820267_INSPECTIONS_20171231

NORTH CAROLINA
r�
Department of Environmental Qua!

type or visit: V uompnance inspection %_l LPperanon xeview u arrueture nvaivation lJ i ecnnical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral p Emergency O Other 0 Denied Access
Date of Visit: 7, B Arrival Time: S Departure Time: ; /0 County: _<A*44f Region:
Farm Name: _ �y/1 /�/� Owner Email:
Owner Name: _ %�jJt2Ji 6. /j/jD7 Phone:
Mailing Address:
Physical Address:
Facility Contact: 645�L;ae-R 0794e­ Title: � y/ �j0 Phone:
Onsite Representative:Integrator:i/T
Certified Operator: EPNCn) 100-fir Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Cnrrent Design Current
Design Current
IY
Swine Capacity Pap. Wet Poultry""' Capacity Pop.
Cattle @apacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder`
-Layer
Dai Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Dry Cow
Farrow to Feeder
f
ul Ca cl��, Pop.
Non-Dai
Farrow to Finish
I
Layers
Beef Stocker
Gilts g.
Non —Layers
Beef Feeder
EL IBoars.
Pullets
Beef Brood Cow
.,
Turkeys
Other
Turkey Poults
Mill
Other
Other
"A
Discharges and Stream Impacts
. 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 ffNo ❑ NA ❑ NE
[—]Yes
[:]No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No NA ❑ NE
Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

• Facili Number: H2, - Date of Inspection: S i+/t�✓ J,Oz
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zj —id/
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]"Ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
t
eat, notify DWR
7. Do any of the structures need maintenance or improvement?
[r Y s
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EaK'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
r--j-<
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes BlIo ❑ 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): Qli'i �i$' 'Alep 4E�w0
13. Soil Type(s): 4)MA.) -��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ET N
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[f] N
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EKO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[i]"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 t. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E] ko
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[j] N
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 2 L, Date of inspection: -- jj�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [/] Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ F 'lure 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: ,0
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 Mlo ❑ 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?
o airy
❑ Yes [/] NNO ❑ NA [] NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes I rJ ' o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
e drawings'of fa_ci[ityjo, tterierplain'situat ons (use -additional pag+ as,necesssry).: n;
uil F� II nl.
CSEG Nv
At -jam C17v
.ew DS feevieo 13 D6t✓ 2-6219
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
V-r W/-/ )
nJ Grin� f't-�r4-=
f>J .�vIJ Lvi f3
Q� Phone: 31. ,91 Di
Date: j 3 PCCL 2,0l is
21412015

01sion f Wa'te Resonrees
Facility' Niumber - (y 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: —/ Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: c�x-Y/%prZ� Title: �. L
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: T&�U�
Certification Number:
Longitude:
Design
Current
Design
`V1'et
Eurren#
Design Current
°,i'�` 'Cattlelh
Swine,
Capacity
Pop .,
Poultry Capacity
Pop..
Capacity Pop.
mug g
�
Wean to Finish
Layer
_
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Vra
a
III ;I
a
Design
CurrentDry
Dairy Heifer
Cow
Farrow to Feeder
''D Poni 4
Ca aci
Po p-
-Dairy
Farrow to Finish
,.
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
fTther
urk2x Poults
i,
Other
Other"
x
k
DischaEges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes KZ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[—]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[—]Yes
[RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
In -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili dumber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): _ 9-
Observed Freeboard (in): 3P-
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 M No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Eq 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 environmhreat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[-Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
g�-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): c�b��jyt ycrf��{/�c�lr �./
13. Soil Type(s): 1AC1`/`Vlli%1� -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rV r! 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 Ea 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 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes fo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes TZ 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 JA No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® 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 21412015 Continued

[Facility Number: - Date of Inspection: / G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:Z21 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 M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 EjNo [_]NA ❑ NE
❑ Yes [j,No ❑ NA ❑ NE
❑ Yes
]&No
❑ NA
❑ NE
❑ Yes
E No
[] NA
❑ NE
❑Yes
foNo
❑NA
❑NE
[gYes
[:]No
❑ NA
❑ NE
fl. , iCl r-�- �tij�f `cam rK Gi5
r� ; rl--� Tc'7 �5/o�L�S� � cfV 7b
fdk
{��v oczf-
Oa
ram.
Reviewer/Inspector Name: G
Phone: �j ray3- r
Reviewer/Inspector Signature: Date: /";z
Page 3 of 3 21412015

