820233_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 01�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1I
Date of Visit: / Arrival Time: ; U Departure Time: 547-777-1 county:,
Region: (7
Farm Name: j�j-r,ie S �-�- rp iir.5 G Owner Email:
Owner Name: z'r ✓r5 r r l�YS _�rl C Phone:
Mailing Address:
Physical Address:
Facility Contact: LEJ 13 ' ��� dz'S Title: Phone:
Onsite Representative: sQ Integrator:
Certified Operator: ce_ j Certification Number: /Of) 7
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop
Layer
11
Design
t_VM
Current
Pop.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
tJ
©D
jNon-Layer
I
Dairy Calf
,
v62
. Design Current
D P,oul Ca aei P.o
I Lavers
Dairy Heifer
r,Dry Cow
Non-Dai
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
1pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other loll
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 10 ❑ NA ❑ NE
[-]Yes [:]No ❑ NA
[:]Yes [:]No ❑ NA
[:]Yes
❑ No
❑ NA
❑ Yes
E�o
❑ NA
❑ Yes
[ ` oo
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Page I of 3 21412015 Continued

Lfacft Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'110
❑ 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): : �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
EEKo
❑ 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
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
0-'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ r Vlvo ❑ 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): p & r i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []-N-o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes B-No ❑ NA ❑ NE
[:]Yes [�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑-11�f0 ❑ 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 [D-Mo ❑ 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 �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 1 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�!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
/
❑-go
❑ 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 [] Yes [] N [] 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 M<o ❑ 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 io ❑ 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
�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
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesEI'NoE]
NA
❑ NE
Colments (refer to questio"i0): Eaplam any�YES-answers.and/orany additional recommendations or.any other comnneriti:
Use di iiwmgs of facelrty to titter. ezplatn, Ituation's.(nse additional pages as necessary.).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

type of visit: tJc:ovou"t'irne
ce Inspection U Uperation Review U Ntructure Evaluation U 1"echnical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $' BIZ Arrival Time: J Departure Time: County: Region: 143i�!C7
Farm Name:✓S �'�r1/c 3 _ ��irG. Owner Email:
Owner Name:y {S r- f7 - r✓ a­3 Phone:
Mailing Address:
Physical Address:
Facility Contact: Z01= 2Lp/ z-s Title: Phone: 2 L4 -,522
Onsite Representative: _��� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Gurrent
�Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
inish
er
Da' Cow
eeder
LLa
Non -La er
Da Calf
Finish
11
Da Heifer
Wean
MjBoars
Design
Gurrent
D Cow
Feeder
D . P,oul
Ga aci
$o .
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es 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 MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FaciIi Number: - Date of Inspection:
7
Waste Collection & Treatment
■ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(g 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): J-5— 41-3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S 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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
JE No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
a No
❑ NA
D. 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
0,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C9-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)r--
13_ Soil Type(s): y
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 Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes g No ❑ NA ❑ NE
❑ Yes ® No 0 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
QNo
❑ 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
allo
❑ 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
No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - It5Wate of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�jNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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
EgNo
❑ 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
Eallo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Pq No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: (9'Comptiance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: �outine O Complaint O Follow-up O Referral O EmerRenc_y O Other O Denied Access
Date of Visit: /(o Arrival Time: ' r7 Departure Time: I Aq" 4S I County: Region: P:7RD
Farm Name:fik4��rx1—/�G, _ Owner Email:
Owner Name: ��� �-- r�/Y�_�I9G Phone:
Mailing Address:
Physical Address:
Facility Contact: 2ZAZ -_ Title: j%rrQ� : J Phone:
Onsite Representative: vs'�,�,.�� Integrator:
Certified Operator: sly_ Certification Number: / _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
C•arrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Da' Cow
Dairy Calf
Wean to Feeder
D
Non -La er
Feeder to Finish
00
Dairy Heifer
Farrow to Wean
Dry Cow
Non -Dairy
Farrow to Feeder
DrV P,oul
Ca aci P,o
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
[] No
[:]NA
ONE
[:]Yes
[R No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

`j Facili Number: jDateof Inspection:
/ d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UNo
❑ 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): /2-- f
Observed Freeboard (in): "3 D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ZC 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
Callo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[& No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CNo ❑ 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): y,/,AMa a /
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [,No
❑ Yes [2�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/41201 S Continued

k
i Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
5�,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
[A 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
0 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
[A 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
[g-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
CaNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� No
❑ NA ❑ NE
Comments refer to uestton # Ex lam -an YES iiif ers,and/or an additional recommends' i fiii—o "�
.: ( q. �L ) ' . P Y Y lions or any other comments.
_.. .. fir,...M1�t'i" b` �.i: ky4 �.
Use drawings of fac�ltty,to,betterFeaplam situations:{use.additional==pages.as.necessary) .,
Reviewer/Inspector Name: ���/Y [T 2— _ Phone:
Reviewer/Inspector Signature: Date:,���
Page 3 of 3 21412015

