820272_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental 06

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (a
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: p.' Departure Time: LLQ- County:Region:
17,
v1 !'f/p Owner Email:
Onsite Representative: r
Certified Operator:
Title:
Phone:
Integrator:
Phone:
f\t5 Q
Certification Number: ( OO Z2 >
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
(Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capaci Pop.
Dairy Cow
Wean to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Non -Layer
❑No )15 NA
❑ NE
Dairy Calf
❑ Yes
Feeder to Finish
p
" `
❑ Yes
No ❑ NA
Dairy Heifer
Farrow to Wean
Design
Current
Pry Cow
Farrow to Feeder
D . Poul
Ga aci
P,o ,
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
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes %No ❑ NA ❑ NE
❑ Yes ❑ No 0 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)?
I
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑No )15 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2141'2015 Continued

FacW Number: - 2 Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo DNA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �J _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑Yes No ❑NA E:] NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes t7" No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives 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 [�j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptWindow ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): QZW 17 6�16114a' )r �C
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
'j No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
® No ❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R, 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
`24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E]YesFNo
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesNo E]NA E]NE
and report mortality rates that were higher than normal? 1P
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 10 No
❑ Yes 1P No
❑ Yes F, No
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
In No
❑ NA
❑ NE
Phone: 0.(0 M_ � �Vo
Date: (�' I Z-, I iv
21412015

0 M10 I?ivision of Water Resonrces
Facility Nutuber - 1�' O' Division of Soil and Water Conservation
_ -O Other Agency
Type of Visit: V Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 4D Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: D Arrival Time: 4 Departure Time: 'E?�1i2, County: S
Farm Name: [- ►� Owner Emall-
Owner Name: - pa bL
Mailing Address:
Physical Address:
Facility Contact: �a i+-. rs�-g� Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Region: T�
Integrator: 1- S
Certification Number:
Certification Number: d0 2:2
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No A ❑ 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 [ffNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: V 2 - 2 2 Date of inspection: 'Z .a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes qTNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes D NoNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structr16
Identifier: r2l^
Spillway?:
Designed Freeboard (in):
-may-.- d�- 3 2`�
Observed Freeboard (in): � .3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �'No [:]NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes TPNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
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 P 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 C_ro� fW�indow ❑ Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): Gc"'f'yxt Grr '- i t ALtA, –
13. Soil Type(s): Watc,ra ' —0ab !+
14. Do the receiving crops rffer from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ YesNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis E] Waste Tra sfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [–]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Cantinued

F iciflty Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo ❑ NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E3 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? ❑ YesrNo
o [:]NA [:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [DNA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes (�ONo
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ YesNo
❑ NA
[:]NE
❑ Yes
CNo
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations;#or any other com:megts.
Use drawings of facility to. better explain situations. (use additional pages as necessary), s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q*1"
3
Date: 277
214/2011

Dfvis"ion of Water Resources
Facility Number L� - I� Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:County: jam' Region:
Farm Name: U01/_
Owner Name:
Mailing Address:
Physical Address:
V\
Owner Email:
Phone:
Facility Contact: "�' z5 lV r Title: Pho
r
Onsite Representative: 4 la
Inte rator: _<Z4
(� �
Certified Operator: Certification Number: 1r]7 15'
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet P©uttry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
airy Cow
E?'No
Wean to Feeder
Non -La er
I I
P No
❑ NA
ai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , 11'oult ,
Design
Ca aci
Current
P,o
airy Heifer
Dry Cow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
F Other
xPKti.-?I;.w �.wi1d:11MAawRiaSa.'•.. ..�Jk`:'�-:.,,. .:.W' - Aut,.x�nP-,^'^.. '. ,•'••�.� ,7'ui�N.NYEwtiirmr'.ra.-
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 ONo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes
❑No
NA
❑ NE
❑ Yes
E?'No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili N mber: W2 - 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 TTTT❑""'` No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r 3^
Spillway?: 1
Designed Freeboard (in): _
-- 3
Observed Freeboard {in}: 3 1 —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [: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 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): R S "'t
13. Soil Type(s): jr
14. Do the receiving craps iffier from those designated in the CAWMP?
❑ Yes
YaNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesNo
❑ 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?
❑ YesNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements [❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. C] Yes �No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: jDate of Inspection:CtOL/Gt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EPNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. 0
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ YesNo
E]NA
E]NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. 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 0 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?
❑ YesNo
E]NA
E]NE
34. Does the facility require a follow-up visit by the same agency?
E]Yes 9No
❑ NA
❑ NE
omments" (refer to question, in any YES answers and/or.. any;additional recommendations or an other -comments.'
Use"drawings of facility to better explain situations (use additi0-61Dages as necessary): ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: f /d—(.Ai�3—J100
Date:��
2/4/1015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r� Coun Region:EL
Farm Name: ti d Owner Email:
Owner Name: rAt! Phone:
Mailing Address:
Physical Address:
Facility Contact:
c.r r U r Title:
�s
Onsite Representative:
Certified Operator: ��& D, -
Phone:
Integrator: -gyp
Certification Number: 1:z 2,c
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
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)?
O Yes n No ❑ NA ❑ NE
[:]Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
Design Current
JIM
Design
Current
Design Current
Swine
Ca!71pacity Peg.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dai Calf
eeder to Finish
I D R7bz
_
Dairy Heifer
Farrow to Wean
Des
u en
l3a Cow
Farrow to Feeder
D , PoaI
Ca aci
Po .
Non -Dairy
Farrow to Finish
Layers
113cef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
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)?
O Yes n No ❑ NA ❑ NE
[:]Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

