820301_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Quai

type of visit: wt ompuance inspection U uperauon mevtew U �rructure Lvamatton U tecnmcat.asststance
Reason for Visit: 0"fioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: dv Departure Time: T County:
Farm Name: �{; t.{t� .fit � tE'-� Owner Email:
1•
Owner Name: I� [ -- Phone:
Mailing Address:
Physical Address:
Facility Contact: 7 L-C,4____
Title:
Onsite Representative: 1
Certified Operator:" l t
Back-up Operator:
Location of Farm:
Phone:
Region
Integrator: fft(!� :s
Certification Number: 2�
Certification Number:
Latitude: Longitude:
Design
Swine Capacity."f
Cua rent
Pop. Wet Ponitry
Layer
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Wean to Finish
I
Dai Cow
Wean to Feeder
I jNon-LRer
LF
D P.oult ,
Dairy Calf
—
Feeder to Finish
Dairy Heifer
Design C Trentrhy Cow
Ca aci P,d Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Others
Non -La ers
Beef Feeder
Pullets
I 113eef Brood Co...
Turkeys
Turkey Poults
Other
Other
Discharees and Stream Impacts
- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No dNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
DNA ❑ 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
0 No
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
B'No
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

MPjFacili Number: NX - .30 Date of Ins ection: - I
Waste Collection & Treatment
•4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-No' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� G
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Lj4o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E 3 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 E 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [I/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): i
13. Soil Type(s)
I'
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 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eg'/Nc
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3 No
❑ NA
❑ NE
Rgquired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d o ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
Page 2 of 21412015 Confdnued

Facility Number: - '301 Date of Ins ection: .
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0-5-0
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 EJ Ko
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q`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 E�Y o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [3*<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F2"No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
C a., ( L-V11141 � - a 5— 16
C
❑ Yes D Ko ❑ NA ❑ NE
❑ Yes 01 o ❑ NA ❑ NE
❑ Yes I__I No ❑ NA ❑ NE
❑Yes ❑Ko ❑NA ❑NE
Reviewer/Inspector Name: 1 l t L Phone:
Reviewer/Inspector Signature: Date: 14t 1- 4�
Page 3 of 3 21412015

C
61MS f 6 :To NE l-i by
ivis'ion of Water Resources
F cilitytNiltl e - ®Division of Soil and Water Conservation
OQ Qther Ageem
Type of Visit: Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: -ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ITZr, :1 Arrival Time: Departure Time: FF00 County:`Ii�Region:rp-o
Farm Name: Owner Email:
Owner Name: ixc/`` �cYS�vwj �CJ_L Phone:
Mailing Address:
Physical Address:
Facility Contact: o Lt4 t 1-4-•t ti Title: Phone:
Onsite Representative: t ( Integrator:
Certified Operator:
E x
-(
Alt, /01,-
Back-up Operator:
Location of Farm: Latitude:
Certification N umber: ,5i;,a y ri Z,
Certification Number:
Longitude:
x
Destgn ,Current
-
esign C*urrectty
Pop
. Wet Poultrpacity P,op.
wn
Cattle Capacity Pop.
_; F
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Dai Heifer
Feeder to Finish
�� Zn
� ` i �,F,,� m ;_
Design Current
Farrow to Wean
Dry Cow
>
D P,auit . .,Ca
ci h` Po P.
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
_. ther*
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 (gal Ions)?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
[J'NA
❑ NE
❑ Yes
❑ No
2- lA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No [3-<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Ej No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ej No [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - 30 1 1 Date of Inspection:
wC
Waste Collection & Treatment
4. 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
❑ NoF![--NA
[] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ 5 --
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
ETNo
❑ 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
0No
❑ 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 CJo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ko ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3/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): 1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �TNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes Ef No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes D No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3"No. ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
[:24o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
[_
❑ 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
E N
❑ 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 21412015 Continued

