820270_INSPECTIONS_20171231

NUH I H (AHOLINA
Department of Environmental Qual

(Type of Visit: Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: tine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: J Arrival Time: ; 3 D Departure Time: '3[ County: Slot_ --
Farm Name: f r Ants Owner Email: �"—
Owner Name: Ohm-- Mor, Phone:
Mailing Address:
Physical Address:
Facility Contact: -z-.f ,-Lv/`r-- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
=� Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: L�
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes JZ�,No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E]NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Carreat
❑ No
Design
Current
Design Current
Swine
@apacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ NA
La er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dairy Cow
Wean to Feeder
❑ NE
Non -La er
❑ Yes
jNo
Dai Calf
Feeder to Finish
of the State other than from a discharge?
Design "
Current
Dairy Heifer
DEy Cow
Farrow to Wean
Farrow to Feeder
D ]poul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults.
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes JZ�,No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E]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
&c No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
jNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection: /a—
—/
❑ NA
❑ NE
maintenance or improvement?
Waste Collection & Treatment
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JKNo
❑ NA
1 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:
❑Other:
13. Soil Type(s):
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [allo
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes [0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No
Observed Freeboard (in):
❑ NE
acres determination?
❑ NA
❑ NE
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.)
2/4/2015 Continued
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[�[No
0 NA
❑ NE
waste management or closure plan?
Ir 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 ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JKNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ NE
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): .� �(,� tit sZ
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
13. Soil Type(s):
21. Does record keeping need improvement? If yes, check the appropriate box below.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No
❑ NA
❑ NE
acres determination?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
17. Does the facility lack adequate acreage for land application?
[:]Yes [�JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
U Yes ,!r�.JNo
U NA
U NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FX�,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
Q No
❑ NA
❑ NE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall p 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
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
j, No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facifi Number: OL- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes E[ No
Other ]Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
r—_1 No
[� NA
E] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ELNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[UI No
[—]NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jj� No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
]E� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
B.No
❑ NA
❑ NE
Comments {refer to goesttoo # Explain aoy YES answersrandlo. anyF addihonaf recomsnendations'or any other comments: �u ,
P y
Use drawings of facili..to better "ex lata situations'(use'addeetional"Pages:as necessary), •,�_
, J Lid D nY
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
2/4/2015

iype of visit: k5uompuance inspection V uperatton tteview V structure tvaivatton V recttnicat Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: ' � Departure Time: L!2� County: S Q —, Region: j� b
Farm Name: C ,r-- E" wt5 -2--r G, _ Owner Email:
Owner Name: , Se-_ r. In ,1 e '. _ ." C' Phone:
Mailing Address:
Physical Address:
Facility Contact: Imo, at ✓ley SGr Title: , y r— ✓ Phone:
Onsite Representative: Integrator:uf
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
qpI
Design .Cprre11
❑ NA
Design
Current
Design Current
3 URI
apacity Pop.
Wet Poultry
Capacity
Pop.
Cat#le Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
I
jNon-Layer
I
a" Calf
Feeder to Finish
_5_V 017
I I
I
Da" Heifer
Farrow to Wean
_ .-
V�
Design
Cit Trent
Cow
Farrow to Feeder
D , bP.oult , Ca aci P,o ,
Non -Da'
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
JBeef Brood Cow
k
Turkeys
Other
: ._ .
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 10No ❑NA 0 N
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: jP7 - j97 LQ IDate of Inspection:
❑ Yes
CE No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
2 No
❑ NA
❑ NE
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
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in): ,L
Observed Freeboard (in): -7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FLNo
❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes[]
No
[] NA
❑ NE
S. 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
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes a�_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): 'L_0')n'U4 / r 42 S: `z
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F2§ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [ayes��o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes B No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CE No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Eallo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5? -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: �qj'—
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 EE�No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes � No ❑ NA [—]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
]g No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ Yes
E!�No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
['No
[:INA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
� No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C�]_No
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E!�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
[R.No
(DNA
❑ NE
to
cations: (use'ac
77>
Ty isms
Reviewer/Inspector Name: �` r�G y� Phone:3�33
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/2015