Type of Visit: Wompliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral O Emergencv 0 Other 0 Denied Access
Date of Visit: %- i / Arrival Time: ,� c'7 Departure Time: ; � County:
Farm Name: g zn✓ r-6 -qL-- z'5-e_Uri Owner Email:
Owner Name: /S rQ_iR'-r c/r-S �srL Phone:
Mailing Address:
Physical Address:
Region: Ezp
Facility Contact: l�6;Y alp/" �S Title: /1j a .— Phone: iltt-5 -�o- 6 Z__
Onsite Representative: !S'�-,.�� Integrator: *n_T
Certified Operator: Certification Number: % s-�5-a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
jDairy Cow
Wean to Feeder
a er
Dairy Calf
Feeder to Finish 7&-o
Dairy Heifer
Farrow to Wean Design Current
Dry Cow
Farrow to Feeder
D . P,onitr
Ca nci
P,a
Non -Dairy
Farrow to Finish
iLayers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars Pullets
I Beef Brood Cow
I e s
Other
Turkey Pouets
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes LOKa L-F- ❑ NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
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 Fs-d No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑( No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

jFaciUty Number: - 3 Date of Inspection:
/S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 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): �!a
-
�integrity
5. Are there any immediate threats too the of any of the structures observed?
❑ Yes
Ej No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, 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 > 100% 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)-. ltd'�--d'r'yZ
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ED No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 01 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes allo ❑ NA ❑ NE
❑ Yes lgNo ❑ 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 ER No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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

Facifi Number: &L - Date of Inspection: — / 7_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �q No ❑ NA ❑ NE
ti 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes JE No ❑ NA ❑ NE
❑ Yes JRNo
❑ Yes 0 No
❑ Yes JNIo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question.): Explain any YES answers andfor any additional recommendations or. any:�other: comments:_-.;'_
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / }— iS__
21412011

ivision of Water Quality
Facility Number �� - ®MMO
©Divisiffitne
oil and Water Conservation
y
Type of Visit: Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: �,_Woutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 0 Arrival Time: Departure Time: I D County: Region:
Farm Name: r-.�►V r_5 j�' ��r- 1LrtQ�►�. Owner Email:
Owner Name: ,. v r ��- rr-+� �� - — n e- Phone:
Mailing Address:
Physical Address:
Facility Contact: 1LF i�� �,r'c5 Title: Phone: 17fy--67D 6& L-7Q
Onsite Representative: dower Integrator:
Certified Operator: Certification Number: J 7�r33
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
�w•.
Des ign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle11 gap tyAMIp.
Wean to Finish
Wean to Feeder --a
La er
Non -Layer
Dairy Cow
DairyCalf
Feeder to Finish
''-`
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , tPoul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layer
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 fA-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
C2 No
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - Date of Ins ection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: `�7)�-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
VLNo
❑ 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
[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
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U?LNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 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): J3> -V_ /ja_ �Ovr✓�rr�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
W_No
❑ NA
❑ NE
❑ Yes
j@'No
❑ NA
❑ NE
❑ Yes ®.No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ZLNo ❑ 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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fj� 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 ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5g-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�JNo
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑'Yes 5..No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes PjNo ❑ NA ❑ NE
❑ Yes [a -No
❑ Yes ®-No
❑ Yes W1 No
[DNA []NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question {): Explain any YES answers and/or any additional recommendations or any other comments& -
Use dirawings.of facility to better explain situations (use additional pages as necessary).
Reviewer/]nspector Name:
'7f`
Phone: 2Z2-_ 4 ,�—kLP
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Ij
him V5 6llgll3
�©ivi'sion of Water Quality
Facility Number ®- ® 0 Division of soil raMMIRMEWonservation
� Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time: a; ry� _. County:
Farm Name:
wj Q. r'pp.'el
rQ/M
Owner Email:
Owner Name:
0131PvP.I4
V Pf- e) AC_
Phone:
Mailing Address:
e
Physical Address:
Region: FA_
.r
Facility Contact: Aff L(A� Title: Mq�pg�%^ Phone: 17$33 ce
Onsite Representative: 3p— Integrator:
Certified Operator: Zhu-, 'Fioters Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Mft
DnCurrent Design Current
Swine Capacity Pop: Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
Zyn
a er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D , P,oult . Ca aci l;o .
Layers
Dai Heifer
Dy Cow
Farrow to Feeder
Farrow to Finish
Non-Daizy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other NO Turkey Poults
Other Other
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
[:]Yes KA No
❑ Yes CR No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facili Number: 3 Datc of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KX No
❑ NA
ONE
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): PIT -
Observed Freeboard (in): 33
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
E 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?
J�g Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CK 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
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff 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): C00ttl 4iuQ� 1! �� .. .
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
U No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
D�rNA ❑ NE
21412011 Continued

Facility Number: a - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
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 (RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes rK No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes [allo
❑ Yes KNo
❑ Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any. -other comments
M. Use drawings of facility to better explain situations (use additional pages as necessary). y `
iae bwrrt wee- c+ tia % ,�ka�� l� ah6( ywuse€;,rowr? , Artv
Q�� d� e- wh e+,r I m t)t
�x"'iha�Cf c9 also s�r�
16ff� s
On a*w ` v o © e�1.1
�nsid t
�y 4a5-�vj �", b re�rd �y�
IF&#, Welds 4 re cu t 1 n jdbe0sf� elm` ar n
1 1
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Dbm ScAllel, -
Phone: Q'+
Date: `Uq 3M B
21412011

Annual Cert Daily Pipe)
Lagoon Name, S, fors illway
2
3
4
5
6
7.
Design Freeboard J, Last Recorded in
Observed
Sludge
Stud e Depth: (ft)
Liquid Trt. Zone ft
Ratio Slud e to Treatni6htiv6lurne ifs 0.45
9
Date out of compliance/ POA?
i -Actual Flo w
Design Diam (ftj
Soil Test Date
pH Fields
Lime Needed;
Lime Applied `j
Cu-1
Zn-I
Needs S (S-I425): ii-i P
Needs P
Waste Date
- 60 Day
+ 6G Day
N (Ibll 000 Gal Min Wm
7�7 - pH
Crop Yield
Transfer Sheets
Wettable Acres ✓
RAIN GAUGE
WUP
Dead box or incinerator
Weekly Freeboa
Mortality Records
1 in Inspections,
Check Lists
120 min Insp.
Storm Water
Wpnthpr Cndpq
W717 M, M
modal
NEW"
Verify PHONE NUMBERS':1and affiliations
wj
Date last WUP FRO !�Jjjj6j FRO or Farm Records
J
X
10-4WIL qui
Date last WUP at farm! Lagoon # N-11
0
U
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I. 3000=108 lb/ac; Zn-1 3000= 213 lblac
If

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7 }, Arrival Time: Departure Time: County:So*hvrol
0
Farm Name: eewi 4 kPe► je t2«, Owner Email:
Owner Nance: Ppet.rpl (L R~1 Phone:
Mailing Address:
Region:
Physical Address: OU, GfA0 5 94rdese U 6&-1,6n
Facility Contact: I!- Iry- _ _ Title:Phone:
Onsite Representative: -J-0se o/toS `J Integrator: "
Certified Operator: �t�1 e Flow Certification Number: L2 33
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
s,
D gn
Ic6apacimpop.
Design CuT�R�Nn-LaXer
Current
Design Current
Swine t Pqultry _ Capacity
Pop.
Cattle * Capacity Pop.
Wean to Finish er
DairyCow
DairyCalf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , $Dolt . Ca aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
lBeef Brood Cow
Outer
Turkey Pouets
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)?
[:]Yes ['No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ta No
❑ NA
❑ NE
❑ Yes
E,'No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili - Number: -6193 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes 7❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 q 130
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tE'No
DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
rgNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�gNo
❑ 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
C'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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
roo�p��W��indow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): l�(J >�A Lexlli'Lm 'I"fA,, _
13. Soil Type(s): ��M 0 5
14. Do the receiving crops differ /m those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2[Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J' No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
Wo
❑ 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
RNo
❑ 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
D' No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CIA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge'?
[:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑" No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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 C' 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
Cg 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
1p No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Nf No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or'any other comme1—MMI
t ref
Use drawings of facilit- to better explain situations (use additiional pages as necessary}. ': �.s y ,
is,
l.as� so; vvas ca I1 Qddfflaf
CMCk n -s©, j ��r1- rfo� n� fir C►�ri� - -f�a>� o- o�g -it 'lac Yr� �
a-rl io Harh, Sm 4- W Iyl- Gr ml I
l {�or
hie0 rn a, W_ f a41"
'Found ylaV. d veio d ar y. �x V1
sl�l esr��e � t�n-N aol3 -do 07e 4hen
Cad 1 �r �, n f n d in a o 1*3 - ev *o �aao 6 f-r �� �`� {
� yR%m +zonsHk�atA,.) Neal 4o A* pmij
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: ION,,I
Date: �V Q
/4/2011

5n
Facility No. '&)—3 Farm NameDate
Permit COC OIC NPDES (Rainbreaker PLAT . Annual Cert Daily Pipe)
</VX717
fit: r�r""a 1rell9; �1,, . 1 M,19
��������
Lagoon Name, S forspillway1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date L
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
Calitka-tion —Date --
-
V �----
■`�
Actual Flow
Soil Test Date ��?asj j, Crop Yield UWJoh Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed WUP Dead box or ' ci erator
Lime Applied 0-Q•j Weekly Freeboard ✓ Mortality Records
Cu-I c/ Zn-IwVy �0� 1 in Inspections 7 Check Lists I
Needs S (S-1<25)� %Q� 120 min Insp. �/ Storm Water
NPpric P lf►w��� / WPathQr rnrtPs
- • . -
rfiil��I1�1�F]�!''��1�71111r1[FTI11
' �I;1����;
! J �
r
` in
��
•
I AM '
`'yk Verity PHONE NUMBERS and affiliations
Date last WUP FRO 543b( FRO or Farm Records
Date last WUP at farm Lagoon # 45TKA
App. Hardware Top Dike 4T,O 50,6
Stop Pump . QUD 46,3
Start Pump l,]
15 �T?
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 lblac

Type of Visit: eFCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint p Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 11111,41]E] 1Arrival Time: Departure Time: , JQ County: Region:
Farm Name: 92i°yt°f ¢Qj �'Q/if� Owner Email:
Owner Name: Rtopm Q Rl, X c Phone:
Mailing Address: 64&4rjr�n�
r
Physical Address:
Facility Contact: Uhje IF n Title: Phone:
OnsiteRepresentative: �We RorP/ _ integrator: M�
Certified Operator: F - �Jaot _ _ Certification Number: 17$33
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Curreaf' Designn C► Design Current Desigurrent
SRrine
Capacity
Pop. WeF Pau IT Capacity Pop. CattleH, Capacity Pop.
Layer Dairy Cow
Wean to Finish
Wean to Feeder
QT
Non -Layer
': '
Dairy Calf
Feeder to Finish
Design `Current
Dairy Heifer
Farrow to Wean
Dry Cow
- D` f d I UltrV ` _ .a aei P,o ,
Farrow to Feeder
Non -Dairy
Farrow to Finish
I Layers
113eef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
Turkey Poults
,the
Other
I
10ther
Discharges 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 [RNo ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes No
[:)Yes No
❑ NA ❑ NE
❑ NA C] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

e
Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: -
Spillway?:
Designed Freeboard (in). IQ ,
Observed Freeboard (in):�_ `!
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
tElYes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR 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
Callo
❑ 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. ERYes [:]No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. RTotal 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 Types) CDI fI ��P/ vda 44Ay .SIiIQ �� 4112 �9�ifSfPd
13. Soil Type(s): Cukh y Sold _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
15? No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
15a No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[RNo
❑ 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
f No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E[ 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

Facili Number: - 3 Date of Inspection: 111144 it
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F�kjNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
'allo
❑ NA
❑ NE
KYes
❑ No
❑ NA
❑ NE
❑ Yes
R[No
❑ NA
❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes &I No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®-No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes 2 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(referComments question ). y y as necessary) c tions or'any�"ot9d comments.
Use drawings of facility to better explain "situaho s {use addtfo'nal page additional recommends 3
-7, Pieo e_ work o, a bee qo% la
I KAT ra�l jh a homtL htr � f* �-e Ids r � �v s� ewA� exc�
0a i gem a lo ry U v�
- Q�anc,�, we �- � ,fie a�a�f� &e n tj h'f hip
qhales, AIe�� re d wg o�• of a t/e. h F n I {br e tr
PLAT Soi � ��fi� is clue eua sY�a tf aid �ro�.ld ha�e,, o�ge r� aoI o.
o �'f oae vas a��,e lay+ cur moil c � 'c�,
Aloe �
a of f s eo r °!°
P shoHs med f %�� balalrr r'
r _9�'�y P
war d 07 e W//I
plPae ef- ree(I 4hot S[t.d e.S`vie e ad
�/A Mo 1,01 t �Ct�f � ��irf 1 �`� c.rtPrrrB4,
fs, S1' San��� j _9
Reviewer/Inspector Name:
�D a.-, se hiq '3±— Phone: 91 o- { Q�
Reviewer/Inspector Signature:
Page 3 of 3
Date: hkV
21412011

.• 4
Facility No. qa -a33 Farm Name ��ej(L—NyeJ Date
Permit COC L/ OIC_ NPDES (Rainbreaker PLAT Annual Cert )
.5 MaI!
-
M
FITW
M.'wimIY MI.W."VRMfi9
Alta r filad d% rf-z..4,
1/!I/ �rir�u�ar
:. R��_
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
II.-,._ f"'I
Actual Flow
Design Width
0bs m' h l
SoilaTest ate Wettable Acres ✓ RAIN GAUGE
pH Fields WUP / Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied laa 1 in Inspections
Cu-I •.-/Zn-I 10?e 120 min Insp.
Needs P r ~IOO A5ok d Weather Codes /
Cron Yield A;n — S' Xl Transfpr Shafts YIIA
- - ` - - -
Irr�ilr,��n�C�c�i
li�L��TII��iIn'��iJ::����■
.
WK
T.
1�
Verify PHONE NUMBERS
and affiliations
Date last WUP FRO
Date last ]NUP at farm
FRO or Farm Records
455M LO
Lagoon # a
Top Dike ���
Stop Pump
Start Pump
Conversion- Cu-I 3000=
108 ib/ac; Zn-1 3000= 213 Ib/ac
App. Hardware

BT04S S - // - z of 0
— �TUivision of Water Quality
iFaciiity Number 2 Z 33 O Division of Soil and Water Conservation
Q Other Agency M:1
Type of Visit ompliance 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: /Z .' County: Region:
Farm Name: ___.. .6P�✓� C�1'itit Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
T�
Facility Contact: ��� Title: Phone No:
Onsite Representative: SSA j � rGS Integrator: Zit eFATr f1V
Certified Operator: ��s �-� rlorP�S Operator Certification Number: / 78_?_3
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 1 Longitude: = o = 1
jj�Gt
Design CurrenSwine
on
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
][]Layer
❑ Dairy Cow
Wean to Feeder 7 Z
110 Non -Layer I
❑ Dairy Calf
1:16
® Feeder to Finish &'74,
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gills
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turke Pouets
❑ Other I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
Ej<
❑ NE
❑ Yes
❑ No
1A
❑ NE
❑ Yes
o/
❑
[INA NE
El Yes
,
2<0 ❑ NA
❑ NE
12128104 Continued

Facility Number: 2 —2
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): %2.
Observed Freeboard (in)_ q ri
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 �`N�o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes BrNo ❑ NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes & No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R<o ❑ NA ❑ NE
maintenance/improvement?
"
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
3 o ❑ 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 Wiindow/ ❑ Evidence of Wind Drift El Application Outside of Area
12.
Crop type(s) $erxruc; liL ►'Z��Af r/Q J
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
21C ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
EKc, ❑ 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
6N"o'❑ NA ❑ NE
,r
Comments (refer to!question #) Ezplam aoy YES answers and/or any. recommendations or.,any other comments „'
Use. drawings of facility to be
pages situations. (use additional pages as necessary) ?'
Reviewer/Inspector Name l� J2�st S. Phone: 10.4<3.3 3300
Reviewer/Inspector Signature: Date: 7-2C�72 — 3—
ZO
12128104 Continued

Facility Number: —233 Date of Inspection
Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
❑ Yes P o ❑ NA ❑ NE
❑ Yes 0< ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O'llo
❑ 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
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElL'EN Yes
o
El NA
NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
� ��No
o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DO<
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L[�'No
9,❑ ❑ '<oo NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Ls ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
vo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
11No
❑ 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
El2
,�
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
B<o
❑ 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
B'iVo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
NA
❑ NE
Additional Coiiimentsaad/cii=Drawings: _AL
12128✓04
12128✓04

Type of Visit Q Compliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit- 0' ZZ-Og Arrival Time: Departure Time: / 2 : 30 County: Region:
i
Farm Name: , 7 p e e ye RE G✓c— Owner Email:
Owner Name: rnw�e PJ/e.S Phone:
Mailing Address:
Physical Address:
Facility Contact
1oS�%rS Title: t� Md^�Q, ✓ Phone No:
Onsite Representative: �OSG r� 0 ►rCrS Integrator:` BI�aL✓/� _
Certified Operator: —� D S� �D1r45 Operator Certification Number: r 19 3 3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 6 = A[ Longitude: =u 01 0 u
Design Current Design
C*urrent Design C*nrrent
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capaclty Population
❑ Wean to Finish
Fjj�_Ayer
1
❑ Dai CowWean
❑ DairyCalf
to Feeder 2500
Non -Layer
Off Feeder to Finish
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
ElNon-Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Brood Col i
❑ Farrow to Finish
Gilts
Boars
PEI Boars
El Pullets
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
ldumber of Structures:
Discharp_" & 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 L'I No ❑ NA ❑ NE
[:]Yes
[:]No
2� A
[I NE
❑ Yes
ElL` No
H<A
El NE
0'�
El NE
El Yes
El Yes
,❑NNoo
B oo
❑ NA
ElNE
❑ Yes
E o
❑ NA
❑ NE
1228104 Continued

Z
Facility Number: 8F2. —233
Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier: aza SiWdl/
Spillway?: /NO ND
Designed Freeboard (in):
�i
Observed Freeboard (in): 3f'p
Structure 3 Structure 4
❑ Yes ff-No E NA ElNE
ElYes No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 8 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application �/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement? ,��
I l . Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes L71�fo [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) 4,� f�f y .50".& IV, A/ (�O.'
13. Soil type(s) C a 1%,,jh01
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
B No
❑ NA
❑ NE
to
❑ NA
❑ NE
[� No
❑ NA
❑ NE
❑ NA
El NE
0io
'No
ET
❑ NA
❑ NE
Use drawings of f feih to=better explain situations. use.a ther comments Comments.. refer tp uestion # : Ex lain'aa YES ansRers and/p>r any recommendations or anyro
g f3' p ( dd�tronal pages as necessary) cry r
Re-dewer/Inspector Name �j�i >�ri✓i.�5` Phone: %0, �3�.d
Reviewer/Inspector Signature: �,� ��+— Date: /O—ZZ—zao g
12128104 Continued

Facility Number: B2 —239 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 ffNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desi gn ❑ Ma s ❑Other
P
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MINo ❑ 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
ONo ❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 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
ff No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,.,/
B 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
No
❑ NA
❑ NE
12128104

Type of Visit (St Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a 5� P Departure Time: � county: s Region: �Q
Farm Name: .�yt'1 4- R1°evew EM Owner Email:
Owner Name: 4` !Ct"�t'�r2,f YIIC _ _ / Phone:
Mailing Address: � Cofeei Kr�G[�tP Pd (�Qr�fin NC—
Physical Address:
Facility Contact: LtrB Q'�1 Title: Phone No:.52ff __31u
Onsite Representative: ±Tm_- IFI D[P, Integrator: M—p-
5 c
Certified Operator: —J'Dho— r �a` ,f Operator Certification Number: AWA 17933
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = u Longitude: = ° = I = "
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder @500
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population.
1❑ Layer
E] Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures I .
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 E.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9No
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 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 RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L",e_ S
Spillway?: s�� -- 3 Ct
Designed Freeboard (in): 1Q•5-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes t1Vo ❑ 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? Byes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JR 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 IffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) l -al
0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
CRNo
❑ NA
❑ NE
Reviewer/Inspector Name f >�j Phone [0 Y�3--�]LJ
Reviewer/Inspector Signature: UA Date: % Q
Page 2 of 3 12128104 Continued

IF
Facility Number: $a -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[St -No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5kNO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
{ffNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ 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
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
R-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
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
PjNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C'No
❑ NA
❑ NE
Additional Comments.andlor Drawings*i
-7, "e&,P-spea( o4k nu, I cA 1Y1. hft bde&i . 01) i Arl d-e ; I arye 1 & 0,27 wa /j
58L4m£war aerl'er- Peb D008'
14. �G�� w dr c A Lout ryes k
1 t I I matA4 A d_ Avm a 4j cod rPcoldr,
Ah*mai P-Ff to,n ayes n o�F o� �d �y ;
�xm if t� ro(* of klc r ie pr txw
Page 3 of 3 12128104

r Facility No. % -X" Farm Name Date
Permit COC OIC NPDES {Rainbreaker PLAT Annual Cert )
Pop.Type
Design
Current
f
76O
-F
0
FB Drops
SQL/
IME ME, 111 ON
Calibration Date
=U,
Design .
. r..
------
M-001411F.111111 rem
DesignVyidth------
Actual Witc1th.
r
------
Soil Test Rb 1107 ✓ Wettable Acres
pH Fields ✓ pH Lagoon Crop Yield-Y1�1��'
Lime Needed e !ggre Q1040 ' Rain Gauge
Cu _.�_ Weekly Freeboard
Zn
a.00gq
Rainfall >1" ✓7�
1 in Inspections
120 min Inspections
Transfer Sheets
waste Analysis bate
�.Wola
MOM
Pull/Field Soil Crop Pan Window
"44-
�-0
S
-Tt?I-VII 45
i�
- 4b,9.4$5 � p 4 8
l�3p cu'`+
�►�n cn cvf�— �

W
01;
Type of Visit "* Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit )21 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: l a) Arrival Time: �• Departure Time: County:
Farm Name: 'e—r on _ Owner Email:
Owner Name: ,eft Phone:
Mailing Address:
Physical Address:
Facility Contact: J� \�� Oyes Title: l C
Onsite Representative:
Certified Operator: —:O z S I V_
Back-up Operator:
Phone No:
Integrator:
Region:
Operator Certification Number: I -
Back -up Certification Number:
Location of Farm: Latitude: = O = 1 ="
Longitude: Q ° = i = u
Design Current ��Desrgn Current
Design nrrent
ne Capacity Popuation Wet PoultryCapac�ulation
No*;
❑ Wean to Finish
a
iry Cow
can to Feeder
SQ7
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�q No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
El Yes
❑ No
ONA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
N 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)
El Yes
❑ No
$NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/78/04
Continuer)

Facility Number: —;Ga, Date of Inspection Inl7 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ANo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5/ Structure 6
Identifier: �� — +� ► YflU—�
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O�4o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'EkNo ❑ 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 '�g 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. [I Yes
Wo
❑ 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 [I Application Outside of Area
12.
j
Crop type(s) � M i r t�f' Y � � n T1W
13.
Soil type(s) CQ ?j
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
gNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
1&o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
NINo
❑ 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
kNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Nance GH VIMT P M Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: SDI Date of Inspection t;jJ
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 ANo ❑ NA ❑ NE
the appropriate box. ❑ Vap ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `OVo ❑ 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 iANo ❑ 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'19:No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 0 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 ONo
❑ 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 9QFo
❑ 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'lo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes )9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

f2
Facility No. % J Time In Time Out Date
Farm NameV1,Q_2__,y�S k _ VC3� 7--O`v rr. _ Integrator 1 �Vr1
Owner , �t� _ _ Site Rep `� �- tO
Operator
�- 5 No. f _7? 3�
Back-up
COC
Circle: General or
Design
Current
Design
Current
Wean Fe
a�5 D.�
Farrow -Feed
Wean - mish
Farrow - Finish
'
(p`1
Gilts 1 Boars
arrow - Wean
Others
I E -6 ( 5 ►%.�
FREEBOARD: Design 1 CI1
IN U Sup rey
Crop Yield
Rain Gauge j � „�^-k
Soil Test lY� PLAT
Observed 0 Id.
0
CalihratinnN_PNA
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard Daily Rainfall I 1-in Inspections
Spray/Freeboard Drop � a •� 3j0 S 11y
Weather Codes 120 min Inspections
Waste Analysis: 12jF� �v—
Date Nei bgen (N)
�fItz [ .
Date Nitrogen (N)
(4q, 1.4 0.i
Y 1 [.I
Pull/Field Soil Crop Pan Window
r
D� r
a$�

Division of Water Quality w
iFacility NumberSO Q Division of Sag. Water Conservation ` ����
Type of Visit �om lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit S outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' Departure Time: County. s Region:
Farm Name:T es e lz7cLy ry-� Owner Email:
Owner Name�,�l,>4� Q eli� C h Cj Phone:
Mailing Address:
Phvciral Address:
Facility Contact: �� 1 tOi"e-S� Title. rm
Onsite Representative: 5Q3 f
Certified Operator: _ OS-- Y f-
Back-up Operator ke d,-n 7% w=
Phone No: { Ix),59 fl (e 1
Integrator:
Operator Certification Number: I 1 C, 3
Back-up Certification Number: I I ` __
Location of Farm: Latitude: ❑ o ❑ t ❑ u Longitude: = o = I ❑ "
n Current Design Current Design Current
Swine E.!De5ig
apacity Population, Wet Poultry CapaeiNty Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder 5p0 -6 ❑Non -La er ° ❑ Dairy Calf
Weeder to Finish I 67GO 1 6.2 0-0 w ` _ �* n ❑ Dairy Heifer
❑ Farrow to Wean
Roultry' ''�` ` ta` = ❑ D Cow
❑ Farrow to Feeder " X v' �' ' ` `�� '''~ - ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Pullets ❑Beef Feeder
❑ Boars ❑ Beef Brood Cowl
- - - - s ❑ Turkeys
Otber ❑ Turke Poults
❑ Other ❑ Other '=Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
IA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
A
❑ 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
Z&A
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
*o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No/S NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 9167 92161_C_.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [I NA El NE
(ie/ large trees, severe erosion, seepage, etc.) 19
6. Are there structures on -site which are not properly addressed and/or managed ❑ YesNo [I NA ❑ NE
through a waste management or closure plan? J
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 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 A +lo ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ElNE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) e l� 1)') � .4` y L2) i n-Qa( GY1 h iAJS
13. Soil type(s) t, Q„i n
14. Do the receiving crops differ from tholesignated in the CAWMP?
❑ Yes *o
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes Y No
11
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes JTo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any othercomments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
r Reviewer/Inspector Name v 'TJ �} Phone:
Reviewer/Inspector Signature: Date: 2.6b
Page 2 of 12/28/U4 Gonhnued

a
Facility Number: a —a3. Date of Inspection 1 �e
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes '1No ❑ NA ElNE
ElUEl ❑ Maps ❑ Other
the appropriate box. WP Checklists ❑ Design // yy
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes No
/❑
❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis
❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes VVo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'Iko
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes *o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/
/ o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
V
El Yes o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
*o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
[:1 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
ElNE
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/]nspector 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
MNo
❑ NA
❑ NE
Additional.Comments and/or Drawings:
~ � �el�� �Q�i iQ.`^�-�Y � � , S-Y1/i T'SUriC'A•-t'•`�yy S C'e�CC.kLtI�`j fY�
n i.i1$eYy,
Opjalcw Q ( o'm+„
rZ55 lheSe J.U'Iri 4kc mono ,
v
0
F-(Jut rM is
nm r ck� o r`
Cp r yV 0" i CA
a,/ tin : s
v ex L16 we 1 j
Page 3 of 3 12128104

