situations (use additionAl pages as necessary). "`,�` k
yO,.Ar W 7:'
,*--hos A)67t.^_ -7
4;90D % 1,7G e -y--
`l
U /
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit (t—compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !?--- 22�21 Arrival Time: /; Departure'rime: County: Region:
Farm Name: I \znl 2 =—d -gi Owner Email:
Owner Name: Kz_-Wrr V Phone:
Mailing Address:
Physical Address:
Facility Contact: "1 _ Title: /i(1JYlYd" Phone No:
Onsite Representative: Integrator: &
Certified Operator: —__ . _0Ae'e= Operator Certification Number:
Back-up Operator:
Location or Farm:
Back-up Certification Number:
Latitude: =0 =& " Longitude: = o = ` =is
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Des€gn C•urrent
Cattle Capacity Population
❑ Wean to Finish
❑Yes
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -Layer I I
❑ Dairy Calf
-Feeder to Finish 2 OfAl D
❑ Dairy Heifer
❑ Farrow to Wean 1❑ry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
F,No
ElNon-Dairy
❑ Farrow to Finish
[I Layers
ElBeef Stocker
El Gilts
❑Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑Turke Poults
❑ Other
❑ Other
-um 0r of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[__1 No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
F,No
El NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12/28/04 Continued
j
t

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): 119
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff 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 8 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? B Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El 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 SNo ❑ NA ❑ NE
maintenance or improvement?
Waste ApplicatioR
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®.No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �IfNo ❑ 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 �f❑ Application Outsidc of Area
12. Crop type(s) Of WL (illi /� �i.�xs � rn�y -a%�® Zrr _413,J
13. Soil type(s) 14-11
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes f -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [SNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes S 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 5 'No ❑ NA ❑ NE
�. �Y�� ice."..iii .t;� ..� ..
Commcnts.(refer to question #)Ezplain any YES;answets andlor any recommendations or ary,othc comments f.;
Ilse ilrawings.of facility to better explain situations. (use add itiohnl pages�as necessary) j r
Reviewer/Inspector Name-" P Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

1
Facility Number: - Date of Inspection
�. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes R[No ❑ NA EINE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. -Yes El No [INA [INE
❑ 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
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 -No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B No
Cl NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
f2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Additional�COmmenfs andlor'DraWings
I �
PJ tynP,01 A- rt
AL
�� �1r%- ! � � ►'yam �a/' y12. %� fU d.S 1 �'l %%1G�/'C�'L � / b
7/e 0;,rr
•
Page 3 of 3 12/28/04

f
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit w outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: O County: 0— Region:
Farm Name: rrk. Owner Email:
Owner Name: r,- N A G I "1. 13 r`at.4 S h a„,,V Phone:
Mailing Address:
Physical Address: �itie.
Facility Contact: .1 ` eel M r6k4 Phone No:
Onsite Representative:. .;u.�°-� Integrator:�r�/ U2 -
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6 =14 Longitude: = o = I = ”
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
MFeeder to Finish O 42Q0 Q
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dray Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑Non -La ers❑
❑Beef Feeder
E013oars
Pullets
❑ Beef Brand Cow
2. Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
[Z -No
Other
❑ Turkey Po its
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Other
100ther
Number of Structures: I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Z -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?
12/28/04
Continued

Facility Number: 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 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure •1
Structure 5
Structure 6
Identifier:
Spillway,?:
Designed Freeboard (in):-------�_q
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
® 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
X No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No ❑ 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
CErNo ❑ NA ❑ NE
maintenance or improvement?
Waste AuUlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
54No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
54 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) o_rr- / W
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo ❑ 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
XNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 -No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): I
tvr al�wp, 721tir oew U'I& e' �}'''a� -�i s CamY-s 0*c y Owd— �"gFieps.
y
Reviewer/inspector Name �,.. Phone:�a—�/ 3 -U2
Reviewer/Inspector Signature: Date:
12128/04 Continued

{ Facility Number: 2T Date of Inspection � D
Required Records & Ducumenls
19. Did the facility fail to have Certificate of Coverage & Permit readily available? R1 Yes 50o_ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EE�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. -YesNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard S -Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
L 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 reviewlinspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
tji-No
❑ NA
❑ NE
❑ Yes
C8,No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
CaNO
❑ NA
❑ NE
❑ Yes
(K No
❑ NA
❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes SNo ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes C -No ❑ NA ❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
9, Axv­e- you XDw's-
.r
12128104

