820312_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua!

I'ype of visit: W Compliance inspection V Operation Review V structure Evaluation U Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z Arrival Time: ;tea,. Departure Time: IW2 3 County: S)jy,_e_0.64 Region: -2
FarmName: Cid ¢3'I�-s-2 2� -3 Owner Email: '
Owner Name: M c n Phone:
Mailing Address:
Physical Address:
Facility Contact: S1, M C LA'l Title:
M
Onsite Representative:
N
Certified Operator:
Back-up Operator:
Phone:
Integrator: Jyvkl i u el 4
Certification Number: /109/
Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrentmAi(.:
Swiiae Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layer
Non -La er
D . P,aultr
Layers
Design
apacity
Design
Ca aci
Current
Pop.
Current
P,o ,
Design Current
Cattle Capacity Pop.
Dai Cow
Da' Calf
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes F
No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No `T' NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Q9 NA ❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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? %
h Page I of 3 2/4/20I S Continaed

•
Facility Number: Z- Date of Inspection: ?2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: If
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): N
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1P 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 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesLP
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? T
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo [—]NA [:]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yesj� No 13 NA [:]NE
❑ Excessive Ponding ❑ Hydraulic Overload [D 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 ❑ Evidenceo
f Wind
Drriftl ❑ Application Outside of Approved Area
12. Crop Type(s): Q`s11 ` .4r4i. �sS , 7�"'�.t 6--,.4- Owwadl
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking D Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued
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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
D NA
❑ NE
the appropriate box.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking D Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 3 Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Q9 No ❑ NA ❑ NE
the appropriate box(cs) 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 IbNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other 1ssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1� No
[DNA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
-33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[V No
❑ NA
❑ NE
. Explain an YES answers and/or an additional recommendations or,an outer comment
mments (refer to question #)• p Y Y . Y y
FUsk
'drawings of facility to better explain situations (use additional pages as necessary).yt
-
'<
Reviewer/Inspector Name: /v Phone: 10-11, 7 r -3100
Reviewer/Inspector Signature: V cGt. Date:
Page 3 of 3 21412011

• Division of Water Resources QA__ C490
Facility Number - Division of Soil and Water Conservation
Q Queer Agency
Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up_ _ 0 Referral O Emergency Q Other O Denied Access
Date of Visit: VL2,QUA Arrival Time: p. 00 Departure Time: County: _-cv-i Region: �—
Farm Name: Q Q 67-3-4,7-3-2-17-3- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:�J !gym 4" Title:
Onsite Representative: q
Certified Operator:
Back-up Operator.
Phone: �?
Integrator• AW4 ¢�
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
„ w
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
G'uCurrent
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
eD�gn
city, Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
NA
Wean to Finish
b. Did the discharge reach waters of the State? (if yes, notify DWR)
La er
[]No
NA
Dai Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Feeder
Non -La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Dai Calf
❑No
Feeder to Finish
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
Qq No
Dai Heifer
❑ NE
Farrow to Wean
❑ Yes
to No
Design
Current
D Cow
Farrow to Feeder
D . P,oul
@ aci
P,o
Non -Dairy
Farrow to Finish
Layen
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ether ,.;
3 -Y_
Turkeys
Turkey Poults
- Other
JMLJOther
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
Qq No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
to No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: - Z� Date of inspection: U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
j No ❑ NA ❑ NE
i[]No �NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
N
Observed Freeboard (in): g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EA No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �j No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
1 I . 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 ❑ Evi of in DC
Application Outside of Approved Area
L� Q"S12.Cro Type(s)- ►
k(
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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
No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[j No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesNo
[:]NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
F] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
['�No
❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
2/4/2015 Continued

Fpeility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [!A No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes t� No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes f�q No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Explain
Use drawings of
to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any
as
Yes �g No ❑ NA ❑ NE
❑ Yes t�? No ❑ NA ❑ NE
❑ Yes [�p No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes ® No
or
❑ NA ❑ NE
❑ NA ❑ NE
0 N 0 N
Phone:
Dater b
2/4/2015

l'ype of visit: 0 Compliance Inspection [,_J operation Kevtew U structure Evaluation V I echrucal Assistance
Reason for Visit: ® Routine 0 Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ' O,'v4 County: ,V_,�Region: 40d�
Farm Name:r3 A'0 0 Z 3 -2-3-2- Owner Email:
4Z1
3 - , 2,3-"tOwner Name: !1 r"LPhone:
Mailing Address:
Physical Address:
Facility Contact: Jj Title: Phone:
tl
Onsite Representative: Integrator -' /
Certified Operator: Certification Number: Z 90//
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
NJ No
Design
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Layer
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Da Cow
Wean to Feeder
Non -La er
❑ Yes
❑ No
® NA
D Calf
Feeder to Finish—VOL)
❑ Yes
No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Da Heifer
Farrow to Wean
❑ NA
❑ NE
of the State other than from a discharge?
Design
Current
Cow
Farrow to Feeder
Dry Poul
Ga aei
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
er
ro
Turke Pouits
!O7th:er
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
NJ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 1/4/1014 Continued

FaciliNumber:[Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: T
M No ❑ NA ❑ NE
❑ No [P NA E]NE
Structure` 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes NJ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan? TT''
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
Co No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[Vb No
❑ NA
❑ NE
Waste ApRUcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes®
No
P
❑ NA
[-]NE
maintenance or improvement?
❑ Yes
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Outside of Acceptable CropWindow ❑ Evidence of VOnd Drift D Application
Outside of Approved
Area
❑ NE
12. Crop Type(s): ( i''�s S�, •
(-�-
Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E§ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P§ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NJ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Vb No
❑ NA
❑ NE
the appropriate box.
❑WUP E] Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[23 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
[ b No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 2/4/1014 Continued

[Facility Number: Z - Date of Inspection: ItZaVZE
2,r Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo ❑ 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:
❑ Yes
M No
YOIJ
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes [$3 No ❑ NA ❑ NE
Comments (refer to question#}: Explain any YES answers and/or any:additional recatrimendattons or''any otbercomments. "r
Use drawings of facrli#v:to better explain situations Ease additional Haz=es as necessarvl.� r�.. _.
Reviewer/Inspector Name: & ev �t b Phone:
za s
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/42014

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Timer Departure Time: /jj; County: Region: ,�✓��
Farm Name: -I±e f j0 (L4 P% 1,3—/ Owner Email:
Owner Name: 1 h P Mir, 14 11_� LP2:4e Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
41
Title:
Latitude:
Phone:
Integrator: _/j' [�
Certification Number: 29 df -;l
Certification Number:
Longitude:
Discharges and Stream linaacts
1. Is any discharge observed from any part of the operation?
DesignCurrent:
_
-CDesign
Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Swine
Capacop. _°
x WefaPoultry
papactty
' 1?op
Cattle Capacity Pop.
['O}NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
r
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
La er
❑ Yes
❑ No
D ' Cow
❑ NE
Wean to Feeder
❑ Yes
No
❑ NA
Non -La er
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Dai Calf
❑ NA
Feeder to Finish
of the State other than from a discharge?
''` "''
""
Dai Heifer
Farrow to Wean
-
-- ..^
Desi n '
g
Current -
Cow
Farrow to Feeder
D , Poul
,Ca aci
, Po ,�
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
= _
Turkeys
Other
Turkey Poults
Other
Discharges and Stream linaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
§5 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
['O}NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 24,2011 Continued

Facji lity Nu ber: - Date of Inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�✓ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Waste Application
Spillway?:
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No
❑ NA
Designed Freeboard (in):
maintenance or improvement?
Observed Freeboard (in): Z
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
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.)
into
T
❑ Outside of Acceptable Crop Window ❑ Evidence f Wind Drift Application Outside of Approved Area
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ YesNo
[:]NA
E]NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
`
9. Does any part of the waste management system other than the waste structures require
❑ Yes
V�l No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence f Wind Drift Application Outside of Approved Area
12. Crop Type(s): �:4
13. Soil Type(s): i
14. Do the receiving crops diler from those designated in the CAWMP?
❑ Yes
P No
[—]NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
TP No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
P No
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
T`
❑ NA
❑ NE
_R_e_guired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
14 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
f� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Y No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1�] No ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes %No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments(refer to question {�: Explain any YES answers and/or any additional recommendations',or_any other conimentsF
Use drawings of facility to better explain situations (use additional pages as necessary).
-qtr'
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: RLzil
Date: "
Page 3 of 3
21412011

(Type of Visit: 0 Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: ® Routine p Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: U Arrival Time: f_ Departure Time: �County: SAYWI(Tod Region: f7120
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ���.+-tis,,r�, N1c Title: Phone:
Onsite Representative: y Integrator:91
ti
Certified Operator: Certification Numb , q o LQ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
Q�NA ❑NE
PjNA [D NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 7O NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�r No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes W No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
Design Current.+ Design @urrenr
Design Current
Swine
a Gaci Wet Poulf`, Ca achy Po
Cattle Ca aci Po .
Wean to Finish
La er
Dairy Cow
Wean to Feeder I INon-Layer I I
Da'y Calf
Feeder to Finish
_ . -
Da' Heifer
Farrow to Wean
�` - Design Curre©t
Dry Cow
Farrow to Feeder
DPoult . Ca -aci P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
NJ Boars
Pullets
Beef Brood Cow
Turkeys
Other
Tur ey Poults
Other
10ther
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 P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
Q�NA ❑NE
PjNA [D NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 7O NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�r No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes W No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

iF'acility'k\umber: - Date of Ins ection: i q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No RNA ❑ 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 ONo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes N No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
0 No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [53 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable C op Window ❑ Evidence o . Wind Drift Application Outside of Approved Area
12. Crop Type(s): at� � '? " r4 t
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p 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 [00 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fait 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
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p 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 [00 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili `!Number: 2 - Date of Inspection: It JAI 11-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Pg No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
E] NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question t Explain.any YES answers and/or any additional recommendations or anyj+other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9&-(ey3 33oa
Date: it Q 12
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'�Qq,. Departure Time: County: Region: LD—
Farm Name: o Owner Email:
Owner Name: ► ^'Kp Phone:
Mailing Address:
Physical Address:
Facility Contact: V t`„�•+-••-7G�t"`� Title:
Onsite Representative:
Ll
Certified Operator:
Back-up Operator:
Location of Farm:
4
Phone:
Integrator: W k!
Certification Number: o
Certification Number:
Latitude: Longitude:
§ Design _Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ Yes
❑ No
Layer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Da' Cow
Wean to Feeder
® NA
T
❑ NE
Non -Layer
Dai Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
Dai Heifer
Farrow to Wean
❑ Yes
No
Design
Current
Dry Cow
Farrow to Feeder
No
Dry P,ouIt .
C•a aci.
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- „ -. _.
Turke s
Qther 1
1 ITurkeyPoults
Other j'I
Other
Discharges and Stream Imuacts
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
T
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge'!
Page I of 3 2/4/2011 Continued

Facility Number. - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No W NA ❑ NE
Struc T
re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P
No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes b 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 P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA E]NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 51
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA [:]NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:] WUP
❑ Yes
NM No
❑ NA
❑ NE
maintenance or improvement?
ri
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 rift Applic ion
Aside of Approved
Area
12. CropType(s): sW, �''tr
44
13. Soil Type(s):
14. Do the receiving crops diff r 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?
❑ Yes
p No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
t'
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box-
ox_
❑WUP ❑Checklists ❑Design [:]Maps ❑Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield [] 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gi No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a AOA 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 1P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fg No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �2 No ❑ NA ❑ NE
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [�4 No
❑ Yes �p No
❑ Yes � No
❑ Yes �q No
[—]Yes ['] No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain. any YES answers and/or any additional rec fiiffi n iitior►s or any other comments. -
Use`:dravvings of facility to better explain situations (use additional pages as necessary,)?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: TIM 53�
Date: 1
21412011

Type of Visit g Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
. I
Date of Visit: l i N�y Arrival Time: [� Departure Time: County: " Region:
Farm Name: C 2 ZT411 Owner Email:
Owner Name: Phone:
Maiting Address:
Physical Address: h
Facility Contact: ++�^�- MCIO-vWL Title:
Onsite Representative:
Certified Operator: k
Back-up Operator:
Phone No:
Integrator: Mwwi4W'r::`�wcjt�
fi
Operator Certification Number: 111),fl
l
Back-up Certification Number:
Location of Farm: Latitude: =0 =6 =46 Longitude: = o =I = u
Design Current
Swine Capacity Papulation
DesignCurrent
Wet Poultry Capacity Population
❑ La er
Design Current
Cattle C*opacity Population
❑ Dairy Cow
❑ NA
❑ Wean to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Wean to Feeder
❑Non-LMer
❑ Dairy Calf
a. Was the conveyance man-made?
Feeder to Finish SqQQ
Farrow to Wean
Dry l?otiltry
❑ Layers
Non -Layers
❑ Pullets
LJTurke s
❑ Turkey PUL[
❑ Other
Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
Beefrood Co
Number of Structures:
❑ NE
❑ Farrow to Feeder.
❑ Yes
El Farrow to Finish
[ NA
❑ Gilts
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
91No
❑ 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
Y4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

}
Facility Number: 7e — �,-;L_ Date of Inspection ? /0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo [:INA ElNE
a. If yes, is waste level into the structural freeboard?
El
No 10 NA ❑ NE
Strucyure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
PdNo
[:INA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctuies lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[;a No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application
of Area
nOutside
,
12. Crop type(s)
/fx/t'
l3. Soil types) v l f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
IFNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
y) No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fi� No
❑ NA ❑ NE
Reviewer/inspector Name Phone• �t� 3-3 30P
ReviewerlInspector Signature: Date: 12--1
Page 2 of 3 12128104 Continued

r
Facility Number: — Date of Inspection F L271 DI
R2guired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes §0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19 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
J�3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
17' 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
[P 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
O 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
CgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�INo
❑ NA
❑ NE
Additional- Com rnents.and/or Drawings•'".
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: pq Arrival Time: 'o4w.
_3Departure Time: O County: 7%T�" � Region:
Farm Name: o 0 t_!/c+�1 oZ v�IS .� �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: .
Facility Contact: 5�^'t+^-ku MC [hl� Title: Phone No:
tt ff__
Onsite Representative: Integrator:Yb L c
Certified Operator: 14 Operator Certification Number: 1 r 0q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 o =1 =" Longitude: = ° = { 0 u
Swine
El Wean to Finish
❑ Wean to Feeder
DesignC+urrent
Capacity Population
Design Current
Wet Poultry Gapty Population
❑ Laver
❑ Non -Layer
Design Carreut
Cattle Capacity Population
El Dairy Cow
❑ Dairy Calf
Feeder to Finish
3 �
Dairy
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
El Cow
El Farrow to Feeder
❑ Non-DaiTy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
P
❑ Pullets
❑ Beef Brood Cowl
Turke s
Other
❑ Other
❑ TurkeyPoults
IE-10ther-
Numi�er of Structures:
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [I Yes RNo ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made? El Yes ❑ No [�NA ❑ NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ) ❑Yes ❑ No [�PNA ❑ 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) El Yes ❑ No �] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes P No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes E32No ❑ NA ❑ NE
other than from a discharge?
1
2/28/04
Continued

facility Number: —'�� Date of Inspection 11
E-1YesNo
f
El NA
El NE
Waste Collection & Treatment
❑ Yes
P No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
'No
1-1NA
[:1 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
64 NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ u
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
LpNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ll
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 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect 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 Area
12. Crop type(s) WQS-W B mt4 q CwQs Q -<"` C-q,�
13. Soil type(s) bqz,.,/,'� l.p
I
14. Do the receiving crops differ from those designated in the CA W M P?
E-1YesNo
f
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[9 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
No
❑ NA
❑ NE
� �: )
Comments refer to question # Exp ` iax
;plain anv YES answers and/or any recomTmendahons or any other comments.
Use_ drawings.oi facility to better explain sttuations.:(use addihonat )ages, as necessary)
f
Reviewer/Inspector Name _4_1 Phone: 210-{633
Reviewer/Inspector Signature: Date: I Vs—/o
12128104 Continued

Facility Number: —3 �, Date of Inspection ll S D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [P 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. ❑ V*TUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[y No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IT No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
[__1NA
[:1NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
fp No
❑ NA
❑ NE
AdditioWIMMAIM
aaf Ciimmea#s andlor1Drs►vings: F °, Y" r
A.
w
12128/04

k
Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 0i� A Arrival Time: %304n, Departure Time: ,' Q County: 5411 S� Region: FM
Farm Name: W Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: .�—
Facility Contact:+'�`^ Title:
bj
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator t* pms
07
Operator Certification Number: 1
Back-up Certification Number:
Location of Farm: Latitude: =0 =1
=11
Longitude: 0 ° ❑ ' = u
Design Current
W������
� k'Desig�nMCurrent
Design Current
Swine Capacity Population
Wet Pouitry{Capac�tyPopru=ia
Cattle Capacity Population
❑ Wean to inih
❑ La er
❑Dai Cow
❑ Wean to Feeder
Laver
❑ Yes
❑ No
❑Dai Calf
�No
Feeder to Finish pD
=s3 ❑ Dairy Heifer
Farrow to Wean
,•�
El Dry Cow
Dry Poultry
El Farrow to Feeder"
� _T
Non -Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
,=
`
Qther
❑ Other
❑ Turkey Pou Its
❑ Other
Number of Struc#ures:
Discharges & Stream Impacts
I , Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
r�nNA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�'No
❑ NA
❑ NE
12/18104 Continued

Facility Number: — 310' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l - No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1PNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): P7"
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
'RNo
[INA ❑NE
through a waste management or closure plan?
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Annlication
Is there a lack of properly operating waste application equipment?
❑ Yes
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
`a No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
F3No
[INA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Cva9W famut& ( 16. . i"adwe_ )) 5 1, & s
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
PINo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0 N
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
1�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[Y) No
❑ NA
❑ NE
Reviewer/lnspector Name Phone: 0'�{�3'33�
Reviewer/Inspector Signature: Date: / 7�Q
Page 2 of 3 12/28/04 Continued

Facility Number: — a, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (§No [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYesNo ❑ NA EINE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o El NA E] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(7i

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I IIJAj W1 I Arrival Time:�{{ Departure Time: ro`•46 6tw J0
County: Region:
Farm Name: o4 �3�it a3-Aos ✓ 7 wner Email:
Owner Name: Phone: C0 2� L�
Mailing Address: i 41 wo�fp qqa
Phvsical Address:
`-�
Facility Contact: t M MC, Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Boars
Other
❑ Other
N
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =i Longitude: =o=, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
E ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design .'Current
Capacity . Population,
❑ Dairy Cow
❑ DaiEy Calf
❑ Daia Heifer
ErDry Cow
❑ NoD-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoYA
Number of Structures: I'
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 PNo ❑ NA EINE
❑ Yes
❑ No
NA
❑ NE
El Yes
El No
NA
[I NE
❑ Yes
❑ No
;Q NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
;R No
❑ NA
❑ NE
12/2$/44 Continued

Facility Number: R)5�3 A Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ElNA [INE
a. If yes, is waste level into the structural freeboard? El Yes No nNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
M
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 fe 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? El Yes � 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 �j No [INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ANo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5 No ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s
13. Soil type(s)
14. Do the receiving crops dimer from those designated in the CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
$1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
EP No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[I No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
W'O' No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name YVV'/'L7 Phone:
Reviewer/Inspector SignatuDate:
12/28/04 Continued

Facility Number: Date of Inspection ltl[T� 11
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 a No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes F No ❑ NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
fp No
[:INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
V3 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
EA 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
No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: fl 3o Z0a Arrival Time: ��5� M Departure Time: :$a County: SA!"II�S6*J Region: �O
Farm Name: T a CDe��aH 23� �i �`��`3�r Owner Email:
Owner Name::16C �wUb Phone:
Mailing Address:
Physical Address: ^�
Facility Contact: Ti r-% Title:
Onsite Representative: u
b
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �U*-[) 6
Operator Certification Number: --
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I
= u Longitude: = o = '
Destgn reurrent;q. Design Current Design Current
Swine cm leeiity Populalfih Wet Paul#ry C►apacity Population Cattle Capacity Population
❑ Wean to Finish 10 Layer I Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
Feeder to Finish 9q00 O "gw-❑ Dairy Heifer
Farrow to Wean"
Poultry ❑ D Cow
❑ Farrow to Feeder z
❑Non -Dairy
ElFarrow to Finish
0, ❑ Layers ❑ Beef Stocker
❑ Gilts ❑ Non -Layers
E] Beef Feeder
❑ Boars ❑ Pullets
� 1-1 Beef Brood Cow
= ❑
Turkeys
Other s. E] Turkey Poults�;,
❑
Other
E]Other F�Wummffmr of 5trtactures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of ,
❑ Yes �D No [INA ❑ NE
❑ Yes
❑ No
99 NA
❑ NE
❑ Yes
❑ No
O NA
❑ N E
$NA
❑ NE
❑ Yes
❑ No
❑ Yes
TNo
❑ NA
EINE
❑ Yes
�LNo
❑ NA
❑ NE
12/28/04
Continued

Facility Number: Date of Inspection ' !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P,NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -sit
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo
tp ❑ NA [__1NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
K -No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
F9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
� No El NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
❑ NA
Waste Application
17. Does the facility lack adequate acreage for land application?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tffNo ❑ NA ❑ NE
maintenance/improvement?
❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
'7tNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ 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 El Application Outside of Area
12. Croptype(s) Ior--r.4 .( Per �u„jb 4.—,e) , Ste. 6!,, Pte[
I
13. Soil type(s) Aq 1 L308 I WR B,T NO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
K -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F&I No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers�`andldi- any recommendations or any other commeatsf
onaUse drwn sof facility to better explain situations: (useadditrl pages as necessary):
�y
7
Reviewer/Inspector Name I
Phone: /O
3
Reviewer/Inspector Signature:
Date: 1
¢
Page 2 of 12178/04 Continued

t
Facility Number: Date of Inspection !l d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? MYes El No El NA [__1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box. ❑ wuP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
[INA
❑NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[).No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
FNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
QSNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[RNo
❑ 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
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/-► J
rtA r, M Clsti,,4 c t i Q c 7 0 Coc— '--r u~ (�C6*� 5_
AL
Page 3 of 3
12128104

r.
Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:.1/� Arrival Time:Q® Departure Time: County: &tiz3 a er, Region: -"0
Farm Name: Tenter��P�rdtt%��3T- Owner Email:
Owner Name: /71c Lang __-__ Gir.00�� A,,,Phone:
Mailing Address: Cradle Z-, G/,;y �d �, Ale- _
Physical Address:
Facility Contact: 47r_LU,.A Title:
Onsite Representative:
Certified Operator: 3%
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
[ 5fteder to Finish L-7,)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: _ A_-.rA" 'Cniu.e
Operator Certification Number: Ig -10 91
Back-up Certification Number:
Latitude: ❑ c =I = Longitude: =0=, o=.
Design Current
Wet Poultry Capacity Population
❑
Laver
❑ Non -La et
Dry Poultry
Lj Non -Layers
❑ Pullets
i
❑ Turkeys
❑
Turkey Poults
i
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current„
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf II
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
[] Beef Brood Co
Number of Structures: ©�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Q -<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
91go
❑ NA
❑ NE
❑ Yes
0-710
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ] — Date of Inspection lr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9 -i -To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure lr 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? ❑ Yesjfo ElNA El NE
(ie/ large trees, severe erosion, seepage, etc.) I t
r 6 S// --o5,-
6. Are there structures on-site which are not properly addressed and/or manageds Ml o El ElNE
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 rest, notify DWQ
I'aQ s;v
7. Do any of the structures need maintenance or improvement?
Ores
[INA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,,....,,..,, ��o
0 o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
ElYes
Milo'
❑ NA
❑ NE
maintenance or improvement?
Waste A I eation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
04o
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
1:1 Yes
_,
E14
❑ 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
r S70
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0.7 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
�es
❑ No
❑ NA
Cl NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
❑ No
❑ NA
[INV -
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
LH'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D�o
❑ NA
❑ NE
Comments (refer to goestion #I) Explainaany Y,E5 answer`siandfo�any recommendations or any other comments.
�t M
Use drawings oflfacilits to Hefter exjlani situations: {use addrhonal`�pagestas�necessary):
t r ` J
ease m�izri� a copy. d�' �h� /a�.eh r�e5%9h Gi7ci Io/ore 4.;A Oh - ," rim itr�r
Ply#se s s
// e°i7c11 C� ecs�ey !a �iie Fay�ffe - e Rce�lon.,f dFF.`et vL ►?:,.,'sre„ 4 ^
/ r
Reviewer/inspector Name Ae4llle (7ranT,Pi . / {,�:,.- Phone:
���L fair .. _--
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: SoZ -3�a Date of Inspection �-irvq-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O.T6 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check 01fes ❑ No ❑ NA ❑ NE
the appropirate box. ❑wty,f ❑ Ch ists
M-15esign ❑ M s ❑ Ot
21. Does record keeping need improvement? If yes, check the ap ropriate box below. QIV'es ❑ No ❑ NA ❑ NE
❑ ste ❑ 4eok1y-Freebe i Lff Soil Analysis ❑
❑ Rttt €e i ❑ Steck ❑ e�eem ❑ ❑ - s ❑
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
3 1 . 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?
M' es ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
S -KL
❑ Yes
❑ No
❑ NA
0-K—E
❑ Yes
Fie o
❑ NA
❑ NE
❑ Yes
-lljlvo
[]NA
❑ NE
❑ Yes
❑ No
❑ NA
RIN5'
[--]Yes ®No ❑NA EINE
❑ Yes © No ❑ NA ❑ NE
❑ Yes CO No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Addehonal Comments and/or,;Drawings' •, l
Used IJ ola l`e/
6e-5V'I s1"19 fSe. ne.,, ���r�� >cal� rdr ic,, y -e4,
ve 0 "Se foie S,
'�•> COtijt'i7L4G -fo CaaCrk O/t ICpOO.v �aatC S�Ofi. p�Y Ina ar � J �l
f G Ow�G TC] "r�L
q
dqrjor0-JGuQ ocr- j"G1r:CGlt.d�-- 6y SO..,..�artL_ Ce..�4�it�
So• E�. St�c�, N+ec_S .
/.*-) F-' cdk ��/ t..,ra�l. arca k�a� victf�� k(e�davc
`0.4�'
e�a�(�4
WZ-�J) Gollb� TGr.-►G11, r�UG- bG[•h +rte-[ COQ L1r.4t�•.�`,�1114 .
LW
Ca v�� i a h �' F-' � Y'i b ^'F 4 (0 �p 1 � W a -a T �- � � 0. a••. � Yv+O h i 4�" � G � G � L. G
i�6TGa''�Q1 Cha C -S b -L D'� 1014.E la•� W t��•� f t^Va O''C R{�Lr 4Pp�aC¢��pU
�a - �r a. a r L'c y -�d r w• .
F L 12/28/04
i7 i - Plectsc l(eeP a GopY of sod lesi / er-.,Js Gv: tA