Facility No. y a�� Time to� Time Out Date �� V
Farm Name Integrator
Owner e eUU 2�j z 1 QQ�st�► _ l •�c _ Site Rep
Operator oft No. _
BacTc-Up ' + No. 1170
COC ✓ Circle: General or NPD
Design
Current
Design
Current
Wean — Feed
P5-00
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Desi n���z
Sludge Survey
Crop Yield
Observed
Calibration/GPM
Waste Transfers ~�
Rain Gauge
Soil Test T ble Acres
Weekly Freeboard `� Daily Rain a I 1-in Inspections
11�
Spray/Freeboard Drop KQV C 'Y
Weather Codes 1271,
in Inspections
8: � 1"Waste Analysis:
Date Nitrogen (N) Date NG ogen (N)
q Z,
Pull/Field Soil Crop Pan Window
m a r— C
�n n

05
a H a3
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
i�
V
Date of Visit: 4S Arrival Time: Departure Time: County: Region: �Pp
Farm Name: _ &e yes n.,J ! P&eAvf„•„• 671.1 Owner Email:
Owner Name: Rfe- e.. aacZ AP-4!S f jazp" j E Phone: yI d 6:9 9 - 3 233/ _ 1*9a- 9667
Mailing Address: Saba GrreanC Re "—/�. Q�� �rcr�a.r e—
�i
Physical Address:
Facility Contact: Tdw F/ears __ - Title:
Onsite Representative: 7 ase e S
Certified Operator: _ ^ Mo s e /eta r
Back-up Operator:
Location of Farm:
Swine
Phone No: 5--77 - 3 Q31
Integrator
Operator Certification Number: 1 r7,9;
Back-up Certification Number:
Latitude: ❑ o ❑ ' = u Longitude: E=] ° ❑ ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
roa a a n r ❑ Non -Layer
GI -Wean to Feeder
eeder to Finish
G
vo
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
El 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
El Dairy Calf
❑ Da' Heifei
El Dry Cow
El Non -Dal
El Beef Stocker
El Beef Feeder
El Beef Brood Co
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)?
Nurn ber of Structures: --al
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 D o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
20&o
❑ NA
❑ NE
El Yes
2'�o
[-I NA
El NE
12128104 Continued

r
Facility Number: g3 —.2,y3 Date of Inspection ? o
Waste Collection & Treatment ,,.�,,/
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [q 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: 1 3
Spillway?: ni2n o
Designed Freeboard (in): _ 0, D
Observed Freeboard (in): -7/ ^' 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ 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 [3'FIo ❑ 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
901�o
❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
['10
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
/9 S sd
12. Crop type(s) eer"I'dot
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
&'l60
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9-fb
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
❑ No
❑ NA 0-NE
17, Does the facility lack adequate acreage for land application? ❑ Yes
No
El NA Eli
18. Is there a lack of properly operating waste application equipment? El Yes
,❑,
l_2No
❑ NA ❑ NE
PlGotC I,ow 4,o+0n61
lu5oa�t �a�fej
GAS-Ve unul oalJ.cle�
lrs re,.,v e, .-4,
See/O!"yGs, NCR rw�p��y�
74S e��sn AA•`j
Gvr•f��f,
Reviewer/Ins ector Name
p
Phone: 9!o- y�� Isy ,
r i
Reviewer/Inspector Signature:
Q
Date: a — Q O
12/2R/QQ ('nirlinuad

Facility Number: 8 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑Yes �lo ❑ 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.
❑ �.� ❑ Ch - sts ❑ De<6n ❑>4s ❑Other
21. Does record keeping need improvement? If�yes, check the appropriate fox belgw. ❑ Yes [ o ❑ NA ❑ NE
J r% � B ?.e, 1 J•7 S-/,,tJ./If5.17 9-J+I).2.3 & r•79)
❑ W, ... " t" I ❑ ❑ ns— , , _-1 - — ❑ waqeqfansFers ❑ ARPmefCertification
❑R-it4 faI1 ❑ Stm6t+g ❑ Crop Yield ❑ _ ❑ W ide
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t;No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
if yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA P CIE
❑ Yes �o ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes O'No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
Additional ,Comments and/or Drawings:
7�3Lf L✓ab-le a/ef%�c` 'a s ¢q �•Pine.7� 4ps 4,e, ea %'OG5t /°l er
Ct G�ir o "A! 0%1Lt� �`� Foi.«• 1 C[a ��!
12128104

Other
Type of Visit (compliance Inspection O Operation review O Lagoon Evaluation
Reason for Visit GrKou ine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: �' a o Time: ': ea
Q Not O erational Q Below Threshold
0 Permitted 13 Certified [43 Conditionally Certified [3 Registered Date Last Operated or Above Th eshold: - - • __.
Farm Name: ......lti `f_.l'.......5M'`....._.................... _......._....... County:.... ...................
Owner Name: 'Af Y s A&- 4• Phone No: s 'Q�•7
D �Q +fir
11
Mailing Address: - - - .... 5 — ' - =—`�L---- ---. _ A ---------- .���..
Facility Contact:s T� �__..........itlPhone No- ��53 .....
Onsite Representative:........ •SG .. EAc _ ___..._. _. _ Integrator: _ _. !�"'�
Certified Operator:.-----.... ..........C...� R£� Operator Certification Number:. —
Location of Farm:
eigiluine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �"
�Desw :Curies
Swine Cauacity Pooulati
IRWean to Feeder
9500
2Sov
Feeder to Finish
b (ep
G tl
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design :Current;
Capacity -Population -�
Total Design Capa�
:
Tonal°SSL'.
Disebarges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes L`d'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
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 gaUmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ KO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [moo
Waste Collection & Treatment ��
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes LSO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ...I ....... .............. p�Z.....� .... _._ .. .... _�..
Freeboard (inches): as 3
12112103 Continued