7©
Type of Visit: Q'Compli nce Inspection V Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: F?,__M_Z�7_1 Departure Time: County: Region: h
Farm Name: Jl G/D�1G� IGGr!`m S _�I�G. Owner Email:
Owner Name: S� rte. r.r�'r -:r-7n6. Phone:
Mailing Address:
Physical Address:
Facility Contact: Gd "r7 e Title: 7x -r- Phone:
Onsite Representative: _''*-r� Integrator: /%Iu•r1�� �r���
Certified Operator: .�-�_ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Correct
❑ NA
Design
Current
Design Carrent
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to FeederNon-Laer
Da Calf
ceder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oultr
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify MR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ©.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
[] NA
❑ NE
❑ Yes [:]No
[:]Yes [aNo
❑ Yes Z_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 1/412014 Continued

Facili Number: - �'D Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Callo
❑ NA
❑ NE
waste management or closure plan?
[:]Yes
allo
DNA
❑ 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
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�C] No
❑ NA
ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RINo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 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): �rrfltcj':11_!
13. Soil Type(s): {`Tj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? -Yes 6 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
allo
DNA
❑ 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
O -No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F;ejNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Nan -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 Ia No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3,No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
� No
permit? (i.c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E, No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑NA C] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA E] NE
❑ NA ONE
❑ NA ❑ NE
Comments -(refer to question #). Explain -any YES answers and/or any additional recommendations or,any otltier r11
�MjUse drawings of facility to better explain:situations (use additional pages as necessary)._ ; Gt
Reviewer/Inspector Name: �r �/� _ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

Type of Visit: ACKompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: UE2F22 Arrival Time: : 3 C7 Departure Time: j c7 County: Region:^
Farm Name: S`L,f--g�2 �aepm 'X7n e . Owner Email:
Owner Name: �j �Y�.-t ��rirt. -:7-- '1 G< Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �/t /-` Phone:
Onsite Representative: j'�...rt� _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: /<)- £e
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M—No ❑ NA ❑ NE
❑ Yes [] No
[:]Yes [] No
❑ Yes
"ty " � t
n ..Currenreeder
Ilan =a::I
F Design
oil
Current
DesiIN
QNo
jjj�jyuesig
t} Po p.
* Wit Poultry . .Capacity
Pop.
Cattle Capacity
Pop.
ish
Layer
Dai Cow
der
Non -La -Layer
Dai Calf
nish
�©
`'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to FeederD
. _P.oul Ca aci
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M—No ❑ NA ❑ NE
❑ Yes [] No
[:]Yes [] No
❑ Yes
[-]No
❑ Yes
ELNo
❑ Yes
QNo
❑NA ❑NE
❑NA ❑NE
[:INA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facili Number: c97 O Date of Inspection:
— 1
❑ NA
D. NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[5U No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
© No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r No
❑ NA
❑ NE
(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
U� 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
[ELNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 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 MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑Total Phosphorus ❑ Failure to Incorporate Manure//Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):i--y.l� Bvris }-,-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ES No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
2 No
❑ NA
D. NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
[5U No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes (a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes M No
[:]Yes Z�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 1/412011 Continued

` Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ' No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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 CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes KI No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
[:]Yes U, No
❑ Yes nNo
❑ Yes F&No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers and/or any additional recommendations or any ottercomments "
Use drn s offacW to better explain situations use additional pages as necessary).
iiwi`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9Dndf3-T -'3 DB
Date:
2/4/2011

� i'vision of Water Quality
Facility Number - 7 a Division of Soil andWater Conservation
Q Other Agency
type of Visit: &ompliancc inspection n Operation Review Q Structure Evaluation O Technical Assistance
Zeason for Visit: �utine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: rl ; Departure Time: County
Farm Name: 5���—�y�� .�1 nG . Owner Email: �—
Owner Name: S A G ,G►^rYi h G . Phone:
Mailing Address:
Physical Address:
Region: r7A
Facility Contact: �r rX _�'GI`&vcG .� Title: ®-CU Al Y✓ Phone:
Onsite Representative: Integrator: 4%4,e'Wro-wk­
Certified Operator: Certification Number: j
Back-up Operator: Certification Number:
Location of Farm:
e
Latitude:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry -
,Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon:LaXer
I
Dairy Calf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
-Design
Current
Dry Cow
Farrow to Feeder
D , P,o.ul:Ca
aci
Pop
Nan -Da'
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
�.
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes F�q_No ❑ NA ❑ NE
❑ Yes [] No [:],NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Ga
❑ NA
❑ NE
[:]Yes
RNo
❑ NA
El NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - O Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo
❑ 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
Q5,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
M 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
Ig No
[DNA
❑ 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
Cig-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (�o ❑ NA [—]NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): vo� to- 10 v rr,3 z:t—j
13. Soil Type(s): h1 U-711:vLK
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ft' No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes LIN, ❑ NA ❑ NE
[—]Yes [&No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes G�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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jo No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: �/4{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes C&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes +MNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Wo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q 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 F No ❑ NA C3 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Mc No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 2] No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZLNo ❑ 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 Wo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers,and/or any additional recommendations or any other comments -r
Use drawiitgs of facility to better explain situations (use:additiunal pages as necessary). Y, ti
cz��� tr' 7;"
Reviewer/Inspector Name: S�tr ��y/�--- Phone: 971!::0 330z
- - _
Reviewer/Inspector Signature:
Page 3 of 3
Date: & v2 Hca / q
2/412011