r Facili Number: jDate of Inspection: ���
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No � NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T Z� !-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):— Z c ! I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo [:]NA [–]NE
(i.e., large trees, severe erosion, seepage, etc.) ?�a
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes []�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ vidence of Wi rift ❑ Application Outside of Approved Area
12. Cro T e s :
13. Soil Type(s): LL2C�u
`/
Required Records & Documents
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
❑ YesNo
E]NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
10 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
P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
No
❑ NA ❑ NE
Page 2 of 3
2/4/2014 Continued

IFacilitay Number: Date of Inspection: rjt7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to questim! #) Explain any YES answers and/or any addrteonal recarnrtiendahons bir any other c encs. 4r
Use drawings of facility to better explain situations (use additional pages as necessary.).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n7lp 3 330'D
Date:
2/4/2014

i ype of v uit: Q uompuance inspeenon v uperanon xeview lJ structure Evaivanon l.1 i ecnntcal Assistance
Reason for Visit: 46 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:('� j/ /fy J Arrival Time: 0/_1 Departure Time: '0 County:
Farm Name: (f� rlXZ4ttl-�Owner Email:
Owner Name: �a.,/[ r• U Phone:
Mailing Address:
Physical Address:
Regiodt '—`,
Facility Contact: Title: Phone:
Onsite Representative: CC- Integrator: f e
Certified Operator: Ozt, �4v Certification Number: 17?
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
gff&D Current
❑ No
Design`-
Current
Design Current
❑ No
Swine = Ga aci Po
P h' p
Wet�PouMy
Ca aci
P h
RW
Po p•
Cattlea aci Po .
P tJ' P
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
Feeder to Finish DD
" `
Dai Heifer
Farrow to Wean
Design -
-Current
Dry Cow
Farrow to Feeder
Dr„1?owl
Ca aci AP,o
,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars Pullets
Beef Brood Cow
=
Turkeys
"ther
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b- Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F No ❑ NA ❑ NE
❑ Yes
❑ No
[k] NA
❑ NE
❑ Yes
❑ No
ffj NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [RNA ❑ 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 E� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - ?/ Date of Ins ection: i
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 2 Structure 3 Structur 4 Structure 5 Structure 6
Struc e 1
Identifier: r�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes y No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ff (❑ Eviiden of W' d Drift Application Outside of Approved Area
12. Crop Types}: - �w--ala 0-- s" M. r �r`���.
U. Soil Type(s): J
14. Do the receiving crops defer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑WI.IP ❑Checklists ED Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo
❑ Waste Application ❑ Weekly Freeboard E]Waste Analysis ❑ Soil Analysis ❑ Waste TrTfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
Page 2 of 3 T
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
214/2011 Continued

lFatility Number: IDate of Inspection: 7 L / "f
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? ❑ Yes [P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes [V No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes .,& No ❑ NA ❑ NE
Comments refer to question . Explain an YES answers and/or an additional recommendations or an other comatents.
( q p Y y y
Use drawings of facility to better explain situations (use additional pages. as necessary)
❑NA F] NE
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes Kj No ❑ NA ❑ NE
❑ Yes 'g No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /
2/4/2011

