820292_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

type oz visit. z7uompuance inspection V uperatnon xeview V Structure Evaluation (> Technical Assistance
Reason for Visit: 0-Mo—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ] Arrival Time: t ° Departure Time: County: -s t!E0_j Region:
Farm Name: q)Y1-c_ Pd -e_ F
Owner Name: K __LLC
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: av'hs -1i a-ywf Title: Phone:
Onsite Representative: I Integrator: 1 / I S
Certified Operator: 2 0 U'I 2 l`'o-1"'A l O M Certification Number: I E e 3 S7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
31
❑ Yes
❑ No
[D -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Destgn Current _
Design
Current
❑ No
Design Current
Swine
Capacity Pop._
Wet Poultry
@apacity
Pop.
Cattle
Gapaci#y
Pop.
[]<o
❑ NA
❑ NE
of the State other than from a discharge?
Wean to Finish
-'�
Layer
Dairy Cow
Wean to Feeder
[Non -Layer
Daia Calf
Feeder to Finish
Z,(Y8 t Y0►
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,aul
"pa
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other -
M F
+.. _ .....:'
Turkeys
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 [11 -Ko ❑ NA ❑ NE
❑ Yes ❑ No [g-I�A [] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[D -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
E j A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[]<o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facili Number: Z - Zq Z Ds ection:
Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-N-P — ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EZ�6 ❑ 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 [ZKo ❑ 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 ❑'N'o— ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Rwo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!3'1 or [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ED -IG— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): A3 4fV^VI-ku �Ka� S G (_o o "t S fi't' # C -,,-,k eti
13. Soil Type(s): ) C-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ivo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes EfNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes CTNo ❑ NA ❑ NE
Reou_ired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g -Ko ❑ 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 [2,�<o ❑ 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 [frNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F`No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facil' Number: J - Z jDate of Inspection: /Ot
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E�No ❑ NA ❑ NE
all
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�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
lCJ 1V°
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑/ NNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C3 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additionalpages as necessary).
Cal; �-f -- C(- II- !U
5Uy, — c(–yt<- (-7 P q.q 'f4
,X 1(0- 36% �-�s{
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:To—qM31f
Date: A,14t
2/4/2015

Divi"cion of Water Resources
-,Facility Number - Division of Soil and Water Conservation
© Qther Agency
Type of Visit:�,o�mpliance Inspection Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: (2 Routine O Complaint 0 Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: o Arrival Time._° r Departure Time: County: ' �ly Regio
Farm Name: H Owner Email:
Owner Name: ��Gp Phone:
Mailing Address:
Physical Address:
Facility Contact: �frcr '�S G �/iftJ i Title: Phone:
Onsite Representative: it Integrator: nS'
Certified Operator: m4A 16" Certification Number: l—S
Back-up Operator: Certification lumber:
Location of Farm:
Latitude:
Longitude:
Dischary-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? ([f yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No [�NA ❑ NE
❑ Yes
Design Current
[a,"NA
Design
Current, Design Current
Swipe
Capacity Pop.
Wet Poultry
Capacity
Pop Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
- Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
,
Current '' D Cow
Farrow to Feeder
P,oultr,
Ca aci P,o Non -Dairy
Farrow to Finish
ers
IN
- Beef Stocker
Gilts
-La ers
Beef Feeder
Boars
ets
Beef Brood Cow
Turke s
_
Other
Turke Poults
Other
Other
..
Dischary-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? ([f yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No [�NA ❑ NE
❑ Yes
❑ No
[a,"NA
❑ NE
❑ Yes
❑ No
[3 NA
❑ NE
❑ Yes ❑ No
❑ Yes E5�No
❑ Yes aNo
dNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 214/2015 Continued