Type of Visit: ompliance Inspection 6 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: e* Region:
Farm Name: C,.-- "M fine-,
Owner Name:HnG_e _ /r�z t fA- --=7Z7C.
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: z Title: ,r/hy/ Phone:
Onsite Representative: Ste•- Integrator:
Certified Operator: J�--�— Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swore
Ca aci Po
p ty
Wet Poul
Ca acs Po p
Cattle Capacity Pap.
gip'
r.::..
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
[�?
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dr, n, U - It ,
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
TU1 &Vy s
Other
Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
[:]Yes []No
[-]Yes [] No
[-]Yes [] No
❑ Yes [3 No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
E] NA ONE
Page I of 3 2/4/2011 Continued

Facility Number: - 01 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
0 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
[allo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 -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�J_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F;dNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
n Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop//Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): V/F—n
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 [4No ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r No ❑ NA E] 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 Lnk ❑ NA ❑ NE
❑ Yes [2�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
[]WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [B -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [R No
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

[Facility Number: rZ - a Ds ection:
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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes M No ❑ NA ❑ NE
and report mortality rates that were higher than normal? WWI
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes RNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes CEI -No ❑ NA ❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
Eq No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[E No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
PSio
[DNA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations onany other comments � r
Use drawings of facility to better explain situations (use addithonal pages as necessary
Ce be�x� WDKI--- 30" L-_`k5,jzc)j
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
s/z��•�,� L� Z—__— Phone: 9/O
/ /
Date:
2/412011

Date of Visit: Arrival Time: 1 9". 00 Departure Time: County: Region:,c�V
Farm Name: Facei6 1;7,ae: . Owner Email:
Owner Name: __rz--7Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: jfiff_-)e�{j,,I Phone:
Onsite Representative: J.-—�—� Integrator: .Ger
Certified Operator: cs'a�-��- Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any pan of the operation?
Design Current
'Pop.
KNo
Design
Curren# .
Design Current
Swine
Capacity '
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
❑ NA
La er
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
Dairy Cow
can to Feeder
i
Non -Layer
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
DryP,oultr.
Layers
Non -Layers
Pullets
Turke s
Design
Ca .acl
Current
PcoP.
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Caw
Farrow to Wean
No
Farrow to Feeder
:-_'
Farrow to Finish
❑ Yes
Gilts
❑ NA
Boars
of the State other than from a discharge?
Other
s
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any pan 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ 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
JZ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - {7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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): I
Observed Freeboard (in): Ufa
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2g, 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 O 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? 01Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes n 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 [NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [allo ❑ 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 M 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): z~ed
13. Soil Type(s): N DLEQUS _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PK'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LM No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZI No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�TNo
❑ 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 p 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 EqNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

�Facitily Number: 6� - a7[> Date of Inspection: 7--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? 1f yes, check ❑ Yes ® No ❑ NA ❑ NE
• the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? []Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2 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
El No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Pg No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CR -No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
MAo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Use drawings of facility io_better explain situations (use additional pAges;as.�ecessary). y _
comments: (refer to question #)- Explain any YES answers and/or4any additional recommendations or an other conifil s.
lJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pbone: -�
Date: Zz: 2, 2
2/4/22011