FacHity Number: jDate of Inspection: -_trtL`7
24. I� o 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 to ❑ 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 �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes E5No ❑ NA ❑ NE
❑ Yes [2-&o ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes Er' -No
❑ Yes E f No
❑ Yes ��No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
F/cam
- � 3' s
3 r�
eQ To- 3 o-VSf
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date:��il�� 7
21412015

1 rat,9 9 �m-'w u
(Type of Visit: (E'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint Q Foilow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: ( County: ,+•`
Farm Name: NAwf�i� dr/Gt Owner Email:
Owner Name: D V"LV4 eti iL ig".4 a I u-. 00 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
I�XGt- o Title:
Latitude:
Region:
Phone:
Integrator: &( {7j ^ S'
Certification Number: Voz
Certification Number:
Longitude:
Swine
De�stgn�nrrent
C acr - P*
„ P ty P
4 Wet Pon .
ryp
La er
estgn Current
r
Ca ad Po
_ ty� P
Design Eurrent
@attle Ca aci Po
P h P•
Dairy Cow
Wean to Finish
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
2 S
" "_ , ; "
Dai Heifer
D gn, Curt -11
D , P,ault . �Ca atEt Po
Cow
Non -Dairy
Farrow to Wean
Farrow to -Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-F n
Turkeys
Othe
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 [al�A. ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
L.TNA
❑ 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
D A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[3'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
la"No
❑ NA
❑ NE
of the State other than from a discharge'!
Page I of 3 21412011 Continued

jFacility Number: �'�- _�Q J jDate of Inspection: L �
Waste Collection &Treatment WNVA
❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es NE
g7o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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 ffrNo ❑ 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 f,
No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ta ❑ 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 OeNo ❑ 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): T
13. Soil Type(s): l 7 U_ A/oo i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[14- 0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UK0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L�7 =moo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
Alo
❑ 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 �o ❑ NA ❑ NE
the appropriate box. TTT
❑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
[� o
❑ 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 21412014 Continued

Facility -Number: - Date of Inspection: PA I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C� N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []KNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0'*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?
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 ETNo ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
es @`No
❑ Yes n No
❑ Yes [6No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
�3 0- 2(7 p 33
Reviewer/inspector Name:
Phone: U 1 I
Reviewer/Inspector Signature: b Date: ' u
Page 3 of 3 214,120 I

• 1 /its
Structure Evaluation Inspection
Facility Number: oo 3o I Date: 2 r C 1I
Time in: /2.`..3v Time out: /a `(S
Farm Name: Towt,411 /016,-% Farm 911 address: 131tete Z.-EJCKs-b•t
Owner Name: T L Gam( /444
Facility Contact: '-i` l
Onsite Representative: !a Integrator: 1
Certified Operator: Gl Cert. Number
Is storage capacity less than adequate? Yes
If yes is waste level into the structural freeboard? Yes No
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): tl t7
Are there any immediate threats to the integrity of any of the structures
observed? Yes No //-
Do any structures lack adequate markers as required by the permit? Yes._ No ,/
Does any part of the waste management system need repair Yes No
Condition of field's tie
Condition of receiving crop 5 cti't-aLT
Comments:

type or visit. (y uompuance inspection CJ uperanon meview V arrucrure ixamatron V I ecnmcat Assistance I
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: County:
Farm Name: OW04,044,\, Owner Email:
Owner Name: p>✓` Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: p ftW} .,- Title: Phone:
Oasite Representative— Integrator:
lye
Certified Operator: O�p./� Certification Number: Q
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity: Fop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Design Current
Dr, P■oul Ca aci P,o
Dai Caifo
Finish
Wean
Dai Heiferto
D Cow
to Feeder
Non -Dairy
tFarrow
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
10ther
Turke s
urke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ejilo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No lA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:)Yes [] No [5"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 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes [TNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E/N"'o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4 2014 Continued