Facili 'lumber: T - Date of Inspection: .n
VV 171
Waste Collection _& Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 33
S. Are there any immediate threats to the integrity of any of the structures observed'?
(i.e., large trees, severe erosion, seepage, etc_)
E3.Na— ❑ NA ❑ NE
[:]No Q-3d'A ❑ NE
Structure 6
❑ Yes �E—J-No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
T Do any of the structures need maintenance or improvement?
❑ Yes
[2rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
[TNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [31N_ ❑ 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, 0 Application Outside of Approved Area
12. Crop Type(s): V x -A
13. Soil Type(s): Wq,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5No ❑ NA ❑ NE
16. Did the facility tail 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 C2,IVo ❑ 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 0 No ❑ NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ 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 [?fNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [/(No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facili 'lumber: jDate of Ins ection: Xy
24#Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q. -X6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-M ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
L2 -No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes []''�lo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L2'Ro ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes [j�fo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No 0 NA ❑ NE
Comments (refer to question ft Explain. any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (ruse additional pages as necessary).
qip_ 3o�_� s�
Reviewer/Inspector Name:
Reviewer/[nspector Signatur
Page 3 of 3
honeDPhone-
Date:
ater All
2/4/2075

I 1'k5 'z�7 orb
Type of Visit: (5 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: Q County: Regiou
Farm Name: OLM
Otj
Owner Name: U t -
Mailing Address:
Physical Address:
Facility Contact: a4(.1 ���tt>l ^ Title:
Onsite Representative: i
Certified Operator: _f 41a...P
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone: Q
Integrator. U S
Certification Number: �S�_qt
Certification Number:
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)?
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?
❑ Yes GNo [DNA ❑ NE
[:]Yes
❑No
ffNA
❑ NE
❑ Yes
Design _Current
[!fNA
Design
Current
Design Current
Swine.. Capacity Pop.
t
Wet Poultry
Capacity
Pop.
Cattle Capacity P.
_
Wean to Finish
La er
Dairy Cow
Wean to Feeder
r
Dairy Calf
Feeder to Finish
DaiEy Heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
D I;oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
41
Other=, _
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes GNo [DNA ❑ NE
[:]Yes
❑No
ffNA
❑ NE
❑ Yes
❑ No
[!fNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes WNo o
❑ Yes
[fNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facility Amber:- Date of Inspection:
•
WN
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [; KA ❑ 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
eNo
❑ 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
CNo
❑ 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
[1f 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? 1f yes, check the appropriate box below. ❑ Yes 21"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)J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): -_J3,g �% 5 .% O C,t, k4
13. Soil Type(s): 0G
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?
Re aired 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 Lg<o ❑ NA ❑ NE
❑ YesrNNo ❑ NA ❑ NE
❑ Yes 5�<o ❑ NA ❑ NE
❑ Yes �lo
[:)Yes [
❑ Yes eNo
❑ Yes PEfNo
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6?rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesLU
23. If selected, did the facility nail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'eNo
❑NA ❑NE
❑ NA ❑ NE
E] NA ❑NE
❑NA ❑NE
DNA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Fa i .N@mber: - Date of Ins ection:
24. Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F/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— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes kI 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 eNo ❑ NA ❑ NE
❑ Yes Cl/No [:INA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes EJINo ❑ NA ❑ NE
❑ Yes o
❑ Yeso
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessary).
c�.�a,..�� �=l s�►y
74
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 3
Date:
2/4/2011

Type of Visit: Q.Ctrm tante Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency C) Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S -6w Region:
Farm Name: H Owner Email:
Owner Name: A; t -C.e Phone:
Mailing Address:
Physical Address:
Facility Contact:
��t 1
�S a� W L u Title:
Phone:
Onsite Representative:
[jNo
y
Integrator: fm 16 _
Certified Operator:
t'1Gtcr-�
Certification Number:p2 l�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Destgn CurrentWoe
z�.2. - Design Carrent Design Current
Swine Capac ty Pop Wet; oultry Capacity Pop .a Cattle Capacity Pop.
Wean to Finish a La er Dai Cow
Wean to Feeder Non -La er Dai Calf
Feeder to Finish _ -�' f;.. Dai Heifer
Farrow to Wean �'
- � Design 'Current D Cow
Farrow to Feeder ;D ..;P,ou1
Ca act Pa s Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
'.
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�o ❑ NA ❑ NE
❑ Yes [:]No [B--N-A ❑ NE
[-]Yes ❑ No []' A_A ❑ NE
[:]Yes
❑No
❑ Yes
L3-1"0
[:]Yes
[jNo
0 -KA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