Type of Visit JD<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit efljoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Arrival Time: : Od Departure Time: �� t7a County: Jor Region: 69JE2
Farm Name: !�C=LDWr'P_ Y4�a--"W i -fin G . Owner Email:
Owner Name: v n_/—ane = re! ✓m S ire Phone:
Maiting Address:
Physical Address: II
Facility Contact: 44re= SC_ ry9.1 e- ef _ Title: I@IUJ''w ✓_ Phone No:
Onsite Representative: _T Integrator: k
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� e [� ' [� Longitude: = e a
Curren#
�_Capmty
Design Current
Design •urrenSwinePopulation
❑ NA
Wet Poultr3 Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
airy Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish O
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑Beef Feeder
FE] Boars
El Pullets
❑ Beef Brood Cowl
2. Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
J& No
Other .._:
❑Turke Poults
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Other
El other
Number of Structures:
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
Q 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
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J& No
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: —a7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZI 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): , 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
([No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate.public health or environmental
threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,KNo
[INA
❑ 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
9LNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fKNo
❑ NA
❑ NE
. maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
J&.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [__1PAN > l0% or ] 0 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) �p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R 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
RNo
❑ NA
❑ NE
Comments (refer to question,##): Explain any YES answers and/or any recommendations or any other comments
Usedrawn =of facility to better explain situations. (u..: se atdtttonalges as necessary)..
C0Pt)1c rjW__ "r k;� D30_
Reviewer/Inspector Name r� Phone: 220 y3J
Reviewer/Inspector Signature: Date: /rZ—
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection—(�—�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �3 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 El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q 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 ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes R No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[a No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
fR No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[&-No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RLNo
❑ 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
U 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
ID No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
1228/04

Type of Visit
pliance Inspection pection
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: f%iArrival Time: �d Departure Time: a a County' Region: M
Farm Name: -5[�--"f��!' e- eA "-P L-4 G Owner Email:
Owner Name' S GYD� G erns -=�7r , _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �-Qrt' y SG/;DrrCe, Title' 9UJ1^,Y V _ Phone No:
Onsite Representative: c+ LSo+->�_ __ integrator: MV i -
Certified Operator: 5�++.'-^' Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E::]' 0' [�" Longitude: F]° 0' [::] W
Design Current
11
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capes Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Yes
❑ No
❑ Dairy Cow
❑ Wean to Feeder11[j
Non -Layer
MNo
❑ NA
❑ Dairy Calf
Feeder to Finish QQ
V„NO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
Brood Co
❑❑Beef
Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & 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?
❑ YesNo [INA ElNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
V„NO
❑ NA
❑ NE
12128104 Continued

Facility Number: — D Date of Inspection �g
'Ot-Mr ad & Sur vrr du e ay
• Waste Collection & Treatment
iJo� i; � Ftrr- y„ SPr �-�-. d rY r� � � � e�,f.P� t-� ► e c-�c Si ud� 9
� �- o+�o�.�+
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(3No
❑ 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): _ 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D.No
[INA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which arc not properly addressed and/or managed
❑ Yes
EffNo
❑ 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
L6No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CK No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[$ No
❑ NA
❑ NE
maintenanceli mprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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)� ��llYr.1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C4No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CEkNo ❑ 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 C,No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
omments (ref
C er to question #). Explain any YES answers and/or any recommendattous or any other continents
Use'drawings•oifacility to better explain "situations: (use additional pages as necessary):
-
'Ot-Mr ad & Sur vrr du e ay
iJo� i; � Ftrr- y„ SPr �-�-. d rY r� � � � e�,f.P� t-� ► e c-�c Si ud� 9
� �- o+�o�.�+
Reviewer/Inspector Name y Phone:
97D c
Reviewer/]nspector Signature: Date:
12/28/04 Continued

Facility Number: — Date of Inspection
• Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes CkNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [tNo ❑ 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 C -No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
;9LNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ 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
J@ 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
EgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[21 No
❑ NA
❑ NE
12128104

Type of Visit QeZim_ pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: n� Arrival Time: ' Departure Time: O' C D County: Region:
Farm Name: J 1�`�ns _ Ff')t 61n, c • Owner Email:
Owner Name: G. Phone:
Mailing Address:
Physical Address:
Facility Contact: �e 4 < Title: eta#— Phone No:
Onsite Representative: Integrator:
Certified Operator: ✓`✓-� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� 0 0 i [n Longitude: [� o = 6 =66
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ can to Feeder
n -La er
❑ Dairy Calf
Feeder to Finish a
❑ Yes
Dairy Heifer
❑ Farrow to Wean
Dry POaItry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
LaEl
El
Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Ca
=
❑ Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
JR 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
KNo
❑ NA
❑ N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/78/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes ERNo ❑ NA [:INE
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):
4
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 J@ 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
5 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
EfYes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�X No
❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[@ No
El NA [:1NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
ffNo—
❑ 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
RNo
❑ NA ❑ NE
Reviewer/Inspector Name/ Phone: r �d
Reviewer/Inspector Signature: Date:3�V- o
l MSG Lr VJ ✓ .-, __ a. v��ar�slsa.ls