Faeili Number: - Date of Inspection: S O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a.)40� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No JA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure S 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 o ❑ 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 environment�o[:]
notify DWR
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 0 Application Outside of Approved Area
7. Do any of the structures need maintenance or improvement?
❑Yes
NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes
�Ro ❑ 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
[�� ❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No ❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s): VV Q
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
io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
❑ Yes
E:rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑Yes
121<
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:)Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vf�No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - p Date of Ins ection:
124. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5-7T5J ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Quo' ❑ NA ❑ NE
the appropriate box(es) below.
❑ failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Irispector Name:
❑ Yes Vj<o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EJ o ❑ NA ❑ NE
❑ Yes r❑- - o ❑ NA ❑ NE
❑ Yes D-I; o ❑ NA ❑ NE
❑ Yes 0' o ❑ NA ❑ NE
❑ Yes 0<o ❑ NA ❑ NE
❑ Yes slo ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
(t Dt/j- j__G
21412014

Date of Visit: Arrival Time: Departure Time: , j County: St32VC1w Region: ;ty<- d
Farm Name: _�-�. h Owner Email:
Owner Name: pWl
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
[ r
1
f�
Phone:
Integrator: • r[ 9
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesiCurrept
Design
Current
Design Current
wine
M
�ty P p.
Wet Poultry
-
Gapac�ty°.
Pop:
Cattle Capacity Pap.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
w= .
Farrow to Wean
Design :
Current.
Dry Cow
Farrow to Feeder
D P.oul
Ca aci
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
aOthi r..
Turkey Puults.
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [![❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [:)No [Z�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No [][4tA ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
[:]Yes [z>0
❑ Yes
NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3
21412014 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
[d_N0--_❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No -
❑ 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
Q'1Qo ❑ 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
B4-Nff- ❑ NA
0 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
❑ 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 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[E�Wo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
[:]Yes
[�J-Nb ❑ 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?
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
[L.ie
❑ NA
❑ NE
❑ Yes
[9 I�
❑ NA
❑ NE
❑ Yes
❑-lq-o
❑ NA
❑ NE
❑ Yes [;I Ko ❑ NA ❑ NE
❑ Yes E;FM ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []140
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrAsfers
❑ 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 [TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [f�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

11pacility Number: fj I Date of Ins ectio Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q~1Qo C] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0,N-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 Q-N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [Dio ❑ 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:
[—]Yes �6 ❑ NA ❑ NE
[:]Yes [3-<oo ❑ NA ❑ NE
❑ Yes Q-o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
[2 "'o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[KrNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C a,.(" r O'. -1 �-
1
Reviewer/Inspector Name: Phone: JJ�
1
Reviewer/Inspector Signature: Date: IQ-
Page 3 of 3 21412014

•G v--" -,,J
1,

(Type of Visit: Q Comptiance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: (4toutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
r
Date of Visit: rrival Time: Departure Time: Coun • Regiotl ,
Farm Name: a ! Owner Email:
Owner Name: I tii' Phone: '4 s
.W n
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
44,
Integrator: lk
Certification Number:
Certification Number:
Latitude: Longitude:
Designer Current
I]esignCurrent
Design Current
Capacity Pap ;. �, Wet Poultry
Capacrtyl'op: --
,Cattle Capaci
Finish
r
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
t^
- -
-
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
.3„ D P,oult I.
Layers
Non -La ers
Design Cui�enf
x
Ca acr Po _
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turke Poults
Other
_
rzOther
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 ETNo ❑ NA ❑ NE
❑ Yes
❑ No
[KKNA
❑ NE
❑ Yes
[—]No
0 NA
❑ NE
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 C! No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [21<o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Type of Visit: �mpllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 1CWt6utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 19-
Arrival Time: Departure Time: County:— Regio
Farm Name: evft,(}�- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
!;K-Uw I ('�
13
Facility Contact: VA WA4 - JM Title:
Onsite Representative:
Certified Operator: 0OA, r
Back-up Operator: �4
Phone: JLI& 1
Integrator: —P-8
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
-
DesignCurrent'
Capacity Pop
M—ant
i' D gn Covent. Design Current
Wet Poultry Capacity Pop.CattleWeo
La er I Dairy Cow
Non -La er DairyCalf
M`# .;F " F DairyHeifer
Design Current D Cow
D . Poalt w Ca act Po Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Other
_
TurkeyPoints
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (I f 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 1 of 3 21412011 Continued
s