I �Ij R10 'AtA41 0-. eons k"
I
Type of Visit:/"'C mpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: eparture Time: County: Region &Y-L&
Farm Name: C t���+ 6 — l.v Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: � a A
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: / ??5
Certification Number:
i
Longitude:
M
Discharges and Stream ImpactsDEnI[)yVR
1. Is any discharge observed from any part of the operation?
E]Yes/1No
[—]NA
E]NE
De§�gn Current
Design CurrenWet
114 1-
P27
oultry.
Cpacrty Pop.
attleCapPop
❑ NE
b. Did the discharge reach waters of the StateFAVZM ��y� �!4(
E] Yes ❑ No
F] NA
F] NE
toFinish
Layer
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes❑
Dairy Cow
Wean to Feeder
2. Is there evidence of a past discharge from any part of the operation?
Non -La er
I
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Calf
Feeder to Finish
❑ NE
-
t
Dairy Heifer
Farrow to Wean
Design Curredt
Cow
Farrow to Feeder
D . P,odlt . _
Ca aci _lPo
_Dry
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
y ,,; �,
Turkey Poults
Other
Other
M
Discharges and Stream ImpactsDEnI[)yVR
1. Is any discharge observed from any part of the operation?
E]Yes/1No
[—]NA
E]NE
Discharge originated at: [3Structure E]Application F e%v er:
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the StateFAVZM ��y� �!4(
E] Yes ❑ No
F] NA
F] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes❑
[DNA
E] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[jYes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/.2011 Continued

'acili Number: Date of Inspection; 491
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;l'fo ❑ 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: Q�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes YJONo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 46 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 IVo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ZO
9. Does any part of the waste management system other than the waste structures require ❑ Yes o F-1NA ❑ NE
maintenance or improvement?
Waste Analieation �%1
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 �Nci ❑ 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): 9 g r a 3 2r/V_,c,,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 E] Design ❑ Maps [:]Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;No
❑ Yes o
❑ Yes
❑ YesON�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other.
❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste ansfers ❑ Weather Code
❑ Rainfall ' ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
N
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

facility Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N E] NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o [:]NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 7No
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
Q13r) 13 C81-1 41 c8V- %%3A 183
1193 cBqipso.
1I-)& 7-4-13 t-81 1,q►o 013- 1.7y aw
1'090 ifroo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
)?fNo
❑ 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
o
❑ NA
E] NE
If yes, contact a regional Air Quality representative immediately.
iii���
34. 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.
❑ YesNo
K
❑ NA
❑ NE
[3Application Field ❑ Lagoon/Storage Pond F1Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U6 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ YesNo
9No
E]NA
E]NE
34. Does the facility require a follow-up visit by the same agency?
C]Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anyaotherrcontme f6,
Use drawings of facility to better explain situations (use additional pages as necessary). V
Q13r) 13 C81-1 41 c8V- %%3A 183
1193 cBqipso.
1I-)& 7-4-13 t-81 1,q►o 013- 1.7y aw
1'090 ifroo
6 2'btq-'9' 13 O Bc Itg7 0- BA 1i9S W
9 le cry 341
v + 0
a� a •�
o— YO
P=S��j
q
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone:
Date: .3
2/4/2011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: D$ J County: N
Farm Name: C. 13, 1-41 _ Owner Email:
Owner Name: C&A -6,1?, -_-Bz24Oq- Phone:
Mailing Address:
Physical Address:
Facility Contact: pu. Title:
Onsite Representative:
Certified Operator: GWo, (-
Back-up Operator:
Region: F190
Phone:
Integrator: `I "4r'L 'r—
Certification Number: I I rt
Certification Number:
Location of Farm: Latitude: Longitude:
l
DiaesignC nt
Ca No
Des gn Gurren Design Current
TPop
❑ NE
Swute
Cap typo.
Wet Poultry
Capacity
Cat#le Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
� NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
Wean to Finish
P NA
La er
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
I jNon-Layer I I
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
a' Calf
Feeder to Finish
Design Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
No
D . P,auit .
..a aci Pop
Non -Dairy
[:]Yes
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ca No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
� NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
❑ No
P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/412011 Continued