t
Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-1 o 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�"NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): Jfl
❑ Yes [2-5o_
❑ NA
[] NE
maintenance or improvement?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-IRo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
[] Heavy Metals (Cu, Zn, 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?
12. Crop Type(s): C 1` ML'LCf0' '-S' G o t,
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
D -N-6
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑1Go
❑ 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 [3 -Na ❑ NA ❑ NE
maintenance or improvement?
Waste AADlieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [2-5o_
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R'1(To
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
[] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): C 1` ML'LCf0' '-S' G o t,
13. Soil Type(s): �(t
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 Q -N6'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes c�[ i o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [g�Ko ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes M1�) ❑ 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 [/] 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 eNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 o. f 3 2/4/2611 Continued

Facility Number: - Date of Ins ection.
2.�r Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [4'�4o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑e �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 R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes Rj No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E&f4o
❑ 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
EEkf-4o
❑ 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
[E�<o
❑ NA ❑ NE
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,
❑ Yes
[] No
❑ NA ❑ NE
❑ Application Field 0 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes1�
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
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Li NP -4k'9 [J I
94,Q s ct VLY-1 — T-
Reviewer/Inspector
Name:
Reviewer/Inspector Signature:
Page 3 of 3
U J4p Phone: J
97�4 Date:
214/2014

(6 1 ►k,S 15
Type of Visit: ID'Co7liance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for VisitRoouutiine O Complaint O Follow-up O Referral O Emergency O Otherr-^�-0 Denied Access
Date of Visit: FVljj i"%Ll /`] I Arrival Time: Departure Time: County: J ' r ' ' ` Region!
Farm Name: t's f A Owner Email:
Owner Name: �3� `9 0 Phone:
Mailing Address:
Physical Address:
Facility Contact: CUJ1 5 J&""Oy to Title: Phone:
Onsite Representative: t( Integrator:
Certified Operator: IN Certification Number: 2- srLq7
Back-up Operator. Certification Number:
Location of Farm:
Latitude:
Longitude:
DesgnCttrreut .mow `# Deslgn Current Desigu Current
3. _
Swine CapacttyPop Wet�Poultryq Capacity Pap. Cattle Capacity Pap.
�.aR• .E
Wean to Finish jDairy Cow
Wean to Feeder Non -La er IDairy Calf
Feeder to FinishI Dairy Heifer
Farrow to Wean DesiDry Cow
Farrow to Feeder►�
<D PoultrviCa act Po..� Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets E Beef Brood Cow
Turke s
Other
Turkey Poults s x,
er Other;" m
Oth
Discharees and Stream Impacts
I Is discharge
. any observed from any part of the operation?
❑ Yes
E3-<
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
LJ'""
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EJITO
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NSA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes E] No aq A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
M*Igo
Identifier:
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Spillway?:
E�fNo
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Observed Freeboard (in):
0 NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed? .
Yes`1Cfo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
�
17. Does the facility lack adequate acreage for land application?
6. Are there structures on-site which are not properly addressed and/or managed through a
Yes �-isTo ❑ NA
❑ NE
waste management or closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
❑ NE
Required Records & Documents
7. Do any of the structures need maintenance or improvement?]
Yes �o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes Va ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
9. Does any part of the waste management system other than the waste structures require
❑ Yes Flo ❑ NA
❑ NE
maintenance or improvement?
the appropriate box.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes❑ NA ❑ NE
maintenance or improvement? :/0[:] 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M*Igo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[fNo
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3'go
❑ 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
E -C-53.
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ETNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
q:�4o­
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ko
❑ 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
2/4/2011 Continued