Facility Number: — 9 7 Date of Inspection
• Required Records & Documents
19. Did the facility fail to have 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 KNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 N No ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No ❑ NA EINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tZ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[&No
[--INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE .
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
AdditionalGamments atidJor, Drawutgs y m
a YA
Page 3 of 3 1228/04
Page 3 of 3 1228/04

O Division of Water Quality S/ 7
Facility Number �— 0 Division of Soil and Water Conservation 49 k�- 0
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Dunne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 Departure Time: , County '~' Region: t_
Farm Name: _S7r-1-QktC-'g -6a t!Ai ' �- a + Owner Email: J
Owner Name: ��'^c 'r- pa c e- ---- Fae S_ 7w e-..-- Phone:
Mailing Address:
Physical Address: // �r
Facility Contact: h J C1` C" Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: s��-�-�' Operator Certificatiumber:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' =' 0 Longitude: = ° =' = w
Swine
Wean to Feeder
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
-Capacity Population Wet Poultry ";Capacity Population
❑ La xc EF -
U
❑ Non -La er
„-- - - -
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
] Dairy Cow _
]
Dairy Calf
]
Dairy Heifer
] Dry Cow
U Beef Stockei
❑ No
❑ Beef Feeder
❑ NE
❑ Beef Brood Co
❑ No
❑ NA
❑ NE
Number of Structures:'
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5Z No
❑ NA
❑ NE
❑ Yes
W. No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 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
JR No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
gNo
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
&No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EgNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
KNo
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
gNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes
]KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
CKNo
❑ 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) . `15r­I/1�1�I�n� Cf lI
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ayes
❑ No
❑ NA
EINE
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
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
57 e-�
rl
Reviewer/Inspector Name Phone: D——JTYdO
Reviewer[lnspector Signature: Date: 12 — J � —I_;Z00']
12/28/04 Continued

Facility Number: — Date of Inspection —
❑ Yes
jo No
❑ NA
Required Records & Documents
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
F2o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check
❑ Yes
Z No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA ❑ NE
K 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
allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PL No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jo No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
oNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
9No
❑ 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
U -No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04
12/28/04

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Gi outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:�j '� D - Arrival Time: I Asoo�# 00 1 Departure Time: ; Q D County' Region:
Farm Name: G r 0n C-4 Fay,,?" s_ :Z4 e . - Owner Email:
Owner Name: Lar/i SG fpijG,= Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Ga/r4 Title: Phone No:
Onsite Representative: –:5 ar� Integrator:
Certified Operator: . fid*^"� Operator Certification Number:
Back-up Operator:
Location of Farm -
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Back -up Certification Number:
Latitude: = o [=, [� Longitude: = o = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
�} ❑ Non -Layer t
Other
❑ Other '
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current:
Capacity ,Population:
❑ Dai C '
ow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
0 N
❑Yes
❑No
❑NA
0 N
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued
J

• Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B 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
CK No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
14. Do the receiving crops differ from those designated in the CAWMP?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
9 No
❑ NA ❑ NE
through a waste management or closure plan?
15. Does the receiving crop and/or land application site need improvement?
LKYes
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
14 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[4 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
ANo
❑ NA ❑ NE
maintenance or improvement?
❑ Yes
.® No
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
JgNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Dd Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 19PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
R Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s) Alor(p � N
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?
LKYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`[]
Yes
Do No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.® No
❑ NA
❑ NE
13 r --A17
b'y
15 ha, g'"--iv'�` b�31��+vy �� Gt���1`r��v//L ufE�-rd�st� �� �� ��T��►s�
14-t- 1 I . A r n y
Reviewer/ins ector Name' { ` ` k �Y Phone:
p v y�liS�
Reviewer/Inspector Signature: Date: —la- DO (n
12/28/04 Continued

• Facility Number: a 22ZQI Date of inspection —L61
—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists - ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
®`aste 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
54 No
❑ 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
Dq No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
93 No
Cl 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
M No
El NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Rio
❑ NA
❑ NE
A'd'rltttoual Commen#s.'andlor Draw�ugs _ -w�,y
12/20/04