l4acili Number: - Date of Inspection: 7 1 Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9i No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:] No C4NA ❑ NE
Structure I Structure 2 Structure 3 Struc—�- e 4 Structure 5 Structure 6
Identifier: 1 2-
Spillway9:
Designed Freeboard (in): _
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes rWNo ❑ NA ❑ NE
IT -
6. Are there structures on-site which are not properly addressed and/or managed through a []Yes MNo [:]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 environmntal 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? ❑ YesNo [:]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 CNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo ❑ NA ❑ NE
[DExcessive Ponding E]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 �Crro`pp Window ❑ Evidence of Wind Drift c❑ Application Outside of Approved Area
12. Crop Type(s): `CX-ISiR[ �1 lktj 45 �i �" vim' r'4� `-)K ;�
13. Soil Type(s): W(,t0 it
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesNo
E]NA
E]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
Dg No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P 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
ED Yes
T® No
E] NA
❑ NE
the appropriate box.
Td
❑WUP ❑Checklists [-]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking [:]Crop Yield 0120 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? E:] Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

racili ° Number: Date of Inspection:
2.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
& No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[%No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C8 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
[F 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
P 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
P No
❑ NA
❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
F-2, No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
mendahans" '
»r an additional recommend an} o#tiercomments.
# answers and/o
Comments refer to question Explain an YES
lase drawings of facility to beater explain situations (use,ad�dttonalpages:'as nece§sar}}
ReviewerMrispector Name: b
Phone: + ro���33' 3
Reviewer/inspector Signature:
Date:
Page 3 of 3
2/4/2011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 541yupslyj Region:
Farm Name: �� r'ts Owner Email:
Owner Name: t � r �+4o,J Phone:
Mailing Address:
Physical Address:
Facility Contact: Ali e 110fyj Title: Phone:
Onsite Representative: �i lj �,, Integrator:
Certified Operator: Car- �n 'TB�J� Certification Number: 77 I Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Design , .Current
1P No
Design
Current
Design Current
S►vine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Qg NA
Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Dai Cow
Wean to Feeder
K
Non -La er
Dai Calf
Feeder to Finish
// (l
❑ Yes
❑ No
kl
Dai Heifer
Farrow to Wean
❑ Yes
YqMNo
Designfi
Current
D Cow
1=arrow to Feeder
No
DrvBPEoultr,
Ca aci
Po
Non -Dai
Farrow to Finish
3` ::
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
MI
jBeef Brood Cow
Turke s
Qther
�:Y»�
Turkey Poults
L_LOther
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
1P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Qg NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ERNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
YqMNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] NoNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 StructGre 6
Identifier: 2 `t
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): yr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ 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 E] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M No [:]NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes rul Lir
No ❑ NA [:]NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f� No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
Wo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):t'Vt Q
13. Soil Type(s):
14. Do the receiving crops t Ter from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TraTsfers
[] Rainfall ❑Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
p Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Faoility Ntttnber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes lNo ❑ NA ❑ NE
[:]Yes (P No
[:]Yes No
[:]Yes " No
❑NA []NE
❑ NA ❑ NE
❑NA 0 N
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Q No ❑ NA ONE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA 0 NE
Comments refer to ttestton # . Ex lain an YES artswers:and/orian adduttonal recommendationsFor'an �otlierYcomments.
Use drawings oftitetlity to better.explain situations:tase:addrtto€aal iiages "s.necessaro ; _
Reviewerl[nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: *_�a_lZ7
Date: 9 4
21412011

Division of Water Quality
+Facility Number `a� 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0Oth�er ❑ Denied Access
Date of Visit: Arrival Time: 12VSDO Departure Time: d - County: ",' ` Region:
Farm Name: UV OSTw+ S ' l�b Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
a
Facility Contact: L -q t Q 1^ t Title: Phone No:
Onsite Representative: { integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=]' [=] ' F__� u Longitude: E:] ° E�] ' ="
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ NA
❑ NE
❑ Wean to Finish ❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish tt S
❑ Yes
❑ Dai Heifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ No
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Stocker
❑ Gilts
E] Non-Lay?letsers
ElBeef Feeder
El
❑ Boars
El Pullets
ElBeef Brood Cow
-
❑Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Qther
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
❑ NE
M� I 111 14,_
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes .�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
EgNA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[0 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
F-1 No
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
qNo
❑ NA
❑ NE
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