,vision of Water Quality ' (1/ �
Facility Number 0 Division of Soil and Water Conservation t� J
0 Other Agency
Type of Visit 0)'1(!`o`mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: L! D Departure Time: 1107 County. Region:
Farm Name: _ JCS nn r"Dr�SL�� 1yY—� Owner Email:
Owner Name: ✓l n'zKPhone:
Mailing Address:
Physical Address:
Facility Contact: kin % Title: Phone No:
:
Onsite Representative` z �Q 55 / %T wPIP V1111 Integrator:
Certified Operator: _ 1�vn P7 if A4 ,, dr Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =, =61 Longitude: =0=1 = 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 711
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
❑No
[:INA
❑NE
[INA
❑ NE
❑ Yes
❑ No
❑ Yes
�3No
[INA
❑NE
❑ Yes
®,No
❑ NA
❑ NE
12/28/04 Continued

rr
i
Soil type(s) G•
Facility Number: — Date of Inspection ` 0
Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
&No [INA ❑ 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:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
CZNo
Spillway?:
❑ NE
17,
Designed Freeboard (in):
❑ Yes
® No
Observed Freeboard (in): -33
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
BNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
JgNo [INA ❑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
FM No El NA [3 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
E� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[4 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.
i
Soil type(s) G•
y
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15.
Does the receiving; crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
CZNo
❑ 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
5?No
❑ NA
❑ NE
Comments (refer, to�gaestian�a, p , in any YES �a�n.swers and/or any recommendations or any ether comments.
Use drawings. ofifacility�toibettcr explain situations�(use additional pages as necessary);
r /
r� C9rn v -r fcak Pc v�L, 4-,-,r- W4tb
y
Reviewer/Inspector Name `° . '" Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EL No
❑ NA
ber: Date of Inspection
Facility Nurn �K
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IgNo
Required Records & Documents
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
59 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
bg No
❑ NA ❑ NE
the appropirate box.
❑ WUP I--] Checklists [__1 Design El Maps - ❑ Other
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
[9 Yes
❑ No
❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ANo
[INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EL No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
[:INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E0 No
❑ NA
❑ NE
Other Issues
S � rr. -570 D
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
@ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
19 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
5&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
g No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
aYes
❑ No
❑ NA
❑ NE
...:<. ..
7.'s �c ��$ NV'o .' eF i7
Addltianal Curn'rnents andbr DrAwln s k r y € ,
b
lave
S � rr. -570 D
Page 3 of 3 12/28/04

Division of Water. Quality ell - J
Facility Number Q Division of Soil and Water Conservations
,
w
_. Q.Qther Agency
m.,
Type of Visit6ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
a omKoutine O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: ; CountyRegion:
Farm Name: zr&� tzj at ryp%' Owner Email:
Owner Name: its x- n N ,-7,4_ Z) Phone:
Mailing Address:
Physical Address:
Facility Contact: '�/Y T�{� s Title:
Onsite Representative:
Certified
Certified Operator: i� � 1 /ds ,�
Back-up Operator:
Phone No: « e
Integrator:
Operator Certification Number: 1;Z000 Ll
Back-up Certification Number:
Location of Farm: Latitude: =0
=1
= Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity' Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
19 Feeder to Finish 2 q D 3 %
❑ Farrow to Wean
ElFarrow to Feeder
ceder
to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
DesignCurrent
Capacity Population',';
Number of Structures: E '
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 a[ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
9,No
❑ NA
❑ NE
12/28/04 Continued