S lam- 1 �z-30
ivi'sion of Water Resources
Facility Number ®- �(� Division of Soil and Water Conservation
� Other Agency
Type of Visit: omplianee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rArrival Time: ,'vim Departure Time: County:Region:
Farm Name:,-�-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �,�'r-�/j.�� Title:
OnsiteRepresentative:
Certified Operator: pfi:-.,t �yJ
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
-�, Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current :' Design Current
Design Current
Swine
Capacity Pop.-_: : --- Wet Poultiy - Capacity Pop xCa#tle ' Capacity Pop.
Wean to Finish
La er �
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
heeder to Finish
p 0 Age-0
Dairy Heifer
Farrow to Wean
Design Currents
Dry Cow
Farrow to Feeder
D :P■oultr. '- Ca act Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Pouets
=
Other
Other
Discharees 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 ofthe State? (Ifyes.. 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 [Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes DD-No
❑ Yes J2]-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NF
[:IN A ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Rf�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?:
Desigmed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
[d No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes & No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):✓7y1 e+dam //Jyrd�r
13. Soil Type(s):[,��.i //41-01-7-YII1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
S Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
C] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
allo
❑ 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
JZ,No
❑ NA
ONE
❑ 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
ENo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JFNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of Inspection:ff
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .10 No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O 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 [S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes r--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 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
_0
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes allo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes allo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes gNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes allo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C!3-No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: v Date: /,;;;z —z"-��1�
Page 3 of 3 21412015

9
Type of Visit: UCozoutine
nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 MIArrival Time: U=Departure Time: County: Region:
Farm Name: /j� �d lh-t. , Owner Email:
Owner Name: j22 Phone:
Mailing Address:
Physical Address:
Facility Contact: a f n- r` Title: `�1 -
Onsite Representative:
Certified Operator:���
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Finish
Feeder
Feedero Finish
o Wean
to Feeder
Design Current
Capacity Pop.
Q p
Wet Poultry
Layer
Non -La er
Dr. P,o_ult ,
Design
Capacity
_
Design
Ca aei
Currentmmmouluesian
Pop.
Current
Poo
Cattle
airy Cow
airy Calf
Dai Heifer
D Cow
Non -Dairy
C►urrent
Capacity Pop.
to Finish
E
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Turkeys
Turke Poults
Other
Beef Brood Cow
-
Dischar2es and StreamImpacts
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
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes C&No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412014 Continued

FaciliNumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
DNA
[] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d�
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
KNo
❑ 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
qNo
❑ 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
J2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
®.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): G'ti� GC/�� 1�r . 1--,.. �r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
EaYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JZLNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
r9,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ELNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
a 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 J No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J�gNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

' Facifi Number: - 1Y 1, Date of Inspection: r/
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 allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [�"o ❑ NA ❑ NE
[:]Yes E[No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
[—]Yes W No
❑ Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412014

type of visit: 3mp6ance 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 0 Denied Access
O" d `/
Date of Visit: Arrival Time: Departure Time: County Region.,7JeD
Farm Name: /wo r-'V­
Owner Name: 70ilOt & fj7p-FIc—
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Vrt'e'l .'fr Title: 2 Phone:
0/1
Onsite Representative: Integrator:
Certified Operator: r f%�--r..� %Z�j- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
r
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)?
❑Yes EQNo ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ 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 1] 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 2/4/2014 Continued

Facie Number: - Date of Inspection: g�O'-/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): %9'
Observed Freeboard (in): sk
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 ❑ No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [:]No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cp✓rt �jiie�r�����tl�ire�+sf� �d �%rt�G�
_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21 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
K] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA [] NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 2] 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 E� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3d No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection: Q_— rT— i
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 RLNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ® No ❑ NA ❑ NE
[:]Yes gNo ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or.any othercomments
Ilse drawin s.of facilityto hetter explain situations (use,.additional pages as.necessarv):
ran Pico 2f,S i rr��u►�� �-�— s't `rK
• r�t � C�� ' `�L�.e- iCJ � f �= : �a-�� fr 9LL� a.�a �-G�r x~ ice% % r� /a�6 �:S � Gr c:✓��
flow � erf,�•sr`e-�-�o�sU
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: !2P�l:;,77<�r0c.-
r
Date: &— T c—'aga
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit:-0711outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:�Arrival Time: Departure Time: ,LO County:
Farm Name: pV 7� �v/ir�. Owner Email: y�
Owner Name: j r, f 4. In 07-t- Phone:
Mailing Address:
Physical Address:
Facility Contact: _Ay_- /11ay✓'� Title:
Onsite Representative:
Certified Operator: S' 7,,-,1,
Back-up Operator:
Location of Farm:
Region:
Phone: J
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pap.
Wean to Finish La er
Da Cow
DairyCalf
Wean to Feeder
Non -La er
Feeder to Finish
D� Q
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P,oultr Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
.111. 11 Turkeys
Other Turke Poults
mill
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[:]Yes [gNo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [-]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ej�_No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/412011 Continued