1
Facility Number: — Date of Inspection 1 1�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ N6--& NA ❑ NE
Structure 1 Structure 2 Structure 3 Struc e 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
r� u t
Observed Freeboard (in): c.! 3 3 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �n No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes -tbNo ❑ 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 /C No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6No ❑ 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 Elj
Yes `b No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑Yes 10 No 0 N 0 N
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19No ❑ 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) �- ,,,s4o 1� V �a 6 g4t!,271s , _ isnA j -q
13. Soil type(s) yae17 kA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K)No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 91 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes J�j 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
M No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
Comments (refer4o question #): Explain any YES answers and/or any recommendations or any other comments. >
.Use drawings facility to better explain situations. (useAdditional pages, as'necessary): ,
ReviewerlInspector Name i Phone: Ib' 33 `3;CV
Reviewer/Inspector Signature: Date: I :X_J;'_D41V
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 I 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 El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dk3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes b No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes &M No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ALJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
19 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[--]Yes
99 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
29 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
h No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
OC No
❑ NA
❑ NE
Additional Comments and/or Drawin � s• "
Page 3 of 3 11128104
Page 3 of 3 11128104

Type of Visit G�-C6m plpliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit [_Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:Arrival Time: C7 Departure Time: / County: Region:
Farm Name: G U j3alefcat S,,,,L Owner Email:
Owner Name: flat ton S _ Phone:
Mailing Address:
Physical Address
Facility Contact: [ , aOr 1 ri Q✓ efi)& Title: Phone No:
Onsite Representative: /�I,/7W1 ZK,,.,CDtc_�l W%- rator: atE-O;3
Certified Operator: Operator Certification Number: 7 27 _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = =di Longitude: =0=1 = u
Design Current
Design Current
Design Current
Swine Capacity Papulation
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ Wean to Finish 1
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Dairy Caif
Feeder to Finish c> `Apa
❑ NA
❑ Dairy Heifer
Farrow to Wean
Elou
Dry Pltry
El D Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
1:1 Layers
❑ Beef Stocker
❑ Gilts
El Non-LayMetsers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Coid
2. is there evidence of a past discharge from any part of the operation?
❑ Turkeys
5&No
Other
❑ Other
❑ Turkey Poults
❑ Other
Humber of Structures:
❑ Yes
.
❑ NA
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: Cl 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
5&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
19[No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: , — Date of Inspection E2�9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes L�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
AL
Spillway?:
ReviewerAnspector Name
Designed Freeboard (in): �_ r g 19 _
i
Reviewer/Inspector Signature:
Observed Freeboard (in): — �-3 4, r) / _- 3z
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U&No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
0,No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T 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
[3 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
WjNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
[9 No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ANo
❑ NA EINE
❑ 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) c�>•//s'1 /i �� �!/r/�S�-r�
13. Soil type(s) J11a 5
- -- —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P.No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ZNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA ❑ NE
- . ti l D - -' "ir''' �=.3 ,17V -
Comments (refer to question #) ' Exp[ain:any YES-ansHers andlrrany�reramniendattons or anyother comments
;Ni
L
Use drawin s of facth to better'ex lain situations. use addittonai�pages as necessary)
g TY... p
::..
AL
ReviewerAnspector Name
k Phone: 3vO
i
Reviewer/Inspector Signature:
Date: —,PV0
- 1 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ERNo ❑ 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
EgNo
❑ 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
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[X No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
(R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[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
[8No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,RNo
❑ NA
❑ NE
AddrtiuualgC,o„mmertfs?"ancffo�Drawrng"s:
11/28/04
11/28/04