12. Crop type(s) 6? ryyt J pL / Cf)r yL
13. Soil type(s)
Facility Number: &9--
Date of Inspection
14. Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & 'Treatment
Q9 -No
❑ NA
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.
17. Does the facility lack adequate acreage for land application?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
54 -No
Observed Freeboard (in): 3�
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
C$ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
� Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside
of Area
12. Crop type(s) 6? ryyt J pL / Cf)r yL
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q9 -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ 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
54 -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,, FX car Q r �oL �-'"` "�'
Reviewer/inspector Name�r/ Phone: 9 -lo -433-3300
Reviewer/Inspector Signature: Date: 7 %g--c;90O 7
12/28/04 Continued

i
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (RNo ❑ 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 [Z No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vj No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility Tail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
91 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
(9 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
0 No
❑ NA ❑ NE
12/28/04

pellilivvision dfWaterr Quality 4 ,
Number.
f�cifltQ DvE
asion of Sse
oil and Water Conrvation��
Y f
Other Agency;.
r
er#. 4
ti
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: ® Arrival Time: D t+i Departure Time:f : �(7 County: �Region:
Farm Name: a tc J at /rte- Owner Email:
Owner Name: r� ✓1 `L cT"�- 13 ►'a�p� � tea., Phone:
Mailing Address: 3 f% /` n-C� f� 4)R ',
Physical Address:
Facility Contact: Title:
Onsite Representative: /
Certified Operator: ��hY7`�t ffl-ae!sLj4l
Back-up Operator:
Location of Farm:
Swine
u [] Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Phone No:
Integrator:z'S��.-�
Operator Certification Number: pyo
Back-up Certification Number:
Latitude: = e =1 11
Longitude: =0=6
°=6 [� «
Design CurrentDesign; Current Design:
Capacity Population Wet. Poultry 'Capacity Population Cattle ;Capacity.
J
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars T __
Otliar' .
y,
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
M_P_4ry Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
+ a
Number of Structures'.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
A
w
❑ Yes W No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
i� No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[2!�No
❑ NA
❑ NE
12/28/04 Continued

y
?lUOt" fC On ��� aha Bn L 09P%,
w:° t -e- ?1-a.�),�1 i✓� ,t/'ou�as�� �; l( b r
Reviewer/Inspector Name F7,Sl/ uJ �� Phone:
Reviewer/Inspector Signature: Date: . 5 ^.,31 r-'2�V6'
12/28/04 Continued
Facility Number: - AA7
Date of Inspection �06
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[� No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
®-Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
,4
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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) C_"P� 1'✓l �/.CJ��P�/�r—�...,--,��,�a�`%� Q fir/ wt�l,�f�
�T lad
/
i8 ✓'+''' $ �C'4;r✓
�+
13. Soil type(s) A ik
14. Do the receiving crops differ from those designated in the CAWMP?
[Z Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
X 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
[A No
❑ NA
❑ NE
?lUOt" fC On ��� aha Bn L 09P%,
w:° t -e- ?1-a.�),�1 i✓� ,t/'ou�as�� �; l( b r
Reviewer/Inspector Name F7,Sl/ uJ �� Phone:
Reviewer/Inspector Signature: Date: . 5 ^.,31 r-'2�V6'
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2; No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
K No
❑ NA
❑ NE
❑ Yes
C?No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
5a No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IS No ❑ NA ❑ NE
❑Yes ®No El NA El NE
[:]Yes [9No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes D? No ❑ NA ❑ NE
Additional Coinmenti:andlo,r.`Drifwin s
12/28/04

Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
(late of Visit: �'% 4 Time:
Facility Number
0 Not Operational 0 Below Threshold
M -Permitted O'Lertified/� Q Conditio/pally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... 1x�nvOl'7............/.'..../...tar na
............................. County: ...... S sm,oP.�f7h.............................. .F.s!1......
Owner Name: ...............e4..Gnn� l................ G:0:1A4, 0m,...................................... Phone No: ..... ....97/0-3.6..1/......5.. 1=42 ......................
Mailing Address: ..ia.1............... �g31...............................................................
....................
Facility Contact: ............/.. r.p £'�akc.�.......... Title: ................................................................ Phone No: .....r7. .... ��..(.?...:..2.z.Q..........
Onsite Representative: Integrator .................................... Integrator:....P/�.5G.....................................................
Certified Operator: .......�le?nn�l�li..............!e..r.Ge._C&k......................................... Operator Certification Number.... EE.vo'!...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • Longitude �'
Discharges & Stream I. mt?ac
1. Is any discharge observed from any part of the operation? ❑ Yes EPfo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®-Ko
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E.No
c. If discharge is observed, what is the estimated flow in gal/min? –r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Flo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes C3N6
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ENo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PRo
Structure 3 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ............. ....................................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Lei
Facility Number:$,
Date of Inspection , o
5. Are'there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
° seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AIRBlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
bSf "!IR SfiJ'3M .l.!!`•'M>t .ih. L r 'V!441 .,�,-Y 41 t1-. '•, t ur ::�: " i!L ..'3 LwE ' :: _. y
Commentsr(re%r to�quesban'#).E Explaia anyfYlE$E veers and/or anyE recammendatlons�or,seyEothercomments. }A ,.
�E.f IEIs}, �€` 4$3131;7 ,7, 4i'£::i'41 - i a'"A'.':IL P fll Ef� ;�ys`p8,ic:, t. � • 4 � ��
F � ExUPi@df.�:Es;, iu6..�{' R 3 J,'E j'.i:.!ff & S.�§.. � , ,..._JLaa4tsa:w.r�3�+,.+.>i�i�wi�:uF�:.,.r+•+..i+.Ps�.,{+�wwy:..@.w.r. F. § x
Use3dra1wi(ggngsEoffaciliyls1�.teq(lbettcreexplainsltuationx:�(useiadditioii l}pyagewas5n{ecesfsary}.a =f],'�y��y1eI Co Final Notes
[��lE.�E4E6`EP.i Copy ❑
``E {{'.I E,- @E• EP�LEE ,h r . i i. {{{°�fiPH i1., }i'Cl' �1 ( .�i 9,� t; E yy- 3 'i 3Si:ie@w{g.'�§g:]t b 4.: p};[ �Ay)r[: `❑y�il': yi..y�e sY f '$ { I� "' 2 -.pit' �1 <ik5yi(y'%4 IY"ri�W,p pe.x(�aa t•'..ni4^. ! s?t...
„f15 E..'9 .„Rr
�STa FC l�rc+rs, i� 2FRS ) i t.,�Sf/ �'� %�'%r,
GL a,7 iEI"SPec�,'oh Pprfor,,,ea,/ Oro �'la'0y A/4 Ott recore%s
Gver elpl,`ca}.'ah 0A / �'e/d, 417e, {v��iPr recDr
// rr� �tPrt lCv,
S w cK
Po0,9hf )v a. recorcJ poee;,,5 �Orv6r{ Le9p,'ejWas fe
L
oerAlcf% e (Oecem6e� �G0,3) fCJr 4L4,,j �ifdTT �b �eY-Irk, 6aG�
�p dTl.ce
ire,
'
T
Reviewer/Imp"tor Name 4
1��^an' '� ” G'Gr".. ru /�"! � ?- . rk-�i, , < t , ."
��ksf «
an` 1. ;: �`' +V d f�P.. ix . 4 ins_.E € _�x . d
Reviewer/Inspector Signature: Date: r`7-0`1
12112103 r Continued

II
•'. s'! � i A..
Type of Visit it Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Vial Q Routine O Complaint p Follow up p Emergency Notification O Other ❑ Denied Access
Facility Number $ Date of Visit: `/'6 a Time: to; oa
0 Not Operational 0 Below Threshold
�erm4ted M<i`rtified 93 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName:.... tnreA,......&!: t-2 ........................................ County:... ................................... ene..........
Owner Name: ...... Jfn►n. t6........ TFt �.%7F...................................................... Phone No: .....9�v:..SGy....�:.�.................................
Mailing Address: ......../-�.'._D3.......Karl:h.f......... ................ C �:' !.1 'r .... /V.�..........3 ]...................................
P 7'H9aayr- t
:SGG'
.siGFacility Contact: ..... c'..4 ........ n ........... Title:................................................................ Phone No: ........'..oa.7....�..�.
Onsite Representative:1(e17n-�...........jfer/s.r...................................... Integratr:........ 4............. ........................................
Certified Operator:,...... (nak.1 ,.......... ....................................... Operator Certification Number:... 25!Z y...•............
t
Location of Farm:
J
T
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��,�" Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [+ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EWo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [9 -No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [fib
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [Ijo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes [ate
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. !...............................................................................................................................................................................•....................
Freeboard (inches): 33
12112103 Continued

