820211_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

�-Div'is'ion of Water ResonrFs
Facility Number - Z f Division of Soil and Water Conservation
Q Other Agency
Type of Visit: % Compliance Inspection Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit: _ *,Routine O Complaint Q Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit:. L Val Time: Departure Time: County:Region:
Farm Name: .� '�-- �o Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �L( C� D�C.�� Title: Phone:
Onsite Representative: t'( Integrator: .'PS ,2
w
Certified Operator: Certification Number: /777Z
Z
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Gurrent
[:]Yes ❑ No
Des* gnCurrent
❑ NE
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Layer
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Cow
Wean to Feeder
❑ NE
of the State other than from a discharge?
Non -Layer
Dairy Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
—Dairy
Dry Cow -
Farrow to Feeder
D , P,oult
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
_.
Turke s
Other
M.-l-ey Poults
OtherL10t.her
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 FpNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes ❑ No
P]NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Z=U jDate of lns ection:
Waste Collection & Treatment ors— 11
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
Struc�e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
` DesigneeHreeboard.(in) ..,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any ofthe sizi,cctures observed?
(i.e., large trees, severe erosion, seepage, etc.).
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes IR No
❑ Yes �Z) No
❑ NA ❑ NE
❑ 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 1P 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
[:]Yes CpNo ❑ NA ❑ NE
❑ Yes IN No [DNA ❑ NE
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No [:]NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WinArift . [Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
[] NE
❑ NE
❑ NE
❑ Yes [!f No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [)R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps p 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 i " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: .Z - 2, jDate of Inspection-
24_ Did the facility fail to calibrate waste application equipment as required by the per P-1if ❑ Yes
�9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
XMNo ❑ 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 fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No F] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
�)No [] NA ❑NE
Other Issue
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No E] NA E] NE
34. Does the facility require a follow-up visit by the same agency?
E]Yes
No ❑ NA ❑ NE
Comments (refer to question fl: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewed]nspector Signature:
Page 3 of 3
Phone: - 330D
Date:
l0/7/21112015
277

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:{ Arrival Time: Departure Time: County: 5y*P_S)':;ftan/ Region: j�
J
Farm Name: {{ 1 {rv"'s j j-1 to Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
q
N
Title:
Phone:
Integrator: Pres-&qQ
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
k
DesignCurre t'
❑ NA
�'Y gn
Desi- Cur�r�ent �, �� Desi Current
❑ NA
❑ NE
Swinei,
Capac h' P p
Wet Poultry
Capacity Pop Cagle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder Non -Layer
Dairy Calf
Feeder to Finish
- ,` v Dairy Heifer
Farrow to Wean
_
Design Current Dry Cow
Farrow to Feeder
3D froult .
Ca acity Po Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
_ Beef Feeder
Boars
Pullets
113eef Brood Cow
v ti;,LJ �, a
Turkeys
Turkey Pouks
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes n No ❑ NA ❑ NE
[:]Yes ❑ No
0 Yes ❑ No
[—]Yes ❑No
❑Yes _ No
[j Yes [,❑` No
OrNA ❑ NE
Qg NA ❑ NE
J�fl NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
6No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
® No
Identifier: �^
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): E/
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 No ❑ NA ❑ N E
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA E]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
`P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
7®'
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i -e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
fer to question #): Explain any YES answers and/or any additional
of facility to better explain situations (use additional pages as nece4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Cp No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes � No E] NA [:]NE
❑Yes F No 7 N ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes `lam No ❑ NA ❑ NE
ons or any other comments.
Phone: _ tp { 3 7 3 ev
Date: f
2/4/2015

i ype or visir: w t-ompuance rnspecuon v uperanon meview v Ntrucmre Lvamanon V tecnmcat Assistance
Reason for Visit: a Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: 43= Departure Time: County: S[]--�kegion: Y5i2fl
Farm Name S� / �' i?�JS �3' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
f/
N
Certified Operator:
Title:
Phone:
Integrator: j e
Certification Number: % 79 %0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet'1?onitry
La er
.Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
2
" `�
r
'D tPoui
- Design ECurrent
Capaci Pio
Da' Heifer
D Cow
Non-DaiEZ
Farrow to Feeder
Farrow to Finish
La era
Beef Stocker
Gilts
Non -La era
Beef Feeder
Beef Brood Cow
Boars
Other
Pullets
Turkeys
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes Epo
❑ Yes No
NA ❑ NE
NA ❑ NE
�]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facility Number: - Date of Inspection: EMIR-
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1p 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
'01No
❑ 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 DVM
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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo [:]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 Cr p Window Evi�.5;,
of Wind
11 Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � 6;%, � ©U -dj &
13. Soil Type(s): Q&I PjO
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes rVhNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ElWaste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412014 Continued