Type of visit Q'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:/�� Arrival Time: `j�[Departure Time: ��r�� County Region:
Farm Name: Gi [T'-��e0�1i+1 �(� Owner Email:
OwnerName: �iijr�8�+� _ _�� Phone:
Mailing Address:
Physical Address:
Facility Contact: C2:dlt"� ffale_IW Title: Phone No:
Onsite Representative: /2r/11-011- �Gi� DBt��� Integrator:
Certified Operator: C�fl��+^� ��I`G �7b Operator Certification Number: 177X)
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [�j o =' = " Longitude: 0 0 ='
= W
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Design Current
Design Current
Design Current
Swine
Capacfiy Pow °t
'Pe it
Capacity P p la[ion
Cattle Capacity Populatwon
❑ Wean to Finish
❑ Yes
❑ Layer
I
Dairy Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ Wean to Feeder
❑ Non -Layer
❑ NE
❑ Dairy Calf
Feeder to Finish
O
_ ..
❑ Dairy Heifer
❑ Farrow to Wean
❑ No
DPoult
❑ NE
❑ Dry Cow
❑ Farrow to Feeder"`'
29 -No
"�
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
[3No
❑ Layers
❑ NE
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
Continued
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
-
: ❑ Turkey Poults
❑Other
..,r
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
EX 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
29 -No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[3No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

L
Facility Number: — 7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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 RqNo [INA ❑NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes P -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 [3No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [9No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [9 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types}
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
[3 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
(SNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ESNo
❑ NA
❑ NE
Reviewer/Inspector Name p-►-- f Phone: q/D ao C;�
Reviewer/Inspector Signature: Date: c'
Page 2 of 3 12/28/04 Continued

Facility Number: Date of inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:)Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CK No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CKNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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 concem?
❑ Yes
JK 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
[KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Callo
❑ NA
Cl NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
q No
❑ NA
❑ NE
Addttiooal"Commen[s and/or`Drawtngs��
r
T
Page 3 of 3 12128104

rvision of Water Quality
Facility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: L- CJ Arrival Time: Departure Time: i� ��� County: Region:
Farm Name:tn� /�. L�•ci't�D�,,5_� l �o Owner Email:
Owner Name: _ / �d�� �yDf Phone:
Mailing Address:
Phvsical Address:
Facility Contact: j!fillZ_ 2tR/'1 ffare-ItO74- Title: Phone No:
Onsite Representative: -lam �i�: aYsr-�-.. Integrator:
Certified Operator: t�'n.�/ L �D"�-.n d�D>hf Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' =' = Longitude: E=10=' =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish JE1 Layer
❑ Wean to Feeder 10 Non -La e1
Feeder to FinishfcSbO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imuacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ' ` ' Current
Cattle Capacity Population
❑ Dairy Cow ,;„
❑ Dairy Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 14 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
El Yes
91No
El NA
El NE
12/28/04 Continued

Facility Number: — Date of Inspection
0 No
Waste Collection & Treatment
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes f9No ❑ 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: tv
❑ NE
Spillway?:
Designed Freeboard (in): X
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 M 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?
ER Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 19 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes J@ No ❑ NA ❑ NE
maintenance or improvement?
Waste ApAncation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes
,_No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 7__7l, -U Phone:
Reviewer/Inspector Signature: 41 Date:
12/28/04 Continued

Facility Number: 6-,;L— % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 -No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J3 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 allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
21 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
J@ No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

L
vision of Water Quali=Conservation
Facility Number'' Q Division of Soil and Wa
- -�_— Q Other Agency
Type of Visit t$ ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l3HZoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (o'7-flio Arrival Time: � Departure Time: .1 DV County: Region: -
Farm Name: 'Q9, 3 0'V e -j bod- rw-e'S % r I V Owner Email:
Owner Name: JS �EariLfm-'r Phone:
MailingAddress:
( 3 fl 1Koag0ft,P &eon -e IA. b G
Physical Address:
Facility Contact:L�ar-5-2'1t Title: Phone No:
Onsite Representative: �Si�..t. _ Integrator:
Certified Operator: Operator Certification Number: /279 -5 -
Back -up
779 -5 -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O
[=d
=is Longitude: =11=1 Q u
Swine
Design Current
Capacity Population
Wet Poultry
Design Current. Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish
14 No
❑ Layer
❑ Da' Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Da' Calf
® Feeder to Finish
0
[--]Yes
Y
❑ Da' Heifer
❑ Farrow to Wean
2Q No
Dry Poultry
'l '' ❑ D Cow
.,:
❑ Farrow to Feeder
KNo
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Cowl
Other
yu4i
❑ Other
�i
.}.�K
Number of Structures: ED
M
❑ Layers
Non -Layers ers
❑ Pullets.
❑ Turkeys
❑
Turkey Poults
❑ Other
[]Yes XNv ❑ NA EINE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DW
Q)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
[JNA
❑NE
[--]Yes
RNo
❑ Yes
2Q No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12/28/04 Continued