ZZ
Facility Number: ok - Date of Inspection:
Waste Collection & Treatment
4. 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 g�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 o ❑ 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 [ErRo ❑ 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 Q;[-Iqo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []�iNo ❑ 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 [t3"'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 �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (TIC/\J&AqK �
' 'C'h-_ —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B'KIo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes r�(
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E To ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes dNo ❑ 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 L.I " ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [::]Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ' [:]Yes Eg No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacI li umber: Date of Ins ection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!]'�lo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [144o' ❑ 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 ETo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Lj"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes r7j�Ko_ ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
0 Yes [(-1lo ❑ NA ❑ NE
❑ Yes L4o= ❑ NA ❑ NE
❑ Yes ri_141' ❑ NA ❑ NE
❑ Yes C6No
❑ Yes L#o
❑ Yes �io
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
Reviewer/inspector Signature:
3 of 3 21412011

t
a
Type of Visit: 1) Compliance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: iO.tx1A1 Departure Time: a',yQ County: Region: f
Farm Name: omr� N ���m Q Owner Email:
Owner Name: p,{r t\os{1 yet Q Phone:
Mailing Address:
Physical Address:
Facility Contact: Zn(VNCT\.J Title:
On site Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: MuCt01hi �Rawl�
Certification Number:
Certification Number:
Longitude:
`�_.DesignCurreat Design Current
Swine n "�° Capacity Popp, Wet Poultry, bCapactPop
Design Current
Cattle Capacity Pop.
to Finish
Turke Pouets
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes [�lo ❑ NA ❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other:
a. Was the conveyance man-made? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ Yes
Ej No
❑ Yes
[xNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 2/4/1011 Continued

r �
Facility Number: a, - 30 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fff No
❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
[�sIo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
alb N°vsC.!-� �q ems{-/f�Zir? flo eye 3
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
[TNo
❑ 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
D"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
EE f No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q,,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
62No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3"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): b�R �1, >? PR , --I by AHS•-
13. Soil Type(s): A }R (a `j o A t A - A _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3"No ❑ NA ❑ NE
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.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes �o ❑ NA ❑ NE
❑ Yes
[30No
❑ NA
❑ NE
❑ Yes
[v"No
❑ NA
❑ NE
❑ Yes
11
[ErNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2fNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes �No
o
❑ Yes N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: $ a - d Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o -
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�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.
dApplication 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 D"'No ❑ NA ❑ NE
❑ Yes [00No ❑ NA ❑ NE
❑ Yes Ea"No ❑ NA ❑ NE
Ea Yes ❑ No ❑ NA ❑ NE
❑ Yes [0" o
❑ Yes Q No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: Cl & I�
Page 3 of 3 2'4/2011

(Type of Visit: 1EMompliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 42M<utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: --r Arrival Time: N Departure Time: County g+—Region:
Farm Name: 0- Owner Email:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact: GLy1-L- Title: �C(%lj�/'' Phone:
Onsite Representative: ��T f(�1 f��`�. Integrator: N/
Certified Operator: 62d A14t.y &f-- Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
..
- DesegnCurrent
,
Design Current
Design Gurreat
SR�rte
Capae ty P P. ;,
Wet Poultry
Cap ty Pop
Cattle Capacity Pop.
1
Wean to Finish
Wean to Feeder
La er
Non -La er
DairyCow
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder " "
Farrow to Finish �-
Des�gnCurrent
D , I$oul ;Ca aeiPo
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Boars
'Non -Layers
Pullets
_Turkeys
Beef Feeder
Beef Brood Cow
Othe.....
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[Z[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Fg[No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - D i Date of Ins ection: �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �- 19`
,r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ED 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
VLNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RjNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
RlNo
❑ 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): tlt r
13. Soil Type(s): H ! L-/L-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®..No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes [0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ea 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 R1 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 5g_wo
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Coo ❑ NA ❑ NE
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MNo ❑ 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 Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
'®"Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes $a No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
IVI Yes ❑ No ❑ NA ❑ NE
YW
❑ Yes 1�21 No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #f): 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).
31, `ATV *"r q- Z 1 Pe-1 z-ld Flo. 1-3 -t_ j L/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