Facili Number: - Date of Inspection:
r 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 1 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [=J N ❑ 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 [ZkVu ❑ 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 �o ❑ 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 2<0 [:INA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes EfNo ❑ 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 ZI No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage fond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes El"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ZVNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
(D9j,'b V -e4#0 G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
u
Phone:
Date:
2/4/201.

r ype or visit. ty[:ompuance inspection v Uperation tceview U structure tvatuanon U l echnical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r L,4 frrival Time: e7 Departure Time: v Countya— Region:
Farm Name: 9, j 1.e:7 " �-O � � Q- s d Fa t�►'L Owner Email:
Owner Name: f' � s z"t f ]d „� Phone:
Mailing Address:
Physical Address:
Facility Contact: X4 '* /7/0 //—*,/ Title: Phone:
Onsite Representative: S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:�rplwy
Certification Number: 7
Certification Number:
Longitude:
Design Current Design Current Design Gntrent
7eeder
e Cap c ty� Pop v WetrPoultry Capac ty Pop jCattle Capacity Pop.
tr- f v-
to Finish Layer Dai Cow
to Feeder Non -La er Dai Calf
to Finish *� m - ti Dai Heifer
Farrow to Wean Des g �Curreitt D Cow
Farrow to Feeder D oul Ca aci,'P_..o`°"` Non-Da'Iry
Farrow to Finish _ Lavers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood C--
Turkeys
owTurke s
Other WIr Turkey Poults
Other - Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes &No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes No
[:]Yes ® No
❑ NA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued

Faciti Number: Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):,
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
� No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
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)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rV1 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El 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):4f4 sw zLV
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
in 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
[S No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes EANo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120II Continued

IF
acili Number: - y Date of Inspection-
24.
ns ection:24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2 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 non -nal?
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
�Z 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
jZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[allo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Sigmature:
Page 3 of 3
Phone: �1/0'_7t,� 7c7
Date: 7 p/�
2/4/2011

i
L
Type of VisitCC�ommp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ('Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rr Arrival Time: Departure Time: County: cs-tve2y" Region: '
Farm Name: A/D /Gt rt{j Fix Owner Email:
Owner Name Phone:
Mailing Address:
Physical Address: Y
Facility Contact: 5 e V —' fl Me- a a: Title:
Onsite Representative: . 5�
Certified Operator: sa-�—
Back-up Operator:
Phone No: is J3
Integrator: %7? l r AOM
Operator Certification Number: 3_';;1_5'_
Back-up Certification Number:
Location of Farm: Latitude: =0
=' = Longitude: = ° 0 . =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current Design Current
[XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design
Capacity Population
Iffirrentoultry
Cattle Capaelty Pulation
❑ Yes
❑ Wean to Finish
❑ Layer
❑ NE
❑ Dai Cow
❑ Yes
❑ Wean to Feeder
❑ NA
❑Non -La er
e. What is the estimated volume that reached waters of the State (gallons)?
❑ Dai Calf
Feeder to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ DairyHeifer
❑ No
❑ NA
❑ Farrow to Wean
2. Is there evidence of a past discharge from any part of the operation?
Dry Poultry
❑ D Cow
❑ NA
❑ NE
❑ Farrow to Feeder
❑ Yes
allo
❑ Non -Dairy
❑ NE
other than from a discharge?
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
Continued
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- ❑ Turkeys
Other
❑ Other
❑ Turkey Po Its
❑
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
C,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

r` Facility Number: — Date of Inspection -G " 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site which are not properly addressed andlor managed
El Yes
L9 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?
aYes
❑ No
[INA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1K No
[INA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CgNo
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [?!�Alo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �/ a[ cY Y E.(1 i "✓�r-r nWV2,d
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes [ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes PRo [:1NA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes R[No ❑ NA ❑ NE
Dew
Reviewer/fns ector Name A r +. Phone:
Reviewer/Inspector Signature: Date:
rcicoivy l,unnr�ucu

i Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ERNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ 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 ❑ 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
Callo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(Z No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 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
(&No
❑ NA
❑ NE
A'dditioaal'Conamentsand/or£Drarnugs
i
T
fi&I-I1L12-Ij