In
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _ / g /9 /2
Observed Freeboard (in): 3 q 173 a�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Rj No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes P4 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 29 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JA 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 JRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. I&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 Area
12. Crop type(s) ,�n, WL # 7 f DytrSY�a�[ j i
13. Soil type(s) A.)&5 Z L-13 1¢
;2,4L 7`7a h�cs� ��c�n t k,,, p u
D %ir5 Wa P�a-n, zli ar�Tl'k s -T6 &Lrt.n GL. -tom -prn &
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
174 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 ?
14 Yes
❑ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
29 No
❑ 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):
;2,4L 7`7a h�cs� ��c�n t k,,, p u
D %ir5 Wa P�a-n, zli ar�Tl'k s -T6 &Lrt.n GL. -tom -prn &
al
Reviewer/Inspector Name F_ S� (� P,` Y G T i n hone:
Reviewer/Inspector Signature: Date: (v-7 --o Eo
Page 2 of3 12128/04 Continued

Facility Number: 95L — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [X�No ❑ NA EINE
the appropirate box_ ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Pj No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �?No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B.No
❑ 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
[ &No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[_1 Yes
Co No
❑ NA
L] 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
ffiNo
❑ 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
4 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Addttli nal Gomnleats�anid/or Drawings
12128/04

f
Fact3 �tf N
_
Aumber
�
[INA
❑NE
Division of Water Quality. 4
Q Division of Soil and' Water Conservation y
O Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: y S•Sr Departure Time: County: Region:
Farm Name: C. nr_�_}nom �d�t£o -- j "' 14. _ _--- Owner Email:
Owner Name:i3^^n+C.�iro.4. - _ Phone: q 0 — S 3 �1 / STG
Mailing Address: !i330 a",ke- 4�_0Q•„ _Ncw+on1, ^rdWt "0—
Physical
C
Physical Address:
Facility Contact: M r . a av P_ Q,.m- - Title:
Onsite Representative:
��++ r C nr-I o r rGt•oe
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: W_
Operator Certification Number: 7 7 9r _
Back-up Certification Number:
Latitude: 0' ❑ ` = Longitude: 0 o =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non-Layet
® Feeder to Finish I/ S60 s'/`
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf'
❑ Dairy Hedej
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the dischar-e reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)`?
Number of Structures: F 4j
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge Isom 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
[INA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
®No
[__1 NA
El NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: $ oZ' 72 Date of Inspection
i (v — ) 3 �' a *. L
A a w..c. 1 CL %c--. i%.
i4-\ <—�o tv ,
Waste Collection & Treatment
`�•.�Qa-�w
�,bY.nLr
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:.= ,3 y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'V " A 3&P81qm IV
S. 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
K N o ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) /_SGr aP�
13. Soil type(s) W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
X No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
91 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�'i No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
7.) oa"-, ees
i (v — ) 3 �' a *. L
A a w..c. 1 CL %c--. i%.
i4-\ <—�o tv ,
(�►�&�4.+c
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PiGa.. r-
*0 prly��-r
P0i1i(n�G �1^C��C►" pQA,i�..ay�
Reviewer/Inspector Name + � Phone:
Reviewer/Inspector Signature: Date: G 0 /bS
12/28/04 Continued

Facility Number: �,� —717 Date of Inspection /2u/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 91 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropirate box. 2WUP ❑ Checklists
Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and[" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ja No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[A Yes
❑ No
❑ NA
❑ NE
z „pili, °
Addthonal�CommenlAaftdlor� Drawings..i fIW
19) CDG waa In 0+ iws +,k.t ZLr I��ea1� SCcr+.rt
� fe�Or S,
a- G a I- es L a cA- v- G wr r cv-.*
oZv� �}Gajb4 S ec,tirt G.- C, Cb aa�r �pur � a- C1 oOto 'a1 Ie --'6 9h1! Qr. oQ
PlGQaG Plaree_ c3•-=4j+r+ai GoP`l 04- y1Q� — l a�pl;cakLor.t w. �
b a.4 k w'.}�. �' a ..r. r e 6 O rCA,.
rYl r. 13 sn�.L� Xia• Jr
i M C piL-.
�•Ik M w1n►1jP ,kr W1 c.a+
�A. Ir
12/28/04