Facility Number: Date of Inspection:
[ No
❑ Yes
No
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
0 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
ts No
Ej NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
q No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �q No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes
[ No
❑ Yes
No
❑ Yes
No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: !lD��3 3 �GYJ3 �GYJ
Date:
2/4/2014

Type of Visit: 0 Compliance Inspection V Operation Review (.) Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t ' Arrival Time: Departure Time: County: Sof Region:
Farm Name • S ��s �J j Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 1)
a
Title: Phone:
s
Certification Number: LzJe
Integrator:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [)a NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[—]No
❑ Yes
No
❑ Yes
-Design @urrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Pointry
Capaeity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder Non -La er
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Cnrrent
Dry Cow
Farrow to Feeder
D . P.oul
C aci
Pia
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
. ,
Turkeys
Other..
urkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [)a NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[—]No
❑ Yes
No
❑ Yes
No
[ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2014 Continued

Facility Number: - 2A Date of Inspection:
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Waste Collection & Treatment
6 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesNo
the appropriate box.
❑ NA
[—]NE
a. If yes, is waste level into the structural freeboard?
0 Yes
No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Struct
re 6
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
Identifier: 13
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Spillway?:
❑ NA ❑ NE
Designed Freeboard (in):
Observed Freeboard �q sit
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'� No
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
tp No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffcrs, setbacks, or compliance alternatives that need
❑ Yes
f %No
[:]NA
❑ NE
maintenance or improvement?
TT
I L 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 Drift) ❑ Application Outside of Approved Area
12. Crop Type(s):S'
13. Soil Type(s): Abo i4_I G�AF;
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes `P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes �] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [] No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
6 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
© No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C? No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Fa6lity Number: z_jL Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
,fer to question #): Explain any YES answers and/or any addi
of facility to better explain situations (use additional pages as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No
❑ Yes No
❑ Yes 1�1No
[—]Yes EPNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Dns or any other comments.
Phone: 3O
Date: f A�;v//
214/201

r ype of v isit: w t-ompuance tnspecuon v uperanvn Keview v Structure r,vatuanon L.l i ecanicat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 h Arrival Time: Q� fJ� Departure Time: County:.5i}rnPSQnJ Region:
Farm Name: S.� pxy-M S 13—& Owner Email:
Owner Name: pia + Phone:
Mailing Address:
Physical Address:
Facility Contact: Awj�
Onsite Representative:
Certified Operator: N
Back-up Operator:
Location of Farm:
Title: Phone:
Integrator: �rese
Certification Number: 0179h
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? [] Yes ❑ No [P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Swine
Wean to Finish
Design ---Current
Capacity .'Pop.
Wet I?oultry
La er
Design
Capacity
Current
Pop.
DesignCurrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
2 O
Non -La er
Dr P,oult .
Design
Ca aci
Current
P,o .
Dairy Keifer
Dry Cow
Non -Dairy
2. Is there evidence of a past discharge from any part of the operation?
Farrow to Finish
[] No
La ers
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Stocker
No
Gilts
❑ NE
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets .
Other
Other
Turke s
Turkey Poults
10ther
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? [] Yes ❑ No [P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
M 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
T
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - Date of inspection: I 27
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 V9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: 1311b
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r":73 No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
Freeboard
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
Observed (in):
❑ Yes
®No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
F
E3NA
❑ 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
[0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [D Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E]Evidence of Wind Drift \❑ Application Outside of Approved Area
12. Crop Type(s): C5Y l- —&u -m tc 6�w l (NST
13. Soil Type(s): NO j c 61, A ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r":73 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0
No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo [—]NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E]Yes tNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: T Date of Inspection; 117 ZGlL
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1P 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 [n No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [5� NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes No
❑ YesLP
No
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
214/2011

E
Visit: 0 Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
or Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: ?D lJ Arrival Time: /;pD Departure Time: % 4 County: Region:
Farm Name: �S, S / 3 40 Owner Email:
Owner Name: �&('Q44 Phone:
Mailing Address:
Physical Address:
Facility Contact: 4 Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number: J 779,6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
'
I)estgn Current
Design
�
Crent u
"f
Design •urrent
Swine
Capacity Pop.
Vet Poultay
► p
Ca acity
Po p
Cattle Ca aci Po
► ► p h' P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
DaiTy Heifer
Farrow to Wean
lil
Design
Current
Dry Cow
Farrow to Feeder
D P,oultry
Ca aci
Pio _.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Points
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes .1p No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes '�q No
[:]Yes 1�4 No
NA ❑ NE
EONA ❑ NE
{,10 NA ❑ NE
TT❑�� NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Fgacili Number: - Date of Inspection: 10 11
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 IO NA [3NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I -T-14
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39pl
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? T
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)
❑ NE
T
❑ YesNo
[:]NA
9. Does any part of the waste management system other than the waste structures require
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [3 Yes T No [:]NA El NE
F-1ExcessivePonding E] /Hydraulic Overload E] 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� ind Drift// [:]Appplica`ti_on Outside of Approved Area
12. CropT e(s): n J Y1 K (" _' - t; • t% "t LJ I�I� pt
13. Soil Type(s): C. f`S'1__ -
_
W. 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
[DNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesNo
[:]NA
[—]NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes r-"A-yNo E] NA ❑ NE
F] Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra`rtsffers ❑ 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? ❑ YesNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fheili ' Number: - d-1 i Date of Inspection: IpjUly
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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?
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g�D��7 33dod0
Date:
2/4/2011

J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
0 -
Date of Visit: 9 Arrival Time: 03100Departure Time: �ffip County: � Region: _
l
Farm Name: �' Owner Email:
Owner Name: /y' �ar� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1:1tr inj? L,—ryj�y J Title: Phone No:
Onsite Representative: l i integrator:
Certified Operator: Operator Certification Number: /7794
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [�] o =' ="
Longitude: =0[::]' ='
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 C6No ❑ NA ❑ NE
❑ Yes ❑ No YaNA
Design Current
❑ Yes ❑ No NA
❑ NE
Design Current
❑ NE
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry° Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
E] Beef Feed
❑ BoarsTurke
❑ Pulletser
❑ Beef Brood Cowl
❑ s
Outer
❑ Turkey Poults
Number of Structures:
❑ Other
I0 Other I
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 C6No ❑ NA ❑ NE
❑ Yes ❑ No YaNA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes [I No 1j] NA
❑ NE
❑ Yes EJ�No ❑ NA
❑ NE
❑ Yes "*,P No ❑ NA
❑ NE
12/28/04 Continued

Facility Number:
Date of Inspection / O
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 _P3 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (7-f 6
Spillway?:
Designed Freeboard (in):
Reviewer/Inspector Signature: Date: 1Q
Observed Freeboard (in): 3 "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
[INA
C1NE
(ie/ large trees, severe erosion, seepage, etc.)
ru
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
MNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ 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
EINE
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 ;9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 1❑ Application Outside of Area !
l2. Crop type(s) be' � 1 �M , ""`i-ir KI, r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes P] No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P No ❑ NA ❑ NE
Comments (refer to question #) Eacplainaty l 5 answers nor any recommendations or any other comments.
Use drawings of facility to better explain sitaatious.,(nse additions[ pages as necessary):
Reviewer/Inspector NameElm: ; d Phone: 7129 33r330D
Reviewer/Inspector Signature: Date: 1Q
Page 2 of 3 12/28/04 Continued

Facility Number: �dZ( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Pa No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [h No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 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 k)No ❑ NA ❑ NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes ❑ No PNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6j No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Page 3 of 3 12/28104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:`71 1(I � ArriivvallrTime: ' QO !' Departure Time:
P
Farm Name: S ' ""' Own
Owner Name: at^ Fore- Ph
Mailing Address:
County: 54 -P-5V Region: ;?-o
er Email:
one:
Physical Address:
Facility Contact: 0� Title: Phone No:
Onsite Representative: Integrator:
/elry ^Y�/10Lc� c^
N
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
= u Longitude: = ° = { = u
Design Current
Design Current
Design Current
❑ NA
Swine Capacity Population
Wet Poultry Capacity PopulatiRn-
CattleM MEapacity Population
❑ Wean to Finish I
IE]Layer I I
❑ Dairy Cow
❑ Yes
❑ Wean to Feeder
10 Non -Layer I I
❑ Dairy Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish $ 0 1
❑ No
❑ Dairy Heifer
❑ NE
Farrow to Wcan
Dry Poultry
❑ D Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
2. is there evidence of a past discharge from any part of the operation?
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ NE
❑ Boars
El Pullets
❑ Beef Brood Cowl I
❑ NA
❑ NE
❑ Turke s
Other
❑ Other
R-1 urke Poults
Other I
tructures:
12128/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�M 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
V9 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

Facility Number:12 — t
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: r
Spillway?:
Designed Freeboard 60:
Observed Freeboard (in)--
5.
in):
Stmeture 2 Structure ? Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No !$� NA ❑ NE
Structure Structure 6
❑ Yes -�fl No ❑ NA ❑ NE
❑ Yes [XNo [__1 NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )PNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes �a ❑ NA El NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes N$No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�6No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Crop Window
! �❑ Evidence ofnWind Drift ❑ Application Outside of Area
12. Crop type(s) -,/ i'i'i [3"asS l HQ,.,, Cum �. Sih •i. �u�/ win-c,��
R� I r
13. Soiltypes) Jti�a{.�O ��. , d In�S�
r
AL
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?
❑ YesNo
FW
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination -,[3 Yes
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ga No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
52 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector NamePhone:
Reviewer/Inspector Signature: Date: 9
12/28104 Continued

Facility Number: (( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ V*1Up ❑ Checklists
❑ Design El Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes �No [_1 NA [INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�3 No
❑ NA
❑ NE
29.
Did the facility fait 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
RJ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�j No
❑ NA
❑ NE
Additional Comments indlor Drawings
I
Page 3 of 3 12128/04

ar/0_5 01/04e1za08
0 Division of Water Quality
Facility Number SZ Z !! 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IZ-x7 -07 Arrival Time: 4:3aR><« Departure Time: County:
Farm Name: f��S /ft l0 �'%3 Owner Email:
Owner Name: , I o -d r< �''� _- Phone:
Mailing Address:
Region: /S90
Physical Address: n
Facility Contact: `1 4-4, 1 0 P_ 0-- _ - _ Title: 0WIV ur Phone No:
Onsite Representative: J Integrator. v - 9,0-0.,J Al
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 ="
Longitude: 0 ° 0 I = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 12 $g0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Dischar es & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current:_)
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: %
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [;FNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[11 No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
12/28/04 Continued

1
Date of Inspection /Z-27- b 1
MNo
❑ NA
❑ NE
Facility Number:
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q5No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ff NO
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: L a4
Spillway?: A10
Designed Freeboard (in): 19
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[� 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
[PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
P1No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[21 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IFNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[4 No
❑ NA
❑ NE
Comments (refer to question ft 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):
ReviewerlInspector Name r`e.. /� VG,IS Phone: 910, 1133.3300
Reviewer/Inspector Signature: Date: 1Z - Z 7-
12128104 Confinued

Facility Number: gz —ZI[ Date of Inspection 1x-27- 07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes [$No [INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists❑ Design Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[?No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -1 S Q Arrival Time: /0.10 Departure Time: .3� (� County: � aSoA1 Region:
Awe—Farm Name: r d pe SizS. fgrw^/-yQ -/3 Owner Email:
Owner Name: _ P0D r__ grb5Phone:
Mailing Address:
Physical Address:
Facility Contact: ziPO 12 c., Title:
Onsite Representative: Gtw PaDCr
Certified Operator:
Back-up Operator:
4/a O-/3 491;1 X393
Phone No: /�
Integrator: Ll 4613 %/
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: n o n n u Longitude: n° FT n u
Design Current
Swine Capacity Papulation
Design Current
Wet Poultry Capacity Population
Design Current
C*attle Capacity Papulation
❑ NA
❑ Wean to Finish
ILI Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I I
❑ Dairy Calf
19 Feeder to Finisha 2S8fl 12
❑ Yes
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
)S No
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
EI Pullets
❑ Beef Brood Cow
-
❑ Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Other
❑
❑ Turkey Poults
❑ OtherIE
Number of Structures:
Other
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(,M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
P) No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
)S 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
7 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
91 No
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5f No
❑ NA
❑ NE
other than from a discharge?
Page ! of 3
12/28/04
Continued

ti
Facility Number: 8�27 -211 Date of Inspection / 'O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway? --
i
Designed freeboard (in): D
Observed Freeboard (in):G,
❑ Yes _] No ❑ NA ❑ NE
❑ Yes *] No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
" No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
�2 No
[:INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
10 No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
WNo
❑ 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 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. Croph'Pe(s) �z�'iur.�� / /iL 5049.ecni5 Wi�fAi- Iglutu_1s
13. Soil type(s) No, �s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
{ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA
EINE
r 7t"
Comments (refer to question #):- Explain any YES answers and/or any recommendations or any otherj'comments
Use drawings of facility to.better: explain situations. (use additional pages as necessary):
Reviewer/Inspector Name! KI Ke�VCZ�5 Phone:()/W 933 —_533 0
Reviewer/Inspector Signature: Date: 20L
Page 2 ej_f 121_7&W Conlrnued

Facility Number: Oz — Z%� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box. ❑ WllP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [29 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[M No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
INo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�LNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EKNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
12/28/04

a H ZZ/I
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /l. 'OV Departure Time: County:Region: 620
Farm Name: _ �nn&,O,S &CM x0c /0-/3 Owner Email:
Owner Name:,_.. 7"g� . crc� Toe _ f�ooN Phone: '7/0-6`12- 6957 or 30//
Mailing Address: S`1S0 &Or, ner /->✓,a�, t�,a,r C%•;�7e.-� NL �83a 9'
Physical Address:
Facility Contact: Ta x Qo 2 Title:
Onsite Representative: 61"
Certified Operator: T ,PSP
Back-up Operator:
Location of Farm:
I Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No: q/0-190-/320
Integrator:rITX _
Operator Certification Number: /'7 9A
Back-up Certification Number:
Latitude: ❑ o =I E__1 Longitude: =0=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
i 10 Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev 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?
Cattle
Design Current;:
Capacity Population,
❑
Dairy Cow
❑ Dai Calf
❑
Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
l I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [q<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
[j Yes
ElNo
El Yes
[9- o
❑ NA
❑ NE
❑ Yes
El -No
❑ NA
❑ NE
12/28/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0110
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Date of Inspection -o
9. Does any part of the waste management system other than the waste structures require
❑ yes
O'Ko
❑ NA ❑ NE
Facility Number: 2a — ;21 t
Waste Collection & Treatment
Waste Application
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
ElKo
Imo+ tvo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 11 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: J!
❑ PAN ❑ PAN > I Wor 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
Spillway?: r10
too
Designed Freeboard (in): C;k0
13. Soil type(s) do d . Go IVO jo o, 1' /?1n(__.
Observed Freeboard (in): g 9 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA e'RE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
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
0 o.
❑ NA
❑ NE "
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0110
❑ 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
O'Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2f' o
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect 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 > I Wor 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
too
12. Crop type(s) Q
13. Soil type(s) do d . Go IVO jo o, 1' /?1n(__.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2$ o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!
[I Yes
❑ No
❑ NA e'RE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA aNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q -Ko
❑ NA ❑ NE
Reviewer/Inspector Name�;`w Phone: CJ/0' SyJ bio
Reviewer/Inspector Signature: Date: S-- c/•oSr
12/28/04 Continued

Facility ;Number: —,;� I Date of Inspection S f os
Required Records & Documents �,,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M1110 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ Wer ❑ Ch jsts ❑ De n 7
❑ M ❑ Qt�ter
21. Does record keeping need improvement? If yes, check theappropriate box below/_ ❑ Yes �o ❑ NA ❑ NE
la -spy / 7. `7 yl -ISS 7..5
❑ 1a ❑ ee y ❑ ❑ . ❑ ❑
E)-Rmn'fatr ❑ ntor rr —p nrtd- ❑ 1 _ ❑ ns ❑J -fie
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?
E�Ye—s
❑ No
❑ NA
❑ NE
❑ Yes
❑-No—
❑ NA
❑ NE
❑ Yes
,O-1No
LTNo
❑ NA
El NE
El Yes
,� /No'
L� No
❑ NA
❑ NE
❑ Yes
L'J No
❑ NA
❑ NE
❑ Yes
[9-<o
❑ NA
❑ NE
❑ Yes
0 -go
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
,O-1No
LTNo
❑ NA
❑ NE
❑ Yes
0-tQo ❑ NA
❑ NE
❑ Yes
Bl o
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
Additions! Comm- enis and/or Drawings:
se ,Hsl� a .h
12/28104

Facility Number Date of Visit: !i J� Time: Q •` Y
� !
O Not—Operational O Below Threshold
Q'�rmitted �erfi red [] Conditionally Certified [ Registered Date Last Operated or Above Threshold-
Farm Name: ...... County:
v
Owner Name: -
......»Toe ------ u=-`-�.........!TQ�k!......./--t<?��..�-----•....................--•----------..... /Phone No:...............»�.�_.......
Mailing Address:..».».». ,? y � ....6-GC1�_. ------ twC!!.�r... » ».» �i- -»_NC _2-9_129_..
Facility Contact: Title: --- ................ -............. -..... -..... -...... ...... Phone No: »...._.....»..»»..» »....». »»..»..
r
Onsite Representative:. ��s~ .»� - - --- - - ... - - Integrator-
Certified
ntegrator Cerkii"red Operator: .......................................... ........ Operator Certification Number:.... {,,,,,,,,,,,
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • f «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes 91go
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes Er<0
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
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 E o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D�Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ea No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 10
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... --.1_ .... _....... _... ............................
Freeboard (inches): 3
12112103 Continued
W

Facility Number: &- `—?1
Date of Inspection •» o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E94ft
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes BITo
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 maintenanceltmprovement? ❑ Yes B-N'o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [3-96
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [3 -Mo
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes [9 -Ko
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload /❑ Frozen Ground ❑/Copper and/or Zinc
12. Crop type QPr �,ur�a , J m.. // frrre CD r n tN � �`r� l d r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9 -No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
15. Is there a lack of adequate waste application equipment?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes EIM
❑ Yes M -Nb
❑ Yes [D-rT,n
❑ Yes 0 -No
❑ Yes awo
[]Yes ❑ No
❑ Yes [}iso
❑ Yes [ 0
❑ Yes [J Wo
Comments {refer to quesizora #) ,Explain any AYES answers and/or auy recamtnendanons or any orner coninichts.
Use drawougs fnc iy to better a plain srtnattons.'{use addrhana) pages as3nec sarp) [ fid Copy ❑ Final Notes
ff // / l 1
Mt. Pole �7at A -M -el "r,14 Some_ 45e.,f5 one
a
�',e ens��ory 0s0u/ of
6Dv5101 eICIS, Coa,4l ReronvA. war �c.rl` (�}. So�+7aTlr.�', TA
hD4! c2l0frG+/; �� 4e /inlor0V;'A
9 .
Reviewer/Impector Name t.:
Reviewer/Inspector Signature: /3 Date: :2
12112103 Continued

Facility Number: Date of .Inspection a7ro
REguired 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/ ]�%T, its, •)
23. Does record keeping need improvement? U yes, check the appropriate box below.
❑ pplication ❑`❑
24. Is facility not in comp lance with any aplicable 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 PWQ of emergency situations as required by General Permit?
(iel 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
❑ &eckhTFormFop Yield Form ❑moi• ❑ ain
❑ 1W Minute &pectiwis ❑
❑ Yes O -M
❑ Yes QAIe-
❑ Yes ENa
❑ Yes ❑Tfa
❑ Yes
❑ Yes
❑ Yes (-NQ
❑ Yes ❑ W
❑ Yes EINa
Q—Yes ❑ No
❑ Yes 92 -Nb
❑ Yes Bl;ro
❑ Yes [-No
❑ Yes [I _
[-f es ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dd/�fii Cor' }y� }�. �j�j)/�� ]�,�..R,� xe .ss ;. i.'3 - Y- ^° s`i "�.. m'�-+f^'�a 9 -?.i. ...5
rUb{iii W fffients,a d/W-1ira*ih _ '= .a.yj.-' - "f... i�
:.... " `I'�.n.' �"� �3_L�_.-.-,�-Y .. =
Pl�asQ �n�ful �I4R� �
/tea M"
E
l2/l2103

,.❑DSWC Animal Feedlot Operation Review s,
h
®DWQ Animal Feedlot Operation Site Inspection x
.�
S Routine 0 Complaint 0 Fallow -up of MV0 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection -3097
I __ J Facility Number 2!/
Time of Inspection � 24 hr. (hh:mm)
Registered [3 Certified © Applied for Permit 13 Permitted 10 Not Operational Date Last Operated:.,,,....
Farm Name: PiPAsr.._.i4rC�.sf..�..( ./d -/.3� tounty: '......................... ...............
? s
Owner Name: ......�rfi/D�....�S1i��R �f�!"�� �,..L ...... Phone No: � �/�`5...........58=TY..................
J. ............................... p2
Facility Contact: ........�1 F. .......� -� ..................... TTiitlle::...............................f.../....................... ... Phone No: ...................................................
'vlailing Address: A.. !..... .... Uo2 ...L.l�r✓ ,rayE.. ,(! :... Lt...L�.................................... ..................
............. ..
Onsite Representative:.......VR__..1'..O .................... Into rator:..eArrD�P-D,t�✓4 -
Certified Operator; .......... 117 vry � o �. Operator Certification Number:..,, e.ri ............
Location of Farm:
......... i............................................................................................................................
.2.....................l„�,►......... 1<_. o�
Latitude 0.0' 41 Longitude ' 9 44
Swine
❑ Wean to Feeder
Weeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design . Current
Capacity Population
Design ` Current Design Current.
Poultry Capacity Population Cattle,-. Capacity -.Population
❑ Laver ❑ Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons] Holding Ponds � ❑ Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
❑ No Liquid Waste Management System
General
1.
Are there any buffers that need tnaintenancehmprovenient?
❑ Yes
tKNo
?.
Is any discharge observed from any part of the operation?
❑ Yes
WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conxevance man -male?
❑ Yes
krNo
b. if dischar-c is observed. dill it reach Surface Water? ( l!' yes, notitiL DWQ)
❑ Yes
No
c. 1f discharge is observed. what is the estimated llo«• in -admin
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑Yes
M[No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
1qNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge"
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
5.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
No
7.
Did the facility fail to have a certified operator in responsible charge'?
❑ Yes
IgNo
7/25/97
Continued on back

.6-1 ,,�
Facility Number: OO.Z —2
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.[fold ins Ponds, Flush Pits, etc:.►
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure'2
Identifier:
Freeboard(ft}: ..�T� ........( .............................................
10. Is seepage observed from any of the structures?
Structure 3
Structure 4
1 I . is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes P4No
❑ Yes M No
Structure 5 Structure 6
❑ Yes KNo
❑ Yes KN0
12.
Do any of the structures need maintenance/improvement?
❑ Yes
P No
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(If any of questions 9-12 was answered yes, and the situation poses
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an immediate public health or environmental threat, notify DWQ)
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13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
*'a
Waste
:application
Reviewer/Inspector Namec�� ".. ._ "' :
Reviewer/Inspector Signature: Date: 7
14.
Is there physical evidence of over application?
❑ Yes
)No
(if in excess of WMP, or runoff entering waters of the State. notify DWQ)
15.
Crop typef�e�J,.........................
................. I.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
%No
18.
Does the receiving crop need improvement?
❑ Yes
PkNo
19.
Is there a lack of available waste application equipment?
❑ Yes
$fNo
20.
Does facility require a follow-up visit by same agency'?
❑ Yes
�(No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
XVo
22.
Does record keeping need improvement?
XYes❑`N'o
For Certified or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes jKNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
25- Were any additional problems noted which cause noncompliance of -tie Permit? ❑ Yes KNo
No.violatioiis oc deficiencies were no'te'd -during this visit- YOU.will receive no further
cofrespondence about this.visit: .
Comments (infer to question #) -Explain any YES ansWers.and/or ani reciiiii dattuns.`o aay other comments:
Use drawengs of facility to better expEairi situations. (use additional pages as`necessary) � F
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7125197
Reviewer/Inspector Namec�� ".. ._ "' :
Reviewer/Inspector Signature: Date: 7