— -.- — Division MIWater Quality f '
=Facifitvumber „3a f Q Division of 5oi1 and Water Conservation 1�a�'��
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,,,
�Koutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: r% `J Departure Time: /Qi3C7 County:
Farm Name: _-7;;m ►sue.+ Il1,ne_,10 e - Fa4w _ / 4,,``/� Owner Email:
Owner Name: l vm nt y �du _l'�l �a� Phone:
Mailing Address:
Physical Address:
Region: /,To
Facility Contact: ��.�mss,� �il�/ Title: Phone No:
Onsite Representative: LfJ✓ Integrator:
Certified Operator: ut'� t7 — Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = A = it Longitude: [� ° = i = «
INE
Design Current
Design CurrentPill Design current
Swine Capacity Population Wet Poultry
Capacity Population Cattle Capacity Population
I ❑ Dairy Cow
1 ❑ Dairy Calf
❑ Dairy Heifer
- ❑ Dry Cow
❑ Wean to Finish
I ❑ La er
❑ Wean to Feeder
10 Non -Layer I
Feeder to Finish
0
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑Beef Brood Co
- - -- _
urke s❑
❑ i'
Other
Turkey Poults
Number of Structures:
❑Other
10Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Ycs ®No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5Z No
❑ NA
❑ NE
❑ Yes
®..No
❑ NA
❑ NE
Page I. of 3
12128104 Continued

Date of Inspection
Facility Number: —
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %ct
Observed Freeboard (in): 7 G%p
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
KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
5.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
RNo ❑ 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
9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EgNo ❑ 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) !d 2 / 4 LR I (�v a Z AJ
- -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
J,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3No
❑ NA
❑ NE
OI *ffi*kAvr_ Ca,—zkn r41 D/Y1ti w D k -11_41 h' tT i,4j emJ ^ - rr e`JO1-e
Reviewer/Inspector Name Phone: `D�f33~330
Reviewer/Inspector Signature: - Date: /a— /3 —,&9/D
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eg�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
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes EfINZ ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections [3 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional.'Coniments and/or Drawings . , , � ...
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes KNo
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
25 No
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
12128104

s"
Type of Visit QrCom�pliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit &I routine 0 Complaint 0 Fallow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l�-ice Arrival Time: Departure Time: County: sue- Region:
Farm Name: A Owner Email:
Owner Name: 4 G1' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f�•--��
Certified Operator: -s«
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = tl Longitude: = o = t = u
Swine
❑ Wean to Finish
❑ Wean to Feeder
Current
DesWig
Capacity_Population
Wet Poultry
❑ Layer
❑ Non -Layer
urren Design Current
Desig�-1
Capacipul�atign Gattfe Capacity Population
❑ Dairy Cow
❑ Dairy Calf
eider to Finish
/":
❑ Dairy Heifer
❑ Farrow to Wean
ElDrFy
Farrow to Feeder
Poultry
�_ El Dry Cow
= ``g
Non -Dairy
El
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
- —Y�
Other
_z-
❑ Turkeys
❑ Turkey Poults�
kY
❑ Other
❑ Other
��Number of Structures: tl-,�JJJI
� , �
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
QNo
❑ NA
❑ NE
[:]Yes
(RNO
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment q-
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 12-Yes g o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes U No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % y l g- _ j9"
Observed Freeboard (in): _ % U. / 17
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�j 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
[R-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
[a No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ NA
❑ N E
(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 10 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
'/
12. Crop type(s) ! 3.�r A / . � �, h/y..,
13. Soil type(s) y,gLva'5-j Ll}
Lk iK,:.,;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z.No
❑ NA
❑ 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
0 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
BNo
❑ NA
❑ NE
441
�Cotnments�(refer�to•question>#): Explain an_y YESyanswers andJor any recominendahvns�Or any.other-ico eats
. -� n s. ,a-
Use drawings offacility to better explain sititations;(use additional pages as necessary):Y
Al /`C 404,/-/1'-a 4e` /2cp%vre -'d►
t
rReviewer/Inspectorwer/lospector Name ed Phone:
Signature: Date:
12128104 Continued