Facility Number: -Zj Date of Inspection: D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes fgL 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 L4 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 eg No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 10 No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Pg 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 Tme(s)= C-4D yen 4 �� r✓`s
13. Soil Type(s): ;//r-- a
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes Pg.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [A No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P5-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rO -No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [—]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: IL2= jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes ZI No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [KNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWN P?
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 [� No ❑ NA ❑ NE
❑ Yes 5d No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JB No ❑ NA ❑ NE
❑ Yes No
[:]Yes �No
❑ Yes ®,No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments, refer to uestion # : Explain an YES answers and/or an additional recommendations or an other coifineats.
( q ) p y. y y
se drawings of facility to better explain situations (use additional pages as necessary}.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _V�X?
Date:
21412011

type or visa: (9Compltance Inspection V Operation Review (> Structure Evaluation {) Technical Assistance
Reason for Visit: tD xoutine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: D: 7r Departure Time: f ' :00 q"'71 County:
Farm Name: ar►►1 Owner Email:
Owner Name: n Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: c Phone:
Onsite Representative: Lie Integrator:
Certified Operator: r�/lr� �1 Certification Number: 251`6ect2-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
:tDes�gn� Current . •= 5 DesignCurrent y
Design Current
Swine a cis + g
C pty =Pop. WettPorJltry:�Capsell y,Pop.
a
Cat#le Capacity Pop.
Wean
to Finish
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes KNo ❑ 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?
[-]No
❑ Yes
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
S-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Z. 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
[K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
ELNo
❑ 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 K] 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): v
13. Soil Type(s): AJ4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes -SST o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a 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 E4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes D 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 C3-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ELNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ 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 fo No ❑ NA ❑ NE
• 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�No [DNA ❑ 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 stmcture(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes M 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:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [5rNo ❑ NA ❑ NE
❑ Yes -Q No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes � No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [ C�Yes -G o ❑ NA ❑ NE
Use drawings of is lityto better explain situations (u a additio aI pages a (fer- to. question #): Explain any YES answers and/or any ational necessary), recommendations or any other commersts:
Loy
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone -
Date: �f O` y33 33
21412011

I
- - -- -� Division of Water Quality �. .r ' � -
Faciiity Number ®- � ®Division of Soil and Water Conservation
© Other Age_cy
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: QKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: W:1i 1 Arrival Time: p; by Departure Time: County: vL- Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: rr/' /71oye in- Title: p�i. lJp��. Phone:
Onsite Representative:
Certified Operator: o cry
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
' Design Current _ Design Current
Swine Capacity Pop
We top oultry Capacity Pop. Cattle Capacity Pop.
zs
Wean to Finish
'
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
6z voo
CD
71-
"
Dairy Heifer
wz ,, Current
Farrow to Wean"
Dry Cow
Farrow to Feeder
.Design
D ,Poultry Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Beef Brood Cow
1pullets
Turkeys
Othe
ITurkey Poults
Other
Othcr
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 obscrvable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Callo
❑ NA
❑ NE
❑ Yes
fg�No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

facili Number: - Date of Ins ection: f-�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
• a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 132-
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
n No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [ ] Yes ® 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): Br ^,,,,, 1 du,•«�%
13. Soil Type(s): ` 5 0 f A u
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? � Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ER'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
Re uired 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 FA 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 W No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes fo No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