acility,Number:8,2
Date of Inspection JY -6 -ay
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
[:]Yes
Q'1g10
❑ Yes
B-fio
❑ Yes
[a'i�o
❑ Yes
[+. -No _
❑ Yes
[T'f o
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑-No
11.
Is there evidence of over application? If yes, check the appropriate box below.
S-T'es
❑ No
❑ Excessive Ponding [SAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
Hw
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ReviewerAnspector Name /( " f � ,x, + , '
w./s%a�
12.
Crop type _ 1. eg6T
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
BlTo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Uio
b) Does the facility need a wettable acre determination?
❑ Yes
2No
c) This facility is pended for a wettable acre determination?
❑ Yes
2No
15.
Does the receiving crop need improvement?
❑ Yes
Leo
16. Is there a lack of adequate waste application equipment? ❑ Yes 2 -Ko
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [9-1'x'0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes S -No
Air Quality representative immediately.
,
�Cbin'imi�nts` refec`toi"q`uestann#`f'Ea" la�ti�aie°d'`YESarisrversigrid/or an ,retommeniationsior an othee comment4 '}`z,`' �`' ' ` ' 11
' lilyiE `iti EM�¢F�,".f;;?i<�lift#ip uEEi6`.`i`�t.S^.>..;�El �f�S ""1 •G(:3i-:S�-`1• ti`.":`,{iSiw'ty'U: 4k:43.3gs. �:€�::^�§`:' S�. :.4!6!€E!%'�f�.s;ay, ..E�P�F4 wEi'?v,.'p,t"`-..y�.iztix..�u;.,..»._...ku..>._.:,.�>.a!e.a3;.::,.J:�i.'.�..r i a�,l ;�+a3d
�Use•drawn�ngs;of ffaci�iyE�taEbctterttppexplarn situationsarase�adldihonallpages as'necessary)ii���„ eld Co}� ❑Final Notes � ��..�";,;'�;r
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ReviewerAnspector Name /( " f � ,x, + , '
w./s%a�
i4.�ru., , :max
Reviewer/Inspector Signature: A104 Date: y- G Uy
12112/03 Continued

Facili$y Number: 8 � _/97 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application-'-[] Freeboard -_0 Waste Analysis Soil Sampling -
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form❑ Crop Yield Form'] Rainfall' -_0 Inspection After I" Rain'
❑ 120 Minute Inspections] Annual Certification Form'-_­
7N
ornn
■ e
❑ Yes GINO
❑ Yes S -No
❑ Yes [}No
❑ Yes S No
❑ Yes G -No
❑ Yes B -No
❑ Yes [ANO
[:]Yes @ No
Ble' s ❑ No
❑ Yes ONO
❑ Yes ❑ No
❑ Yes 2igb
❑ Yes &-1'd'8
❑ Yes G -No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Addittottal'Comments n Y.,��,t ter
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"7 i4e e.0 c4y 6esevee G 4/ qv4{rte e. ^,* le 4Lfr A114 '4"
3 P k lhd
S r�Gy kGs r-�o,,e ��e *4%-- unnX41 51tW9e Survey. 6„f AGs
3 S"�/'-SLuSSr �'CCc9r
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12112103

Site Requires Immediate Attention:
. Facility No. e,2 - j 9 -Z
-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 , 1995
Time: f 1
Farm Name/Owner: - ifAkg&�&z
Mailing Address: R g-Zf
County:
Integrator: Phone:
On Site Representative: Phone: -
Physical Address/Location: ±B is i4l t"4�AjeI62a M­-,.I�­.La&la�&O—�Z
Type of Operation: Swine Poultry Cattle
Design Capacity:a,? Number of Animals on Site:.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1, Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard:�Ft. Inches
Was any seepage observed from th goon(s)? Yes or No Was any erosion observed? Yes t5)
Is adequate land available for sp y? Yes or No Is the cover c p adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 2 Feet from Dwellings? )res or No
100 Feet from Wells? IQ or No
Is the animal waste stockpiled within 140 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes order
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices?' Yes orl, If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover prop ? Yes or No
Additional Comments:._j.�__ 9
1��Zjo -,-a I L L -z
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed,