820217_INSPECTIONS_20171231

�,dM
NOHTH CAROLI NA
Department of Environmental Qua!

ype of Visit: UCompliance Inspection U Operation Review Structure Evaluation U Technical Assistance
Reason for Visit: (34outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7i Arrival Time: Departure Time: County:
Farm Name:—J=P�t,�J1 GK ]ZJ �j i�c /'"i �j Owner Email:
Owner Name: + ``� 1 < <L t C.� �1-" ' Phone:
Mailing Address:
Physical Address:
Region:-�/
Facility Contact: 14164-t 1 Z- ✓'Q[i(% Title: Phone:
Onsite Representative: l t Integrator: P'lf &y
Certified Operator: i( Certification Number: {? � G Y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Cirrent
liill
lt
Current
Design Current
Swine Capacify Pop.
Wet Poultry Cap city
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
Dairy Cow
Dairy Calf
Feeder to Finish k
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ..Point .
Ca aei
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
n
Qther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes [/ No ❑ NA ❑ NE
❑ Yes ❑ No ErNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. WhaE 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
OONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
OlNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ff"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faciti Number: - Date of Inspection. -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -C3-Na ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [-]No Lr i'vH ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
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 [2 o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
VNo
❑ 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
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s). [� e✓ r
13. Soil Type(s): b 1�-E - kh.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R"&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L.J 14O
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑`1Vo-
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes 0-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: .2
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[g No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
� - ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
13 o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[1 o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[E[Tlo
❑ 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
214o
D 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
D<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U N
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�rN
❑ NA
❑ NE
Comments refer to, uestion # E lam an MES'ansRers and/or an additional recommendations or
( _ 4 ).- Y `. ...:: y . any other conimentsk
�, ...
Use drawmgs°of facility to better esplamzsittiahons (use:addrlZonal paaesas raecessarv).°"
t C 0 3 3 1 3
Reviewer/inspector Name: Phone � \ {� �`
c p�
Reviewer/Inspector Signature: Date: Q
Page 3 of 3 21412015

I'ype of Visit: t9 Compliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: ` routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access __
Date of Visit: Arrival Time: Departure Time: County: s Region: F9 Lb
Farm Name: Owner Email:
Owner Name: C.auet/`�' H/G✓" Phone:
Mailing Address:
Physical Address:
Facility Contact: Q. %It( 6 vi-�� � Title:
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: jDVer�`f�
Certification Number: [ 71 D 7
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -La er
Design Current*. Design CurrenE
CapaeityPop_ `*WCaftle Capacity Pap.
Dai Cow
I Dairy Calf
Feeder to Finish `+� b
Farrow to Wean
v .- DairyHeifer
Design .. rrent Dry Cow
Farrow to Feeder
D . l;oul
Ca ae� �Po T Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
+`
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gailons)?
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 [!3-15-o ❑ NA ❑ NE
❑Yes ❑No E�NA ❑NE
❑ Yes ❑ No E5RA ❑ NE
❑ Yes
3 No
aNA
❑ NE
❑Yes
[rNo
[]NA
❑NF
❑ Yes
[ZNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection-2 a`
Waste Collection & Treatment �--,,�
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E ' o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ©NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [frNo ❑ 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 [SNo ❑ 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 [! <o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [--'Tlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [I No ❑ NA ❑ NE
maintenance or improvement'?
1 L Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ETNo ❑ 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): &"444
13. Soil Type(s): 00
/M I
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 [3'1—qo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ 14-o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ivo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[?rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check
❑ Yes
[�J`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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No [DNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L_I� ❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes hio ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C3 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
dNo
❑ 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
[ErNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑moo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
❑�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2-No
❑ NA
❑ NE
a(11 64-4110-1 .-
sI�e_ sL.CV7
Reviewer/Inspector Name: '
c
Reviewer/Inspector Signature:
Page 3 of 3
t� z 0,'- k' 0
Phone:L- 1623'-3,3 3
Datal__J;
21412015

Type of Visit: GrCompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Iteason for Visit: 8'ftoutine 0 Complaint Q Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: rj jT Departure Time: /UEa-� County: J Region:
Farm Name: {` B+r� V^_ r Owner Email:
Owner Name: ��y r( �' ��¢Q,t,Y/'�� Phone:
Mailing Address:
Physical Address:
Facility Contact:
-3er V Bp-, Title:
Onsite Representative: Rpy(KI G Dem'.'e^
Certified Operator: t
1(
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: I Ver
Certification Number:
Certification Number:
Longitude:
rVFarrowto
.,
- Design Current
wine Capacity Pop.
inish
. Design Current
'Vet Poultry Capacity Pop.
Layer
_=_�
Design Current
Cattle Capacity Pop.
Da' Cow
eder
Non -Layer
DairyCalf
Da Heifer
D Cow
inish
ean
='.
Dry P,ouit
Design Gnrrent
Ca acit P,o P.
eeder
Non -Dairy
inish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
El
Boars
Pullets
Turke Poults
Beef Brood Cow
hrTkeys
Other
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes [3-K-6 ❑ NA ❑ NE
❑ Yes ❑ No J?'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[lA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
e No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Z jDate of Ins ection• �
Wa to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EJ.Nr ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No U21CA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): X J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ j j� ❑ 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
[.Nu ❑ 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
�o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q'5o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O'1lo ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[/]<o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FIN0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[frNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®'No
D. NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Do1Qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[DVo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes []j'No [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes 6�0 ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FadlityNumber: - Date of Inspection: )a-"
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes L&kIQ'o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [[ o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ETINO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes <o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes [:K ❑ NA ❑ NE
❑ Yes [2 o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? [:]Yes UTNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ETNo ❑ NA ❑ NE
Comments (refer to question Ezplaru any`YES answers and/or any additional, recommendations or any other comments
use drawings of facility to better ex !am situations use additional pages as necessary).
C'9-�.�
0 - 3.7
Reviewer/Inspector Name-
Reviewer/inspector Signature:
Page 3 of 3
Phone: 4-Vi- q _� � f
Date: "_S'j I b
21412014

type or visit: c;.Compi�pitance inspection V Operation Review U Structure Evaluation U Technical Assistance
R..,,
Reason for Visit: �xoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: F% JF, Arrival Time: Departure Time: i County:
Farm Name: l[0 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: or^y\ '� C L Title:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ffk C<L n
Certification Number: f
Certification Number:
Longitude:
Region: F7�_
Design Current
Design'Current
�llllllllllllDesi Current
Swine Capacity Pap.
Wet Poultry
Capacity`
I'ap.''
Cattle Capacity Pap.
Wean to Finish
La er
Non -La er
DairyCow
DairyCalf
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
D , l;o_ul
Design
Ca aci
Current
Po .
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Poults
Other
s F
_Turkey
Other
R„n
=
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes - 221*'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[]g/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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
ns
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ Ko-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[[ A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�To
❑ 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 4fi 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
[ 10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[KyKo
❑ 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
[J�Ko_
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Flo ❑ 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
C / �
12. Crop Type(s):
13. Soil Type(s): c p
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 [r NNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes E3/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
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.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes ffNo
❑ Yes CE-'<o
❑ Yes [aXo
❑ Yes io
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? 1f yes, check the appropriate box below. [:]Yes [;j'<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �N ❑ 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

IF*itity Number: - Date of Inspection:
G
+ 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
t� l`o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and.date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[5No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ErNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EDINo
❑ 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
[DNA
❑ 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
EI'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
j`No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments:refer to heshon # �::Ex lain an YES answers andlor an additional recommendations or any ottier;comets:
( i )� P y Y
IlUseArawin s of facili to better explain situations (use. additional pages as necessary).
Reviewer/Inspector Name: AN
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �SS:SS4
Date: IS IFS"
21412011

c, "051�2`416_
Type of Visit: @Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: w ontin O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Countyt-•k Region
Farm Name: R 0`Ilctt y{/� l \ Owner Email:
Owner Name: ��Q�(/li+ +( /.�--CJ� Phone:
Mailing Address:
Physical Address:
Facility Contact:Qc/`��" [ J> fM_JL.r' Title: Phone:
Onsite Representative: �� Integrator: _
Certified Operator: �� Certification Number: 7
L!
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current"- Design Current
Swine - Capacity Pop'~Wet Poultr achy Pop. Cattle, Capacity Pop.
y
_
Wean to Finish Layer Dairy Cow
Wean to Feeder -La -Layer Dairy Calf
_]Non
Feeder to Finish * DairyHeifer
?
Farrow to Wean` * 4 Design Current D Cow
�,
Farrow to Feeder 0 aPoW Non -Dairy
Farrow to Finish I ILa ers Beef Stocker
Non -Lavers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s"
Qthery 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?
❑ Yes ffNo ❑ NA [] NE
❑ Yes ❑ No Q5,NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No EJ-KA
❑ 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
❑ N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
WNo ❑ NA
❑ NE
of the State other than from a discharge?
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
22'1 o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ io
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []�<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
DJ ❑ Evidence of Wind D 'ft ❑ Application Outside of Approved Area
12. Crop Type(s): SG�{
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3.Xo ❑ 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
To ❑ 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 ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [E'<o
❑ NA
❑ NE
the appropriate box.
❑WLTP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes Na
❑ 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 b Io❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes ��Xo
❑ NA
❑ NE
Page 2 of 3 21412011 Condnued

Facifl Number: Date of Inspection -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r. Ro
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3- o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ffNo
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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Nf o ❑ NA ❑ NE
❑ Yes [ "No ❑ NA ❑ NE
❑ Yes [54o ❑ NA ❑ NE
❑ Yes [; No ❑ NA ❑ NE
❑ Yes EA o
❑ Yes []I -No
❑ Yes []/No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain anS :YES ainswers and/or any additional recomiztendations or, any other, cdihfiR ts.
Use drawmg' i. f facility to better explain situation`s(use additional pages as necessary) ,i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phones✓
Dater
21412011

MoD —,;to13 TG o�5-9-
Date of Visit: 144LI-71 Arrival Time: (V D 1 Departure Time: # pQ County Region: �J
Farm Name: 1"r_-Uu <r' ryv Owner Email:
Owner Name: rc-- w xPhone:
Mailing Address:
Physical Address:
Facility Contact: 9 rtrt a rY[�4./ Title: Phone:
Onsite Representative: Integrator: 4 r.• -
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
11
Certification Number: /7.0-V"I
Certification Number:
Longitude:
Desi Current
Swine Ca act Po
1? tS' P•
Wean to Finish
Dest nCu„ t £ 'g went Design Current
P sty_.
Wet Poult �; `ram op. Cattle Capacity Pop.
ry... , Ca act P
La er Da' Cow
Non -La er Da' Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
'-" D ' Heifer
Dgn Current D Cow
DPoul Ca rct P,o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
--
Boars
Pullets
t Turke s
Other uTkey Poults
Other Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E;�No ❑ NA ❑ NE
[]Yes
[—]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [-]No
❑ Yes 1,No
❑ Yes QjNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: 7 Date of Inspection:
Waste Collection & Treatment
`4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
54 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: i.�Ci.frq
Designed Freeboard (in): _ / !a Ic -
Observed Freeboard (in): � 2
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
[S 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
rrw
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes n No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload 0 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):�l7Y1� f 4�z'%STY l F�SGu e.
13. Soil Type(s): %OA LA at ! Zy pf'
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 j(0 [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 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
MNo
❑ 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
S No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - A17 I jDate of inspection: f —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JKNo ❑ 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 ❑ LagoonlStorage Pond ❑ Other:
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
D Yes allo ❑ NA ❑ NE
[:]Yes Co No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
,MNo
DNA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
EqNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
E�LNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anytather-comments <�; $-
Use drawings of facility to better explain situations (use additional pages as necessary). �...:
LA-6-0 rc-:t"
Reviewer/Inspector Name: ���-��'��� Phone
Reviewer/Inspector Signature:
Page 3 of 3
Date
�- 3
21412011

type of Visit: ( Uomphance Inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: 04oufine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:Arrival Time: Departure Time: CJt. County: �nSp R
Farm Name: ZRF_W T_R "C,s V(:Ng ,n t- '::9 Owner Email:
Owner Name: llcnf.fl 3 L U . '71 ( x'0 T_ 2 _ Phone:
Mailing Address:
Physical Address:
Region: r90
Facility Contact: { 6t\c m ¢ RLw e K Title: n t 21a,ng-t2 Phone:
Onsite Representative: 9MM Integrator:
Certified Operator: 50, M R Certification Number: 1-7 9nQ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
U- a c i RM Pop.
W,ef Poultry
Capacity
Pop.
Cattie Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Nan -Layer
Feeder to Finish
Wo
Dairy Heifer
Farrow to Wean
Design
MCI,
D Cow
Farrow to Feeder
Non -Dairy
JLayers
Non -Lavers
Beef Stocker
Farrow to Finish
Gilts
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [�] No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
[-]Yes []No
❑ Yes (0 No
❑ Yes [6 No
[] NA ❑ NE
W NA ❑ NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: a - Z n 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
t� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
W NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:�,� p�
Spillway?:
Designed Freeboard (in): 19 , I
Observed Freeboard (in): as a:
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
ERNo
❑ 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
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[V] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 Iack 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
D Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: '5�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ja No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M] No 0 NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[N No
❑ Yes
[j�] No
❑ Yes
® No
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
Phone: �I(0'3(3B`&us-i
Date: O is I / -)-
2/4/2011

(Type of Visit: QCompliapce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: o%ut►ne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p ' p p Departure Time: County: �­Region:
Farm Name: f',CL eoe Af—p�' �a/yrt� /� �! Owner Email:
Owner Name: ' v /l l' Phone:
Mailing Address:
Physical Address:
Facility Contact: gpa a G y rYi/�!� Title: /r ec/ Phone:
Onsite Representative: Integrator: �1e.
Certified Operator: _4rt_c1 —� Certification Number:
Bach -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
, ,Destgn Current
f- Design Current urrent
MattIMMEMapaci%tvPop.
Swine Pop.
Wet Poultry Capacity Pop.
fCpac
We to Finish
La er DairyCow
We to Feeder
on -Layer
DairyCalf
Feeder to Finish:
�. - ,.,-.� "" - -
DairyHeifer
Farrow to Wean
_ -
Design Gurrent
D Cow
Farrow to Feeder
D . P,oul ;Ca act Pop.
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation`? ❑ Yes EINo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes '� No ❑ NA [] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
]a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
0 No
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: / Date of Inspection —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): L _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes �3 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
eg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
® No
[DNA
❑ NE
maintenance or improvement?
`
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. CropType(s):��'nr�c�. , lcca
13. Soil Type(s): _�pf �}� m Aj f) /4
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 K�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes F7, I No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes J0,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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
EINo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:)Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E[-No
❑ NA
ONE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JE3-No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F•
iW
IFacihty Number: - ( Date of Inspection: (j —'Z /
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 Jallo
the appropriate box(es) below.
0 Failure to complete annual sludge survey Failure to develop a POA for sludge levels
0 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 tissues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes EJ No
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
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 Ug'No
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 [3-No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Jallo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes allo
34. Does the facility require a follow-up visit by the same agency?
[] Yes 14. No
NA NE
NA ❑ NE
NA NE
NA NE
❑ NA [] NE
NA NE
[] NA ❑ NE
[:]NA [—]NE
NA [] NE
NA ❑ NE
❑ NA ❑ NE
Comments (refer to yuestlon #i): Explain any -YES ansWers and/or any additional. recommendat,ons or any<ather contafe`nts.
Use�drawingse.o..f f teili to better explain.situahoast nse additional pages as neeessa
ty( p g r'y)t �F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:j�.�`�
Date: If
21412011

Type of Visit Q Compliance Inspection O Operation Review ructure Evaluation he0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral O Emergency rd'Or ❑ Denied Access
Date of Visit: /D Arrival Time: ! t7 Departure Time ; p ci County: a"" Region:V
100-
Farm Name: fig - Wrq"- Owner Email:
Owner Name: :9 Dhk7 , r 4✓ tcy�dJ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 7,i2gi I i CL / Title: _gJ2.>& f Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = { = H Longitude: 1:1 0 = , El "
Design Current Design Currents Design Current
Swine @apac�ty Pap la 'on Vt'et Poultry Capacity Pouul hu Cattle Capacity Population
❑ we to Finish
❑ Layer
❑ DairyCow
an to Feeder
❑ Non -La er
❑ Dai Calf
❑ Dai Heifer
FEIF eeder to Finish
;,r$�
, *x
`'
Dry Poultry
La ers
Non -La ersPullets
f[F-1
ElTurke s
❑ Turkey Poults
❑Other
❑ Farrow to Wean
❑ Farrow to Feeder
❑ D Cow
Non -Dairy❑
Farrow to Finish
Gilts
Beef Stocker
El Beef Feeder
ElBoars
❑ Beef Brood Co
Other -
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 93-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
El No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
9INo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: a— Date of Inspection
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -SN 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,[No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ICI No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IN No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo ❑ 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 ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) if�PW,7,,4
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 acre determination ?
❑ Yes
El No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E}No
❑ NA
❑ NE
Th'�s i n ay -was T� I-ek r-uj 1-rev�
-Z" r Kos d-�e-41
G' ��� pGC1fL ��� K- •� ri r �v'l�Lt-ACL C(Ji�6GJ
Reviewer/inspector Name s , Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
rZIiwvv a.vrusnkru

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 J&No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo ❑ 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
E.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JN No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ 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
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
2�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector tail to discuss review/inspection with an on -site representative?
❑ Yes
14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E!�No
❑ NA
❑ NE
7'_9V'
047' D J 1�04u ,_�
cv", G
Page 3 of 3 12128104

1'
Type of Visit G-;20-Uline
cHance Inspection p operation Review O Structure Evaluation p Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7r/ Arrival 'time: c7 Departure Time: O County: Region:
Farm Name: raw tCYz- / Sr Owner Email:
Owner Name: g o ri " ; 2-- Ly �3 /'ec.cr e_►r Phone:
Mailing Address: 1 ?an rm-71 7LJe- `7 f
Physical Address:
FacilityContact: C>7121r f &u) r!� Title: >h ��' _ Phone No:
Onsite Representative: S.•-�G� _ _ _ Integrator:
Certified Operator:-SG""'� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = =" Longitude: =n =,
Design. ._ .Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I I
❑ Dairy Calf
ER Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑Pullets
us
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other 1
of Stntctures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
El No
❑ Yes
,® No
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�{
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [9Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit! ❑ Yes W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fg..No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)2��CdL!
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 231Yes 1 0 . ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ®. No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ®.No ❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes Eallo ❑ NA ❑ NE
AL
all) eet-L
� z5 n 7
Reviewer/Inspector Name Phone: Wig"y33�
Reviewer/Inspector Signature: Date: /rr7
Page 2 of J f 6/40/VY %.unrrnueu

Facility Number: &E Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes §�LNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5;No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 OLNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J@ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E&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
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JUNo
❑ 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
EgNo
❑ 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
®,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C3-No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit E)-Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: Arrival Time: ` p (� Departure Time: 0; County: Region:
Farm Name: ,i3%e uj ee tfD� �a�r �— $� Owner Email:
Owner Name: 'R D yt,A , ,rro a ) e-V- Phone:
Mailing Address: ap / � � a L. IIJ Fit t is t7''�' y�
Physical Address:
Facility Contact: n» ►n � Y 134 e i i I ed" I Title: Phone
��No:
Onsite Representative: Integrator: Ivd 6
1011
Certified Operator: Operator Certification Number: 7s�y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = ` = 11 Longitude: = ° =1 ="
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry M
Mwiapaclty
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI
Non -La er I
❑ Dairy Calf
❑ Dairy Heifer
Feeder to Finish
El Farrow to Wean
El Dry Cow
El
Dry Poultry
Farrow to Feeder
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑Yes
gNo
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
[I Yes
[--]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
IR No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
NNo
❑ NA
❑ NE
other than from a discharge`?
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r.No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes ®,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
'0 No
Vhk
❑ 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
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EX No
❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a, et
� ,
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA - ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lallo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
59.. No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EjNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-No
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any recW.om nendatto'ns or any ottieF comm nts
Use drawings of facality to better ex `lain siivations: use additional a es as nec ssa
Reviewer/Inspector Name r' - Phone: �}J trdtP33 ��a0
Reviewer/Inspector Signature: Date:2-a --d as
I L/-,61" uonunuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5d No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No Cl NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O-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
[2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Q No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
r,,U.INo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ 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
Ao
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ZNo
❑ 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
[KNo
❑ 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
R 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
[j No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
12128104

Type of Visit Pe�ffipliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: ! +`� Departure Time: : Q O County: Region:
Farm Name: Ste Owner Email:
ell
Owner Name: Rpmz2 bu Zr->- ccJ ter' _ Phone:
Mailing Address:
Physical Address:
Facility Contact: X'C>nt?r l'}-c..- Title: Phone No:
r�
Onsite Representative:integrator:
Certified Operator: S.o Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 t 0 tl Longitude: 0°= I= u
Design +Current ��""` �.
�a
Design @urrent ,��, Design Current
swine
Capacity Populahon Wet Poultry
Capacity PopWaiton Cattle Capacity Population
[]'Dal Cow
❑ DairyCalf
�Weanto
Feeder to Finish
(„TNon-Layer
_.
D 6 = "°
DryPouitry
- DairyHeifer
= ❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Farrow to Finish
Gilts
k Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Cn
Other
urke Poults__
❑nOther
n
' 'Number of Structures:
❑ Other{'
Laer
r
� Non -La er
Discharges &stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (lfyes, 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 J4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
El NA
El NE
❑ NA
❑ NE
[:]Yes
❑ No
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3
I2/28/04 Continued

Facility Number• —
Date of Inspection 7 /S 09__�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Pq No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ERNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
14 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(R No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area /
12. Crop type(s)PfC 40
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5 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 9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [&No ❑ NA ❑ NE
Comments (refer t%gneshon;#) eel gm any YES answers and/or any recommendation or. any the comments.
Use drawings ofifaciltty to,better explain situations. (useyadktional;pages as necessary)
T i
7
Reviewer/Inspector ]name �f,.�,(� f� Phone: d 33'-3300
ge
Reviewertinspector Signature: Date:
rage z uj J izi�zorvlr a urnurrweu

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JRNo
❑ NA
❑ NE
21 if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IM No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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
8ZNo
❑ 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
` 1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
Ailitional Comments and/or Drawings
t x
a
i
7
Page 3 of 3 12128104

ivision of Water Quality-�`
FFaciflfi7tyNumber 0 Division of Soil and Water Conservation. [r
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: :3i7 County: Region: ff�f P
Farm Name: �I�'ZtJ�i'i7� Owner Email:
Owner Name: ^�/7 ,1 /. � �� Phone: tr%`'
Mailing Address:
Physical Address:
Facility Contact:Z!'rrrx►~Title: Phone No:
Onsite Representative: Integrator:"
Certified Operator: �S�a-. e� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: [=0 ❑ Longitude: I=]° =' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
f ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Da'
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures: a
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 1K No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
i
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2.No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Designs ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ 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
[KNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C&No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DINo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JRJNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
[&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X.No
❑ NA
❑ NE
Additional Comments and/or Drawings: ! ,
A"f ar ' r` 'V# r.*.v_rr-c-ems
12128104

Facility Number: Off% Date of Inspection 7 /LC,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: r
Desigmed Freeboard (in):
Observed Freeboard (in): 3 3 (p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J4 No
Cl NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IN No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W-No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop types)S�,cc��/77��i4./St�,�
13. Soil type(s) 9-19A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
Cl NE
19. Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ 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):
p4
/ v �� �rC 01 i /!7
Reviewer/Inspector Name r Phone: !2/D1--Lf33— -z jDP
Reviewer/Inspector Signature: Date:
12128194 Continued

Type of Visit (`Compliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit ®'#outine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: trio Arrival Time: LeWil-30— I Departure Time: + County: O'+- Region:
Farm Name: ,e k02 `zrf rr / Owner Email:
dv
Owner Name: �t]n.2 ; Phone:
Mailing Address:
Physical. Address:
Facility Contact: Z on tii 'L IS rein eIr Title- Phone No:
Onsite Representative: ��t�,� integrator:
Certified Operator: Operator Certification Number: �7�L
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e [::] ' = « Longitude: [=] ° =' 0 «
4.._s:.....,
Resign Current
Design Current
FCC,a
DesigA rrent
Swine Ca aci Po ulation
Wet Ponit .
r3
Ca aci Po ulation
P tY PP
Cattle
acitP
❑ Wean to Finish
iry Cow
❑ Wean to Feeder
❑Non -La er
iry Calf
Feeder to Finish
'''
❑ Dairy Heifer
❑ Farrow to Wean
E]Dry Cow
❑ Farrow to Feeder
Dry Poultry
❑ La ers
br`
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
m-
❑Non -La ers
ElPullets
❑ Turkeys
❑ Turkey Poults
❑Beef Feeder
❑Beef Brood Cowl
- - �.
❑ Boars
_;:irk...
Other _1
❑ Other
❑ Other
Numtie afStructures:
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 CR No ❑ NA ❑ NE
❑ Yes
[M No
❑ NA
❑ NE
El Yes
0No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
D�No
❑ Yes
� No
El NA
[-INE
❑ Yes
'R No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
' a_ If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Qg
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
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
ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes B,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop
13. Soiltype(s Csra�-rl_ /h ,� �razr �Sm,�Gl �'rc�ai� �s✓az���sxc&dZ'a/mu'Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�gNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�lNo
❑ NA
❑ NE
Reviewer/Inspector Name , Phone: f
Reviewer/Inspector Signature: Date:
L/L6/V4 UU"99""C"

Facility Number: g2� Date of Inspection �L D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5jLVo ❑ 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
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fZ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,UNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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
P 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
IR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
'Eat-.-. P, _ ey�rov� y-•� • It`s �
AddrhonaiComments sad/oi Drawings r'�r �� �_
12128104

Fac>tlify:Namher
Q Division of Water Quality
O Division of Soil and Water Conservation
O 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: /r?9�pt� Arrival Time: p : 3S� Departure Time: County: SO-n pSar.-t Region: p�
Farm Name: �rC tJe" - - -- o� _ _- Fes► r'"� - Owner Email:
Owner Name: rsn h ; _[�,�� �, �r Phone: �� t°� S33 3 ` 7
Mailing Address: , , 1�0 f`ar.�aa��>�cA-- �a�:LS�n� l�-'��y_j_ _
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:- 1[_onr.-a_e_ j._�eyJ�tr
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
Q Division of Water Quality
O Division of Soil and Water Conservation
O 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: /r?9�pt� Arrival Time: p : 3S� Departure Time: County: SO-n pSar.-t Region: p�
Farm Name: �rC tJe" - - -- o� _ _- Fes► r'"� - Owner Email:
Owner Name: rsn h ; _[�,�� �, �r Phone: �� t°� S33 3 ` 7
Mailing Address: , , 1�0 f`ar.�aa��>�cA-- �a�:LS�n� l�-'��y_j_ _
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:- 1[_onr.-a_e_ j._�eyJ�tr
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish16'S8c)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Q Phone No:
Integrator: ! r dS+a6e_
Operator Certification Number: 41 / 74a SP
Back-up Certification Number:
Latitude: ❑n =' =" Longitude: =° ❑, ❑
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Nan -La et
y! tCb G�.Zp /a
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity Population
❑ DairyCow
❑ Dairy Calf
❑ DairyHeifei
❑ Dry- Cow
❑ Non-DaiEy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notifv 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 frorn a discharge?
❑ Yes [)qNo ❑ NA LINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[t Na
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: $� — Z � 7 Date of Inspection 61 71 ad
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A No
❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I�=
Spillway?: .1.2 //J/9) 51.31 �9,r
Designed Freeboard (in):
Observed Freeboard (in): -3iT-Mx
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[]Yes
[NNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, 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
�9 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
[J9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[& No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r wt a /r G e/ Q S ' Srs / C J G4— It-/ J
-S 04 1 1
13. Soil type(s) C. A No
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
M No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
['No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA ❑ NE
R G-0 r.�.- I.�,-- a .a *0 % V_12�aJ
�•.� . .,1 a 1 Op Lj Ma 4.1cX. K_ 1 l
Reviewer/Inspector Name �+-'Phone:
K: °':-"
Reviewer/Inspector Signature: Ze Date:
1 �/7R//1Q C'n.�Jinimd

FacilityNumber: g'z — 2 17 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IX No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below, IN 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ,® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EM 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
M 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
K] 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
JK] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
A'ddihoaaitConiineu anclldr Drawings , { r
�> y,
P1ra>'_ 6cli-%
-11-0 '.S ��p�.►��L JQ-'-"._j 4-
�ctilddt-1 kltv�l_
rv-% + - . 13 r W ,.
t... a k c c to •.� r c CZ ,- 69 a
d.> r cPt�
i +-,,Q Ila L._'t'-
nc.
yk C. �.Q�+i
c t-+c— �-' a r %-'s a
'. •". "' 1 `-j
l AJ -+ p . OlDck%
ff,
12/28104

I
a Division of Water Quality
Fac�i�ty:Numbeir /r] 0-Division of Soil and Water Conservation '
— O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 7-/ - O Arrival Time: /O.' d Departure Time: County: &Z1f%SQ02 Region: Z!iW
Farm Name: 16re-J,,.4 K4 F�r.i Owner Email:
��_
Owner Name: %G —, Phone: 2/0 -,5-33LI39791
Mailing Address: /PD/ PanA'a '(it��4 �ar o._ � NC .?83'/I
Physical Address:
Facility Contact: Qo.�il 'e Qlt4.r+r Title:
Onsite Representative: �Qo�.�;• �iec..e� - __
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = F Longitude: ❑ ° = , = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation'!
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
Number of Structures:
b. Did the discharge reach waters of the State? (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 EKo ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑ Yes
,❑__,,NNo
L�No
❑ NA
❑ NE
[--]Yes
2xNo
❑ NA
❑ NE
12128104 Continued

Facility Number: g2 —./ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ErNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA QI E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA L?KE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA D-NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA 91gE
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑14E
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA FIVE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
❑ No
❑ NA
Q
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
2TE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
❑ No
❑ NA
�VE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
YJ NE
Reviewer/inspector Name /f% ? J� �c ? ` _. � , ' w ^C33 Phone: `fire
Reviewer/Inspector Signature: Date: -
II1-YaVU4 c.onnnueu

Facility Number: Date of Inspection i `/ -af
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
LVE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
21N' E
the appropirate box.
❑ WUP ❑Checklists El Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
aNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
2<E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
131NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
❑ No
❑ NA
21�E
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
F::f �iE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
❑ NA
1a 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
LTNE
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
12-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
©'� o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[.a'{�to
❑ NA
❑ NE
Additional Comments and/or Drawings: ,
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12128104

Type of Visit ptompliance Inspection O Operation Review O lagoon Evaluation
Reason for visit O'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number D2te of Visit: D3 0l O Tune: . OD
0 Not rational 0 Below Threshold
Q*ermitted Certified [a Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 1County:
Owner Name: '�`" R Phone No: �33 g
Mailing Address: /fpl, , , 3 le /Pei. >�ti►sa+ NC � r'
Facility Contact:...»......................................_..............................._ Title:.. .. W... Phone No:
Onsite Representative: ... .... .,n C.....✓t.,rR._� ».--- - - - ... ».-- - - Integrator: fir!! r•' S......_».......... -------- J'
a+�cwrie '7$C�
Certified Operator:.... ............................................. —�.� . .._ ............................ Operator Certification Number:------...� ...._..... �.............
Location of Farm:
Ej4Yw`i`ne © Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ��°
Discharges & Stream Impacts
i- Is any discharge observed from any part of the operation? ❑ [�Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Elmo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Imo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 01140
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M-Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes'No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier �3 �3
Freeboard (inches):
12112103 Continued

Facility Number:
Date of Inspection O o/
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste _Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �' "^ ra`�I ,.,,R
13. Do the receiving crops differ with those ddignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a 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 attor 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 EPro
❑ Yes nwo
❑ Yes ❑Iicr,
❑ Yes BW6-
❑ Yes Q4o
❑ Yes Ml' o
❑ Yes g'No
❑ Yes B- ffo
❑ Yes [,Z.M
❑ Yes �io
❑ Yes [g-N
❑ Yes ❑lqo_�
❑ Yes ❑ No
❑ Yes EPo
❑ Yes Q41-0—
❑ Yes E!Mo
❑ Yes ❑'�
a " ."
Comme�tts (rder to ques6oa) Explain away YESaasrrers and/or, any recammeaaahans ory ctl_ier man:
;Use drawings of fatty to better ezplaen s�taataas. (ase addrteonal as necessary) veld Copy ❑ Futal Notes
rrr- fr' xr
L-.:.5;..-=� .-"7�'i_ _-..- .y
-rQ 1:_ g .:s: ..,:..•_� /'�I .. ac-..-».- u .ate},..,- t-,:+' `:-�zwY:. m:r e...- -- -
•�7 / ace Mrs &14 k (✓l wL. f V W [J� 1 T1�.
- T
Reviewer/Inspector Name Reviewer/Inspector Signature: Date: a� b
12/12/0-3 C�nlin�isd

r
Facility Number: g? — a n Date of Inspection o 1 oej
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EgNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Q-N-0
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3Wo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P-Nb
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[IWV—
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
Q
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[9'96.
28. Does facility require a follow-up visit by same agency?
❑ Yes
O-No'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[moo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
&Ye�s
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
32.
Did the facility fail to install and maintain a rain gauge?
❑Yes
B
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
O-P7o
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑'&
35.
Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes
B-I<10
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
12112103

J,
Site Requires Immediate Attention:
Facility No. Wa- 2-1-3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 — / 9' , 1995
Time: �g - zd
Farm Name/Own
Mailing Address:
County:,
Integrator: f�E S;
On Site Representative:
Physical Address/Locat
Type of Operation: Swine Poultry
Design Capacity: a S-4D Number o
DEM Certification Number: ACE
Latitude: Longitude: ° .
Phone: 029 —S9z
Cattle
f Animals on Site: f z44D
DEM Certification Number: ACNEW
ld.� .tea..' Al
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 'e or No Actual Freeboar&:_�Ft. Inches
Was any seepage observed from the la oon(s)? Yes or No Was any erosion obse ed? Yes or(s
Is adequate land available for spray? (es or No Is the cover crop adequate? es No
Crop(s) being utilized:,aged-:55 -0 C'20-®
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ordo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 0rt9i]
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(&D If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or(gi) Np
Additional Comments:
74�� A.�/T
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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