Facility Number: Date of Inspection I /. —/ V
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E4 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
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ 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
[a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E[No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[91 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
EQ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
[a No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
B No
❑ NA
❑ NE
AddiboeiCcim ieiitsfdnd/oriDrs ngs:
i
td?-re 4 uJr`
� � �l C OS z'. . rt Au��•y� f .5��� � OG� � r`�
T
12128104

Facility Number: ,3
Date of Inspection 7 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
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 J' No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E!yNo ❑ NA ❑ NE
❑ Yes allo ❑ 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? 0-yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes � No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tZ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 64No ❑ 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 Winnddow/ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6r
13, Soil type(s) A,01'r NOS
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ER No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [N 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
No
❑ NA
❑ NE
❑ Yes
tij 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,):
!'a prr-
l/
ocr
Reviewer/Inspector Name +, , _ ;rY Phone: �/pJJ3yo
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

1
Type of Visit ,�yommp/pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t7Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l Arrival Time: `3a Departure Time: i J County: Region: _7r�?o
Farm Name:/ylrms ,Qii Lor ��r�'" r� Owner Email:
Owner Name: �Le eft- . �� Phone:
Mailing Address:
Physical Address:
Facility Contact: — 7^1" ��� Title: Phone NNoo: // (o
Onsite Representative: Integrator: Al
Certified Operator: ����'� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = t Longitude: = o = 1 = u
estgrt Current , Currenurrent
_egn
"wineCapacity Pationactty Poulation
Cattle Capacity Population
nish
❑ La er
❑Dai Cow
eder
❑Non -La er
❑ Dairy Calf
seder to Finish
fv ��O G Lb0
❑ Dairy Heifer
El Farrow to Wean
f� � �;�
Dry Poultry<�"+�,�
El Dry Cow
El Farrow to Feeder
-
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Nan -La ers
❑Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
_
❑ Turkeys
—:
w 4_
�__ =-A
❑ Turkey Poults
N
❑ Other
r_
_
❑ Other
RUN of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
f9 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12.128104
Continued

Facility Number: —30 t Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes DINo ❑ NA ❑ NE
the appropirate box. '
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Ez Yes PFNo ❑ 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
PSNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El 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
[A 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
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;,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
[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
[0 No
❑ NA
❑ NE
Additional Comments and/or Drawings. ru -
.., r re
Page 3 of 3 12128104

AgeDivision of Water Quality
-17
Facility Number Division of Soil and Water Conservation y
Q Other Agency
lType of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
ReasonforVisit outine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I Z4�123 Arrival Time: Departure Time: d_ S County:
Farm Name: � Q % Owner Email: 1001,
Owner Name: /V /�� Phone:
Mailing Address:
Physical Address:
Facility Contact: r' Title:
Onsite Representative:
Certified Operator: 2��—.c�
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
�o
Latitude:
Integrator:
Region:
No: //0'_,�(o ��a % /
Operator Certification Number:
Back-up Certification Number:
Design Current. Design Current
Capacity Population. Wet Poultry Capacity Population
❑ Layer
lI ❑ Non -Laves
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Longitude: = o =, = "
Design Current
Cattle Capacity Populahonti
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ D "Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3" Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�&No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
[21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 ,A.j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R[No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
J} No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
)RI Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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
[9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N 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
[KNo
❑ 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 'ame Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number:,,3tj j Date of Inspection 1,V
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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
18 No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J{] 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
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5?LNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ 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
X 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
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
CK No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Comments and/or Drawings:
I2128104