Facility Number: �,Q — � Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [3<o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes 53 No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [fNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes p l�o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes VNo
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenancerimprovement? ❑ Yes ®'&o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &w", %,Lw.{.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW")? ❑ Yes [;'No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
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 at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes Rlgo
❑ Yes [jrNo
❑ Yes [.j'No
❑ Yes &IT40
❑ Yes 2<0
❑ Yes �No
❑ Yes &3�No
❑ Yes [jKNo
❑ Yes LK No

Facility Number: g� — Date of Inspection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
GIT40
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'No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[glKo
❑ 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
OK40
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q-Ido
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
09-KO
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ig-Ko'
28. Does facility require a follow-up visit by same agency?
❑ Yes
9,90
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[g o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[ 4es
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[94100,
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1;Ko
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Eg-No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
[R'9'0
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
09,90
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
14D Routine 0 Complaint Q Follow-up of DWO inspection O Follow-up of DS%Vc review O Other
Date of Inspection
Facility Number
Time of Inspection y'. aU 24 hr. (hh:mm)
U Registered © Certified 13 Applied for Permit O Permitted IDNotOverational Date bast Operated
Farm Name: ......t211.cbfr� ............ County:........... � ^J......................................
Owner Name:........G�.!r.�!S .. Phone No: AlqlO. 5�..........
Y59/.......................
J
Facility Contact: 0....f1� ............ ..... Title: ...../.... Phone No:
Mailing Address: 2 9.rd G r' ,,K� . / y,,�!/ �P�y�
................. ..........R�rE,r-I'... ,r��.. :�..... i?,rile................ ................ - ......----....
Onsite Representative:.......................................................... Integrator:....... 'v.. ...................
Certified Operator: ..... 2; : ,.e% ... Operator Certification Numbers ........................
Location of Farm: .g.— f�// .4,i�. �.�•� .�/ �ci S�/ZQ�
Latitude • ° « Longitude ' =' 0"
#ems' x r "Des ign.�;,Current
x °Design ;,Curierit Design Curretott
_
:Somme h Capacity
z .-:.
z.
Piulafon a Poultry YCapacttyPoptilatton Caine raj GapacxtyzPopulattan >'
-,
Wean to Feeder
76Ga
�,O
❑ Layer 0 Dairy
ram,
❑ Non Layer ❑ Non -Dairy
._
Feeder to Finish
K
❑ Farrow to Wean
❑Other 4 Y 1 y K mow,
❑ Farrow to Feeder
F
vial DeS1�A Capacity5
Farrow to Finish
t= K
: Total°SSLVy
El Gilts
[I Boars
£
v Pm.
Numbe r of I,agtions / Holding Ponds t Q ❑ Subsurface Drains Present ❑Lagoon Area ©Spray Field Asea
.-'Tg
❑ No Liquid Waste Management System'- ,
y.5-L2-. .,«.i .{ �' � .w'k^`." _.. --y ..
A �*..d^-,.i" �.'" .,.a.r ¢. • ..,... � Sao`,l`.31i..---..we.t.�,�r.S%.
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-mad0
b. if discharge is obsenoed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system`? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes CKNo
❑ Yes No
t
❑ Yes No
❑ Yes
""� No
r''IA
❑ Yes No
❑ Yes ,® No
❑ Yes CgNo
❑ Yes 0' No
❑ Yes No
❑ Yes No
Continued on back

+ Facility Number: .. .„...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
jo No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
110-No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
,� No
Structurgs fLagwonsand/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes _
No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
71
10. Is seepage observed from any of the structures?
❑ Yes
U'NO
11. Is erosion, or any other threats to the integrity of any of the structures observed?
'(Yes
[:]No
12. Do any of the structures need maintenance/improvement?
IR Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
RYes
❑ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement? ❑ Yes )RNo
19. Is there a Iack of available waste application equipment? ❑ Yes R1 No
20. Does facility require a follow-up visit by same agency? ❑ Yes KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes &No
For�Cer-titied Facu;ties Only
22. Does the facility fail to have a c2pj of the Animal Waste Management Plan readily available? Yes ❑ No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,R No
24. Does record keeping need improvement? ❑ Yes ,W No
Continents (refer to question #I) Explain any YES answers and/or,any recommendations or anygther ccmments.�­"! f
Use,drawings 0£facllity to better explain situations :(use additional pages as necessary) K P u
a� s� a a.
s�
/ram. ,e .� .+ �/, ,r /.z " ,.Cdw�cs .e-ii/ Gam, ll f', �s,,td 4
R, %.,�. , • �a .� G.�'. t.� f�EE.r�is�A4 AV jl� Are `�
�� �i-'i_IC�. , w+✓ / iris% � Fes+" "' �-q~� � ��/�/�+�i%d�i
"w� 40'y
Reviewer/Inspector Name
Re
Reviewer/Inspector Signature: ;e
. r _
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97