•- 4 w
Jim;-
� � - �.._y'e•„��.. �----r„n .s z �� --tet l}�r �s_'�.... �.s—•-�_ _3'c" _� sr .ir yam?-'r+r i^'^'...��° c ,zea -ice. � -- r,.e- � �1�,� �..r
ae�:.: '-.� '-�.:� 1✓^.�. -i.: �-s�... .tet_ ,.,...s�� V.
Type of Visit O Compliance Inspection Q Operation Review l) Lagoon Evaluation
Reason for Visit O Routine 0 Complaint t) Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facilitx Number Date of Visit: — .70.07v Timc:
—.10 Not Operational 0 Below Threshold
13 Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
I_
Farm Name: _ 1 �or P �r�'►f _ S'� C - County: �KreQlOq�
Owner -Name: rr -J[roj//L� Q' Phone tiof— 1IO slr� — 4a010
'Mailing Address: 1301 F—dnOnQ %�etM1f AV, _ t H / ., N.C- 2,iLd
Facility Contact: nn f j Title: Phone No:
Onsite Representative: _ l L; t- I leQ ►IFS/ Integrator: �rL_ _'Aroop?
Certified Operator: LArr - rr017re- Operator Certification Dumber:
Location of Farm:
Q0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �' �• l�,J
Design Current
Swine C2n2city Panulation
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to, X jean
❑ Fatrov.- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps E== 10 No Lis uid Waste Management System
Discharees & Stream Impacts
1- Is anv discharge observed from any pan of the operation?
Discharge originated at: ❑ 11 ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes 99No
Structure 6
Identifier:
Freeboard (inches):
0
05/03/01 Continued
Design Current Design Current
Poultry
Capacity Population Cattle Ca acitti- Population
❑ Laver
I
I❑Dairy
❑ Non -Laver
I
I[] Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps E== 10 No Lis uid Waste Management System
Discharees & Stream Impacts
1- Is anv discharge observed from any pan of the operation?
Discharge originated at: ❑ 11 ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes 99No
Structure 6
Identifier:
Freeboard (inches):
0
05/03/01 Continued

Facility Number: ?d —a 70 Date of Inspection
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes 21 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? - ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type ta/ zfP1/7a014 P Q�
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ®No
c) This facility is pended for a wettable acre determination? ❑ Yes J@ No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
®No
Reuuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
(M No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
(2 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments=(refer
to, quesboit #) ?E'xplam anysY,ES answers andlor'eany recommendations or any'other comments;,
U� riwmgs of faeiltty two better explain sttuagonsc (use.addihonal pages.as?necessary):
h, . . , ._ a . r - 1_ .. ❑Field Copv ❑Final Notes
05/03/01 . Continued

Site Requires Immediate Attention: 140
Facility No. 92 - z'70
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 - z? , 1995
Time: 13: z.tt
Farm Name/Owner: _ �-AQ
Mailing Address: X4. 14(. A G ! Al i- z n z-%
County: S0401gsoj
Integrator:Phone: d?/a - 5 3 L
On Site Representative: Phone:
Physical Address/Location: f /' x _
S 6bSkr�10
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: -2,Y S a Number of Animals on Site: - z- PSD
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoonha a sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No Actual Freeboard: S Ft. _6Inches
Was any seepage observed .from the lMor
n(s)? Yes or ©o Was any erosion observed? Yes or�
Is adequate land available for spray? No I the cover crop adequate? & or No
Crop(s) being utilized: I �-a-
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinI e or No
100 Feet from Wells? (�or o
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(E)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management r s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?Yes or No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

I
14
13:2 z
REGi-STRATIDN FORM FOR ANIMAL. FEEDLOT OPERATIONS S'S' e
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If r.ne animal waste management system for your feedint operation
is
designed 4o serve more than or
equal. to 100 head
of cattle -
75
hors,s, 250 swine, 1,000 sheep, or 30,000 ::girds thou
are serve,'
by
a liquid waste system, then this
form must he filled
o;.t and mailed
by December 31, 1993 pursuant to
15,E NCAC 2H. 022 7 V)
in order to
be
deemed permitted by DEM. Please
print clearly,
Farm Name:---- e-
/11
Mailing AddreSS - �-__-'�0
County: -- - -e hr,
Owner(s) Name. — = azold
manager(s? Name:
Len8ee ,tam
Fara Location (Be as speCific as Possible: road napes, direction,
mi 1ec:

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