1 ype of visit Qletffi pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint 0 hollow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , Q Departure Time: r' County: 7T'~ Region: z
1-7 le -
Farm Name: X1`T� � �rara!/— Owner Email:
Owner Name: /i"�D���*� a� Phone:
Mailing Address:
Physical Address:
Facility Contact: ZW /�4��� Title:
Onsite Representative:
Certified Operator:vr�_
Back-up Operator:
Location of Farm:
Phone No:
Integrator: %��!hY _
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c= 4 Longitude: 0°= 0 u
Wit, `,DesignCurreat
Design Current
Design Current
�
Swine'" Population
Wet Poultry Cap�ac�tyP�opulahon..,_
Cattle :Capacity Population
_"'Capaeity
to Finish
❑ La er
Fto Feeder
❑Nan -La er
❑Dai Calf
Feeder to Finish
❑ NA
Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
_ ...., -
❑Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers
Beef Feeder
PD Boars
❑ Pullets
❑ Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
Turkeys
M No
r
Other ,
❑ Turkey Poults
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Other
❑ Other
Humber',of Structures:
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3.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
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JR No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
11/18104
Continued

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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O No ❑ NA [-INE
[:]Yes [A No ❑ NA CINE
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? R Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes (3 No ❑ NA ❑ NE
❑ Yes EgNo [INA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z[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. Croptype(s) %'/rn��vr/s�,�/ �G�-�T�r�7 fGv`rt✓�� —
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo [INA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
/J'Tu�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
Phone:�3 3�oa
Date:
12/28/04 Continued

Facility Number: — Date of Inspection
F
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P.No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;�INo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® 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
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
rMNo
❑ 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
[ANO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
kNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
rage .t of s 12/28/04

iss1,~ivision of Water Quality
Facility Number O Division of Soil and Water Conservation t� _��-m7
O Other Agency
Type of Visitccommppliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit utine Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: // Arrival Timee:J111 30
Departure Time: �dQ County: D"L Region: �!
Farm Name: _..IR,L el -t / a t-ra— d Owner Email:
Owner Name: e±±, -5 • HO L& r� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: d16?AA; LTitle: Phone No: 9iO`S��_la
Onsite Representative: -s^-L- Integrator: /amu✓_
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =]' =' = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
_ ❑
Non -Layer
Dry Poultry
Nan -L,
Pullets
U Turkey Poults I I d
❑ Other
Discharzes & Stream Impacts
1 _ Is any discharge observed from any pan 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
El Yes 5dNo El NA 0 N
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E$No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
12128/04 Continued

Facilit}'Number: — Date of Inspection L
Waste Collection & Treatment
t
Reviewer/Inspector Name ��� Phone: q/D- yj- -33ao
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): >I g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
E? 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
e'o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[j� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No
❑ NA ❑ NE
maintenance/improvement?
1 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below.
[:]Yes
14No
[INA ❑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 Window El Evidence of Wind Drift El Application Outside
of Area
Crop
12. Crop type(s)t�rr4; e.�! �'?�L1/%'�'�rs_���
13. Soil type(s) T�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 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?
E] Yes
CR No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(?No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
19 No
❑ NA ❑ NE
Comments (refer to question ft 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):
t
Reviewer/Inspector Name ��� Phone: q/D- yj- -33ao
Reviewer/Inspector Signature: Date:
12/28/04 Continued

�i
Facility Number: —9 Date of Inspection %
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes RINo [JNA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ 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
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
SNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PLNo
❑ NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[)I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Wo
❑ 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
ERNo
❑ 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
�0 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
54 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
06)�j eke Ao v -c a iso ud[),-,- 5arv7 A...- Fbr �° 7
12/28/04

Type of Visit ®'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 County: Region:
Farm Name: Vb f iT r Owner Email:
0,#vner Name: . t _7 _�. �}D� •�f Phone:
,flailing Address:
Physical Address: p � r
Facility Contact: Iz f`_ l� b Title:
Onsite Representative: _A21a.-I&y H �� ! Q✓1
Certified Operator: __ Mal, 11 ( ui D 11 12 -IJ
Phone No:
Integrator: —Ur P_ A I
I
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 =t
0 Longitude: =o=,
o=, =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
B oars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laves
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ I -
Dairy Calf
❑ Dairy Heitei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EE
d. Does discharge bypass the waste management system? (Ifycs, 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
[2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PQNo
❑ NA
❑ NE
❑ Yes
[Q,No
❑ NA
❑ NE
12128104 Continued

Facility Number:— Date of Inspection s 10
40
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway'?--
Designed
pillway?:Designed Freeboard (in): 1
Observed Freeboard (in): N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 14 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? 2 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IV No El NA C1 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 [Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [--]Yes 1KNo ❑ NA CINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes jK 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 Chop Window [:]Evidence of Wind Drift ❑ A,pplic�ation Outside of Area
12. Crop type(s)
13. Soil type(s) (moi'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 57No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, E] Yes ® No ❑ NA EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes KNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes )KNo ❑ NA ❑ NE
Comments (refer to question"#): -Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Fame I a-�-� ' . Phone: —16W 1.
j
Reviewer/Inspector Signature: Date: ---02 Ob
12/28/04 Continued

Facility Number: 420 —Date of Inspection 9Na
j
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5INo ❑ NA ❑ NE
the appropirate box.
❑ VVUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
Vr Waste Application ❑ Weekly Freeboard EZ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Z Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
d Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
KNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W 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
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
f@ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N 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
A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
4 No
❑ NA
❑ NE
Additional Comtnenis andlor.Drawings:
`�
�uff /i%a YS n�p2. Dr
1A W#1 1 Jeo_) W11 j r_ .44lt
Vb- , 7 5, �11_
Kpt-p Croy
12/28/04

Type of Visit • Compliance Inspection Q Operation Review Q lagoon Evaluation
Reason for Visit 40 Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date or vise: Tune: /O; 004
O Not erational C Below Thr=eshold
M4 rmitted Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: —.
Farm Name: &//one/ __C County-SQ'„Eun ..,e!/tO
Owner Name: ..__� s H o I ,,,, Phone No: 9 /4 - $-&-17--.2.233
Mailing Address: .45-4 Yajale,- . , ad _ .Sa Len_6� L
Facility Contact: ..__ Sievc Mr Akk l' ....,...Title:
Onsite Representative: S t ye _ Mr p�
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number.
2 wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude •
Number Is "
Discharges & Stream Imoct5
1. Is any discharge observed from any part of the operation? ❑ yes Imo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B -90—
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 9 -Mo -
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ---- .___ ._ __. _. w_ _ —
Freeboard (inches): yo &
❑ Yes 0 -No
❑ Yes BWo-
Structure 6
12112103 Continued