facili Number: - Date of inspection: — f /1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
- 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (, No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�a No
❑ NA
❑ NE
❑ Yes
Cg No
❑ NA
❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ta.i No ❑ NA ❑ NE
❑ Yes I No
❑ Yes Z No
[—]Yes [ZI No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�x� b�
�-�—
V al& z ',0* 716
e fiL L�5 /yi�r / C i ► t�Yf/n �"' IA�o C.i m e Wa-v
6a;h-.i TV
L��� � t�r3e.�m �r��7'4��,-�- �hC`,..ti ire'/j ✓t � �'%'i'T /C.s>l
Cky-e,
Nr,v i�`.4+ }j•�sr�-�N �':� ti'�oLa.�ra•-•.�
you h&v e. 3 a ��� -r O f?V1►0- 4 w ors d' i :5 A.I,,�' m�--f-
JyMaVi le e- W,,J' A✓, /( it )Ur}�`�
Reviewer/inspector Name:
Reviewerlinspector Signature:
Page 3 of 3
Phone:�dJ73A
Date: /l Ia f /)
21412011

Type of Visit @f 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: ' 3 o Departure Time: : 3 D County: s / » Region:
Farm Name: `►
IWA- // �R�''`�� Owner Email:
Owner Name: U f9 914 71— Phone:
Mailing Address:
Physical Address:
Facility Contact: ��� t�al}'� Title: Phone No:
Onsite Representative- � `�� Integrator:
Certified Operator: ,�'~ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� ° Longitude: ° u
=_C-u7ent
tSw�e
Capacity opulation
Wet Poultry Capty Population
Cattle Capacity PoL.pulation
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PGilts
Boars
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Other
❑ Turkey Poults
❑ Other El
lVum>ber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B-No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

r
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® 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
N No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9No ❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo ❑ 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) r a d
13. Soil type(s) 1A K,
14_ Do the receiving crops differ from those designated in the CAWMP?
® Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[3 Yes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ZNo ❑ NA
❑ NE
/it /S,
o-ee_j F- r p u.G/ 1 A
�Klls ! 4' 1 �rrn�-ot2r'�d�, % v t3—rea eu//l-
7-v N- • C i �m yf// Gv I -a I-ry / ru/ F ,G /du r- Sri' Jai Y /dJ
Reviewer/Inspector Name Phone: 4/D-q37—:Z2 of
Reviewer/Inspector Signature: Date: /1-1
Page 2 of 3 12128104 Continued

Facility Number: — G Date of inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5.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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [21No ❑ 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
g] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
ayes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
f.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW-W?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9. No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[. No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[SNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[0 Yes
❑ No
❑ NA
❑ NE
Addttinnal,Ciinimen6 and/or Drawings:
o A , r-or- ,lieu.
yo V �► r�P�:,—your ���"����s.
No �J 6_t_-F_ 77"
aG. 1F- you,,- CvrtY
l�T2_
33� �;) CV a W, I FU 1 ivw up wA r-i,L) rrP�' r5
Page 3 of 3 12128104

$Ii1/5 /Z -16 - 2eo
Type of Visit &3 ompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V 1 routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: %Z-yy/S=O q Arrival Time: /.2.'OS Departure Time: 2. S County: —5a±549trLt/ Region: F'�a
Farm Name: ko-If /:�r1rA., AID. I Owner Email:
Owner Name: :a—o 1 N mo+4- Phone:
Mailing Address:
Physical Address:
Facility Contact: G 1rr� ✓cOYL Title: �L S�cG ' Phone No:
Onsite Representative: QCY�cY wave_ Integrator: N SPOu!A/
Certified Operator: &te aY�— Operator Certification Number: Z 4SSS
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = 6 = Longitude: = o = I = u
Design Current Dwill esign Current
Design Current
Swine
Capacity Population Wet Poultry Cap�ty Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish
Oil 2
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
El Beef Stocker
Gilts
ElNon-La ers
ElBeef Feeder
PO Boars
El
❑ Beef Brood Co
❑ Turke s
Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes E o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
EJNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
ET A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
3`�o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 82
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 2,9
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 E NNo ElNA ElNE
ElYes 9'No ❑ NA ❑ NE
Structure S Structure 6
❑ Yes LTNo ❑ 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 ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes BNo ❑ 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 ❑ L� Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Blo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) a ce r ti.. c�� t!fla��� sw � .t/ 6nu ;,� �O � -S
13. Soil type(s)� �$
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EJ-50- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ell-o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes E No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,0-110 ❑ NA ❑ YNE
❑ LS
Yes No ❑ NA ❑ NE
I Reviewer/Inspector Name W�"TWIRM =RM.11 _ - . Phone• 4?1,9, 3. 3 3 a
. I
Reviewer/Inspector Signature: o_Date:lZ —/s 200 9
12128104 Continued

Facility Number: 8Z —2(9-71 Date of Inspection
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2< ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R'I n ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9'9o_7 ❑ 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
D o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[EKo—
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B- o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El- o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B N-o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1=1 tvo
❑ NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E' o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
0'1 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
21 o
❑ 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
3'90
❑ 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
Ehqo'
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D'N-o' ❑ NA
❑ NE
Comments and/or Drawings:
12128104

(% t3j.4-_s 1- o g - OF e,, —
Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit DM!Gutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: %� ,pe Departure Time: ���4r' �Fw� County: Region:
Farm Name: ...M_D.t'Y— FaY i`^ # I Owner Email:
Owner Name: 3 ok" Mo-4- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: --F.4z • Phone No:
Onsite Representative: rrc Moojr<-- Integrator: /Wu�P4y �zatj'y
Certified Operator: Mao t
Back-up Operator:
6rex-r I QDl -q-
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = Longitude: = o = 1 = u
Design; Cu rr ent �9 `Dgr�'A Current Design Current
Swine Gapty. P pulatton. Wet I'oultryCa aci Po elation Cattle Ca Pa
Po elation
- p . h Lp p ty p ac
_ --
❑ Wean to Finish ❑ La er ❑ Dai Cow
❑ Wean to Feeder -Layer ❑ DairyCalf
Feeder to Finish Z�f�D
❑ DairyHeifer
❑ Farrow to Wean s ❑ D Cow
u�yl?oulty
❑ Farrow to Feeder - ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder �.
❑ Pullets ❑ Beef Brood Co
❑ Turkeys
Boars
Other ❑ Turkey Points
❑ Other ❑ Other Number a# Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
E3190
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[3TA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[I NA
❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[TVA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,[5No
V Igo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Condnued

Facility Number: �2—Z(� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ErNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure
6
Identifier:
Spillway?: _ AI Q
Designed Freeboard (in):
Observed Freeboard (in): � — ,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LI 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
�
B 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
L7 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Li No El NA El 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 EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo [:]NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
BINC ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Area
12.
`❑
Croptype(s) ���;+�lu�do� J �i+tiall Gra.;►s �OS�
13.
Soil type(s)kA
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
B<o ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,L��"N�o
L4'1go ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
EJIN'o ❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment? El Yes
,J,
[3 o ❑ NA
❑ NE
l Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �v f—I S Phone: WA143.3. 333 D
Reviewer/Inspector Signature: Fi 2 Date: /2_-/.7_ ZDOEr
12128104 Continued

Facility Number: $2 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [- fo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes 0 o ❑ 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 B o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 o ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[>llo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DTo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D- o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, _,
L1'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?
El Yes
��.,,��
Llivo
❑ 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
[3 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
El Yes
,.,�
N'o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,LDS,
L7No
❑ NA
❑ NE
fi
Addt#✓ g ��^�
�ona1 Comments arcdlor°D�aw n s , ,'. _ �n '4
AL
Page 3 of 3 12128104

Facility Number Z Z 7
vision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit G�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit d'Frutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /Z-/3-07 Arrival Time: Departure Time: Q:Yekw� County: S±PSr.+/ _
Farm Name: /MOW- Fa 1-rt., � � _ Owner Email:
Owner Name: o k N Ax0f+ Phone:
Mailing Address:
Region: )=40
Physical Address:
Facility Contact:—�'��-�-y' VVL0ar<__ Title: i SP t-e • Phone No:
Onsite Representative: 61-cc 1007-n--9— Integrator:
Certified Operator: _]3lake fucare, Operator Certification Number: 2 6SSS
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = c = g =di Longitude: ED ° = I = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 1E
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
[r No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: gZ -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 1 Structure 2 Structure 3 Structure 4
Identifier: :#_ i
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): -3z
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 [0 No
❑ Yes H No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes q No ❑ NA ❑ NE
❑ Yes [�j 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 to No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a k—mNq ou sc'd
13. Soil type(s) X-A R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes QNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [ZNo ❑ 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 ® No ❑ NA ❑ NE
j Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
IUse drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name RicC_ 3 Phone: y/D-"- 33,0 0
Reviewer/Inspector Signature: ji� Date: /Z-13 —Z607
12128104 Continued

Facility Number: 8 Z — zlo7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�j No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[j�] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 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
[A 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q3 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: //-/ ~O+!v Arrival Time: Z.' Departure Time: �'DO County: S4rf�So.✓
Farm Name: NO e4A_A4 _ _ Owner Email:
Owner Name: .Sal Aj luo 4ll Phnna-
Mailing Address:
Region:
Physical Address:
Facility Contact: Gt «/�' oovt Title: /cc�. 0ze—, Phone No:
OnsiteRepresentative: C9rC /L(pQ1-L _ Integrator: W[lk �NOLc//✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = = Longitude: = ° = 1 = v
Design Current
Design Gurreut
Design Current
Swine
Capacity Population
We# Poultry Capacity Population
Cat#le Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Galf
Feeder to Finish
24100 O
e r
El Dairy Heifer
❑ Farrow to Wean
D Poul
ry
❑ Dry Cow
❑ Farrow to Feeder ' "'�`'""- >=' " ❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poulls
❑ Other
Number of Structures: 7
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [$No ❑ NA ❑ NE
El Yes
14No
❑NA
❑NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
r _-TNo
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
No
ElNA
ElNE
12128104
Continued

Facility Number: FZ—�
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?
El NA [I NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 �
i
Observed Freeboard (in): ZZ
❑ Yes [#No
❑ Yes [2fNo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� No ElNA El 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 PFNo ❑ 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [$No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[JPAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window ❑ Evidence/of Wind Drift Application Outside of Area
12.
Crop
/❑
Crop type(s) �u'+E!•r d �. « �lKa�/ ��'`��/t/ [ Q S
13.
Soil type(s) � A soff
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
K No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
V9 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
® No
❑ NA ❑ NE
17,
Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
V1 No
❑ NA ❑ NE
Comments (refer -to question # ): Explain any YE5 answers and/or any recommendations or g ",-other comments
Use drawings of facility to better explain situations (use additional pages as necessary)
Reviewer/InspectorName I K,-<Kti��ye,f Phone: (9/,p ow-3.330
Reviewer/Inspector Signature: Date:
A "ge vJ [ziZoiv4 t,orill"Mea

Facility Number: $z -Z� Date of Inspection !/-/3-a
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 [21 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[gNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Mo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
PdNo
❑ 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
PfNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JgNo
❑ NA
❑ NE
Page 3 of 3 12178104

l ype of Visit ® Compliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11- I /— S _. rrival Time: SS r Departure Time: l/,d County: .« 10 Region: LPL
Farm Name: 7M b ff 7 FOL vr'L Owner Email:
Owner Name: 3-0 n k M o+ t Phone:
Mailing Address: O 3 o rI2 rr e IVC eA1U
Physical Address:
Facility Contact: _ A. (3✓B 10-0` ALOE r ie _ Title:
Onsite Representative: ��i ✓tJ' ffdp
Certified Operator: � mv5 & hP
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: � & 5�S
Back-up Certification Number:
Latitude: = O = ' ❑ Longitude: ❑ o ❑ 4 ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population - Cattle
❑ Wean to Finish
i
❑ Wean to Feeder
weeder to Finish cj 3 p d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts #
❑ Boars_
Other
❑ Other
❑ Layer
LEINon-La et
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
[EllTurke Pouets
❑ 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
Capacity Population '
❑
Dai Cow
❑
Dai Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stoekei
❑
Beef Feeder
❑
Beef brood rnvA
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E:1I
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 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
/9No
ElNA
❑ NE
El2 Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:,Z —„�C 7
Date of Inspection dS'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNo
❑ 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): _ o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1r No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RrNo
❑ NA
❑ NE
Reviewer/inspector Name f �i _��� Phone:
Reviewer/Inspector Signature:i �` Date: ,fJ
12128104
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R
::rN. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BIN
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q No
0 NA
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ 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
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ET 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
20"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
ElL� 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
�o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑Yes
ONo
❑ NA
❑ NE
Additional Co'_tnments and/or -Drawings:`...
12128104

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit • Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Tune- Time: :30
O Not Operational C Below Threshold
efermitted Cj Certified ©, fConditiioonally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: __ . 14e3 EI - rar�'�'l...__ County: _ S& A-,£ —mn.
Owner Name: ICA A Ar���..f�7� 'Phone No: lid - 93 a
Nfai-Ung Address: _ _ P, 4� ..Box - - -� sr5. .. Y4 rr-G. /l s � & (.. .2 R 4y4/ - •.-
Facility Contact: .._...... Sad Title: Phone No:
OnsiteRepresentative: Sep - /VifiltE Integrator. MregzA r.._.
Certified Operator: _ Tea�tn M,�__•• • _ Operator Certifiicahon Number:
Location of Farm:
M-Swine ❑ Pounry ❑ Cattte ❑ Horse Latitude Longitude �• �' �"
Design ' Current • Desag�at Chi,; - :Design Cnrrmt
Swine Cabanas Peiptitation "p Y ::.,C.a criv Povidation. Ca�ai q. Folsu on
Cate
o Feeder
_ Layer
Non -Layer
to Finish
?
to Wean
- --
to Feeder
rc..ts
to Finish
TOffiXDeA
�' _
- . _..
D1S C5 - si!'e8ffi hup8M5
I _ Is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
*:Capacity
IDW SSLW
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
9No
❑ Yes
❑10
❑ Yes
[moo
❑ Yes 9440
❑ Yes 2<o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [TIC
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (incites): ? 8 ' _ -
12/12103 Continued

Facility Number: Date of Inspection 9
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yeses
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 919o_7
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 24
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [:]Yes �ID
elevation markings?
Waste Aaalication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 21Vo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Q;T°
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
P1.41P241002A Z SD o+7s 3
12. Crop typeha Q / Osteru��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ W
14. a) Does the facility lack adequate acreage for land application? ❑ Yes UXo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 2No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge ador below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, . ❑ Yes Eallo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional [-]Yes 9a
Air Quality representative immediately.
IS-. HQs 4V'o*,)etool 404ie T ;e1als
Pe1 1p�;h 't
J CdArIO/J TIuS '00/an5 Aa
Reviewer/Inspector Name
Reviewerlinspector Signature:
FuW Notes
or., -,"A . /hG►r h«41 �d syos^y, 014,,,S 'Adl-
Pespr,'raaS/al
',^ SD�re a�epf
Date: c! - ) > -
iw114ivi "nanuea

Facility Number.-
,gT7,26f7j Date of Inspection -7J'
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ❑ Yes 9-Wo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )Y c ts, 4pigri, 5yps; etc.) ❑ Yes �o
23. Does record keeping need improvement? If yes, check the appropriate box below. 7 ❑ Yes ❑ No
❑ Waste AWH ❑ FreebffiF4 ❑ ❑ Soil Sampling
93 Im c7 -19 > d. s 7 -!& -71 y t` � -� l 7 !y ».
24. Is facility not ompliance with any applicable setback criteria in a ect at the time of design? ❑ Yes h
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ O
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes RNO
27. Did Reviewer/Inspector fail to discuss reviewtmspection with on -site representative? ❑ Yes Pb
28. Does facility require a follow-up visit by same agency? ❑ Yes &#o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E3-No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
MR<
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I- Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: NO
Facility No. S 7-- Z 6 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7- -L7 , 1995
Time: _ ]: 5$
Farm Name/Owner: -9. 9 • Mo
Mailing Address:— Pb, & -7 z_ /!a "it Z 9 Cif
County:_ S10�„!
g - _ -
ante rator: 3 4+S sari,•.,, Phone: �/o - 53 Z - P7�.
On Site Representative: 14A Jt< Gam Phone:
Physical Address/Location: . .5- ' Ie a ' Nam s ea7 o
Type of Operation: Swine ✓ Poultry Cattle I
Design Capacity: _ 2 $4$a Number of Animals on Site: zt9d _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: '5 Ft. 5 Inches
Was any seepage observed from the lagoon(s)� es or&O Was any erosion observed? Yes or
Is adequate land available for spray? Yes or&o Is the cover crop adequate? Yes o No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DweIiin s? es r No
100 Feet from Wells? e No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue tne: Yes or(
Is animal waste discharged into water ofibe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on svecific acreage with cover cron)? Yes or No
J
9rG /:y Rev? -Is
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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