}
sion of water Quality
=F-qCi1itY_umber M - 3 p O Division of Soiland Water Conservation
0°Other Agency
Type of Visit &Compliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of visit: Arrival Time: 94, O l7 Departure Time: Q County:-��',L �" '_-__ Region: IL��42
Farm Name: _ p�Yyir ,► N r �ixl�r� � Owner Email:
Owner Name: -,rr �s �Aurr� N�L-oi Phone:
Mailing Address: /.�7fi�5� 14-3 Y„9C.._AU [Xf7'~ C • " & (e
Physical Address:
Facility Contact: f�zA7 M_ y !Z 0' Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 92 g/b4/
—r
Back-up Certification Number:
Location of Farm: Latitude: 0 0 F—I . F—I « Longitude: = ° = d 0 "
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/ a D
—ad
TO V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarZes & 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
❑ Dairy Calf
❑ Dairy Hcifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cols
Number of Structures: ©'
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached Nvaters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DIN'Q)
?. 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 CkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
[I NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PQ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number:Date of Inspection LIB
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes. is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 --Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): . Z 3�L
Observed Freeboard (in): 3 -3 �--
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®-No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes allo ❑ 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? n1Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 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
U�-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CE�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop �Gt1/�r
type(s) +r'►'t _57"
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®.No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination.
❑ yes
® 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
[KNo
❑ NA ❑ NE
Reviewer/Inspector Name Phone:lS�
Reviewer/Inspector Signature: Date: 7- v 4,
12/28/04 Continued

Facility Number: a — IV Date of Inspection
j Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Kyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield 91120 Minute Inspections ❑ Monthly and 1" Rain Inspections N Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes SNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z 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
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C,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)
JQ
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
G[/o/%���'/d��
�QG� .K%iYZ Q Ne-Wr_ZZRP f 9 .e&7---�i+�rtl ,
12128104

(Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation {
for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: JD Tune: �p
Not Operational G Below Threshold
13'Permitted 13- Certified [3 Conditionally Certified. 0 Registered Date Last Operated or Above Threshold: .-..
Farm Name: _ Q!� _ IV �_FG • . _ cy _ County: Se.."yi ., F/1 a
Owner Na.me:........ ,.lw. -i ce, , .. Atom16P 'Phone No:
Mailing Address:
Facility Contact: ._ .' T-d;t, , f-- ------ Ajt, � Title:. _ Phone No:
Onsite Representative: �g "ya `o/ ._ _ Integrator Ave F�� Sri' 2 s
Certified Operator: a e r Operator Certification Number:
Location of Farm:
05iivine ❑ Poultry ❑Cattle ❑ Horse
Latitude Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [39o'
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes a24-
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes [3No
c. If discharge is observed, what is the estimated flow in gallmin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [}No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes [RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 13,No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3
Identifier:
Structure 4 Structure 5
❑ Yes d'No
Structure 6
Freeboard (inches): 31 ar
12112103
Continued

' Facility Number: j ? -- 30
Date of Inspection a-.Y
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 DW(2)
7. Do any of the structures need maintenance!unprovement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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 maintenanc ermiprovement?
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
tp`t IG 119 lag f Hy
12. Crop type 6or r1 , soY F.a�..r ti , �✓f1 P•� �'
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 Jallo
❑ Yes [ No
❑ Yes 0'No
❑ Yes ❑No
❑ Yes [allo
l
❑ Yes 0'No
❑ Yes Rz' fo
❑ Yes [,Ia
❑ Yes &],No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [3 No
❑ Yes ❑ No
❑ Yes L 1410
❑ Yes UNo
❑ Yes allo
❑ Final Notes
i �e !'C r.✓ S �m C �ra; 4 �.st
7 l�• rn C Corr1�� G1` U�It
d4 lk Ale,en
C ..10 v ea �k
J
Reviewer/Inspector Name y ..
Reviewer/Iaspector Signature:
Date: `J _-2 0 -
12112103 ContUreed