Facility Number: 9_2 — �q
Date of Inspection 4 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceJimprovement?
8. Does any part of the waste management system other than waste structures require maintenanceo improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below-
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
R ;2 67 So GG !00
12. Crop type 161or lila 4alall _ k Gi C' -A' * Ar AM4 ✓/t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
B14-0-
❑ Yes
,
lino
❑ Yes
04go-
❑ Yes
❑'No—
❑ Yes
(-96
❑ Yes
[Mo
❑ Yes
CR46'
❑ Yes Deo
❑ Yes R -Ko—
❑ Yes 2W -o
❑ Yes Cwo
❑ Yes Leo
❑ Yes 0'3 o_
❑ Yes ❑ No
❑ Yes D10
❑ Yes UNo
❑ Yes 8go-
mks (refer to gaeshoa ) s lam any:' DOES_ orany orbic cQ:amsarL . _
[he d s,toatia�. ��as rY) Q'eld
ECopy 0 Final Notes
l`leo e GOhl`, y ve- /I kvar k Ort dare G f -ea f 40 E.tk&,S4
G4ver- I'm �OtevEn� era5.`.t
Fo,
spry wto./S n See, C'tX�
Soo
aS Cc nc�r.htP,�Qnr�
?1�Q,SuPC
Reviewer/Iospector Name
ReviewerAnspector Signature: Date: 9 - J4
12112103 Condnued

• Facility Number: g 2_>q,2 Date of Inspection
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/ RRT,-ahecMts, doses, maps; =.)
23• Does record keeping need improvement? If yes, check the appropriate box below.
❑
Waste Appheatim ❑lar d ❑ Waste Analysis ❑ Seil-Saz sg-�
S-1'7 7,;t1 2•y a 1,y
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?
(iet discharge, freeboard problems, over application)
27. Did Reviewer/tnspector 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?
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . 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 ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [Q-lro—
❑ Yes (-#o
❑ Yes ❑ No
❑ Yes
9 -No
❑ Yes
0 -No'
❑ Yes
G34o
❑ Yes
[}I'Qo'
❑ Yes
❑ No
❑ Yes
[moo
❑ Yes 01 0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
© No violations or deficiencies were noted during this visit. You w71 rive no further correspondence about this visit.
Car�'andlaa'Dsawiug���- - 3 � -
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-73, Re v.'ewej W asie ana ly 5.'s tVejle SfIPt dire y a.D&
before rAn(I pFler jn..ys�e ��re. RRGOniIl7�viG� 7�+WT L,iolff SGrryp%tS �{
�u lied every
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12112103

Division of Environmental Management 2
Animal Feedlot Operations Site Visitation Record
Date: !7
Time- L30
General Ino adon:
Farm Name: Connty:
Chvnec Name: _ _Phone No:�Sz_233
On -Site Representative: Integrator,
Mailing Addri=:-..�
Physical
Latitude: / I Longitude: I I
... OperatiQn Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Carole No. ofAnin=U
❑ Sow 0 Layer D Dairy
0 Nursery 0 Non -Layer O Beef
0 Feeder
OtherType ofVvesioek Number of Animals: aqY
Number of Lagoons: (incladevin the Drawings and Observations the frxboard of each lagoon)
k'acilftE JnU ection•
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour, storm storage?:
Yes 0
Nom
Is seepage observed from the. lagoon?:
Yes 0
Naii -
Is erosion observed?:
Yes 0
Nd 5 -
Is any discharge observed?
Yes 0
NdV-
0 Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
W5—
Does the cover crop need improvement?:
Yes 0 .
Nd:a-
( list the crops which need ' )
Crop �a
type: s� Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes 0
NeOi-
•Ls a wall located within 100 feet of waste application?
..Yes 0.
NaZL
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes 0
NoG—
'Is aminal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes 0
Noe
A01— January 17,1996s°-

' Does the facility maintenance need improvement? Yes C] Nom
Is there evidence of past discharge from any part of the operation? Yes ❑ NAi,
Does record keeping need improvement? Yes 0 NcrS
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes O No D
Explain any Yes answers;
cc FacMry Assessment Unit
Drawings or Observations:
Date:.
Use A=dmnenu lyNeeded
r
• - . . � wnrf�+�.-- � v n •ice. `L `f. •�. iYFrIfMT/v!.v'.a��+�.� �!_.
AOI -- January 17.19%