Type of Visit • Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notifcation 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational C Below Threshold
[9 -Permitted D-6ertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name:......._ ... ........
.._ County:
Owner Name:„ _.Car �e!.? ....!�C�?� PhoneNo: s.`J_ �..: 1.�
Mailing Address:3JJG�_....��c��l�._ . �Q�Cc._ .. �!!�o<r1�o G r cX-- ,/✓ �.._. ;2036c,
Facility Contact: .- Cal-. L4%a....... Title: Phone No:
Onsite Representative: f�fiG� �� �'rs Far, W .__ Integrator:.., tCf.1j���....
Certified Operator: ....... �e�, l on.....__ i'G, _e 1!0 0� Operator Certification Number: . 7 9 S`
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��� Longitude • 6 64
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation? [:]Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes KP
b. If discharee is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 9190
c. If discharge is observed, what is the estimated flow in gal/min'? -�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [.io
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [, Ko
Waste Collection & Treatment ^�
4. Is storage capacity (freeboard plus storm storage) less than adequate? El spillway El Yes Leo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:........�...//....... ..... -........ ...�__ .. _. �. _.... ......
Freeboard (inches): % yU 5-
12112103 Continued

Facility Number: 7 Date of Inspection ® 3, 30o c- j
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0-1�o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes M1" 0'
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) �
7. Do any of the structures need maintenance/improvement? [:]Yes 21 o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [-to
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes QNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes EDXo
❑ Excessive Pondin ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes G-Aio_
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0-No
b) Does the facility need a wettable acre determination? ❑ Yes [3-NQ
c) This facility is pended for a wettable acre determination? ❑ Yes 0P?io
15. Does the receiving crop need improvement? ❑ Yes ON-10
16. Is there a lack of adequate waste application equipment? ❑ Yes ELNc'
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EINQ--
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 8 -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes EINO
Air Quality representative immediately_
'Comments (refer Lo gnestron'#}�Explarq arry•YFS affi>vets and/or nay recom�endatsons ar<aoy oti��r comm_enfs':., , , _ r �-M '
:iJ� draiwrngs o�'far�ty to'better eiiplaui s�tnatzo s (use sddibon_al�pages � ae�essarY)_ [� Fre7d Copy ❑ Funal No� es T r � �7
r - i�- + r' _� r `�"niJ^xY^ �-=_-r r' -= .x., _ '� _,...:.: "r" �.-`�:" —.: -'�?-i � ' �� _ - 7 ,:-, ,,..., x n _ �:1'..,«..'.` .-s'.-•i�ui _,«.�.�-.[-4.. �� ".r�
7-�icre �s et 9ao�/ S"Ze flare jo 44 1,ac% a /Ac 1<<ye,., C �) li, "f� u
1 iMe E/05.'017 i �� �A/C YCCc-�- •.S yD�n� ><U ��mC ,� Gn✓' %J� �di -1; J,� tln if �d
� Y /. 0�/"/�
�3/,7/1/0'S4 � DOGS./ G /Lis e 0 V e On PA.0 baclerS lajao i
err ure a /e Gvaocfr SuP/,,,95 f�af Mme, 13ar�%01 /G-�s fo c�7�
dawn .
Re cords aie we // flcp7�
Fa,-ry, /5 u, r// kedl,
Reviewer/Inspector Namear-
Reviewer/Inspector Signature: % Date: 3- 3 o- o y
12/12/03 Continued

Facility Number: � .2 =-) Date of Inspection - o -a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIPE checklists, design, ma�.etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling f
f
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain,__
[:1120 Minute Inspectiggs­❑ Annual Certification Forn�.�
❑ Yes M -No
❑ Yes UNo
❑ Yes allo
❑ Yes O -No
❑ Yes &No
❑ Yes [3 -Nb
❑ Yes O -Ko
❑ Yes O No
❑ Yes [No
❑At'es ❑ No
❑ Yes [ lmP
❑ Yes [INe-
❑ Yes ONo
❑ Yes ©-xo--
❑ Yes ®-No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Addid Commenu=and/or
�D.�ra-wYr-i'rn-_5r a. r
tor P5JuE4G; /0,e --Ae cr.7n�cr� Sli�e19e.. 5✓rvr;.
l33
�j,r fit SFS r1a� I'FCcF.vrc! Ga
C°r/,
•
12112103