Facility Number: B,�- —3 p Date of Inspection ,O Y
RSquired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [;INo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
{iel ; the s, dm etc.) [I Yes J-No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 o
❑ Waste-Appliaden--❑ Fs ee� E] Waste Analysis ❑ '4 el
7H ro >yd;r
24. Is facility not in compliance with anlicable setback criteria in effect at the tune of design. ❑Yes ©-No
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/lnspector fail to discuss reviewfinspection 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
30. 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 NPDFS required forms need improvement? If yes, check the appropriate box below.
❑Steclaa ❑ iald 1~erm ❑-RaWM ❑erection-After-F—Raiff
❑ on Foam_
❑ Yes Jallo
Yes [:TNo
❑ Yes Q No
❑ Yes m-No
❑ Yes 0 No
EMS
❑ No
EaYes
❑ No
❑ Yes
O-Ko
❑ Yes
E]-No
❑ Yes
Leo
❑ Yes
[ago
12/12/03

taceruy Number__
Division of Environmental Management AP'd -&& L
Animal Feedlot Operations Site Visitation Record
Date: 8 y
'Time: Io .Z�
General Inform ration:
Farm Name: _ R_ F
Owner Name: rn ae No: 56 Y - Y0 9 y
On Site Representative: off sepIntenr Mailing Address: - n .2�
Physical
Latitude: I 1 Longitude:
Qperation DescririiptigD; (based on design characteristics)
I jape of Swine No. of Arnim is Type of Poultry No. of Anin=b Type of Cattle No. of Animals
0 sow O Dyer O Dairy
O Nursery » Non-L"a 0 Beef
O Feeds
OrherType of livestock f Nwnber of Animals: 3l; 7oZ
Number of Lagoons: .2 (include in ee Drawings and Observations the fioeboard of each iagoan)
Facility ImRggf}on:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour, storm storage?:
Yes 0
Now
Is seepage observed from the. lagoon?:
Yes 0
NdH-
Is erosion observed?:
Yes 0
No
Is any discharge observed?
Yes 0
NoQ
0 Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
NoqB
Does the cover crop need improvement?:
Yes 0
. Neff
(list the crops which need improvement)
drop type: �escve'r Co r.���. Gotaf)r Acreage-,
r
Srtbac Criteria '
Is a dwelling located within 20O feet of waste application? Yes 0 No'M.
Is a well located within 100 feet of waste application_ 7 Yes 0
Is animal waste stockpiled within 1O0 feet of USGS Blue Line Stream? Yes ❑ Nqp-
'Is animal waste Ian applied of spray irrigated within 25 feet of Blue Line Stream? Yes D Now
AOI -- JannwT 174M

�'latttteAaJtCC
Does the facility maintenance need itnpmvemcni7 Yes ❑ NoA
h them evidence of past discharge from any part of the operation? Yes 0 No r]
Does record keeping need improvement? Yes 0 No ip
Did the facility fail to have a copy of the Animal Waste Management Plan on size? Yes D Npa
i -
Explain any Yes atiswas`�
Side: Date: G
cc Faculty Assessment Unit Use Att&dunentr #'Needed
Drawings or Observntions:
FrGc,b o c�4
. � - ... _ _ . nn`r•1• � a�-• �r .+•• fra. r �' A�•r��.t7 �PrlM�r:+!•va•�• `�� �, ...
nr.'s�•�:•.�-^ ��-..•r •.r •ens /=(:f w�:.'1�.�• L.ra..•�rrw mow. -
AOI — Ianlsary 27 j9%