f
Type of Visit 0 Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
9 312
Date of Visit: -a Time:
Facility lumber
lot O erational 0 Below Threshold
M—fie-rmitted Eatertifled 0 Conditionally Certified 0 Registered pate Last Operated or Above .Threshold:
Farm Name: —Ae County: Same&_ a�2 _ U
Owner Name: ___�� LlCoca Phone No: "II�J- SSS'G'792
Mailing Address: .3��- Cr . A /Q oi-e U' ;An L 3 g3 8
Facility Contact: T�,++...+-• All 6_ Title: Phone No: . IWO- 592- 15'1
Onsite Representative: 3�,mrh.. �a�..�Lj __ Integrator:
Certified Operator: j;^ �G ���� Operator Certification Number: y0 el
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑Horse Latitude '' 0` Longitude U' �K
Design Current
Serine C.2n2rity Ponulatinn
❑ Wean to Feeder
weeder to Finish 7 rs bio t]
❑ Farrow to Wean
❑oyFeder
❑ Farrow- to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca achy Population Cattle capacity Po uiation
❑ Laver I I ❑ Dairy I
❑ Non -Laver I 1 10 Non -Dairy 1 11
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Laaoon Area 10 S rati l;ield Area 1.
Holding Ponds / Solid Traps ]] No Liquid Waste Management System
Diseharpes d: Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharce originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar_e is observed, was the conveyance man-made?
b. If discharge is obsen-ed, did it reach Water of the State? (If ves, notMl DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge by-pass a lagoon system? (If ves. notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard phis storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier: r
Freeboard (inches): 24
05/03/01
❑ Yes B No
❑ Yes 1_JNo
❑ Yes 13<o
❑ Yes N -
c,
❑ Yes BNo
❑ Yes faNO
❑ Yes B_<o
Structure 6
Continued

{ Facility Number: — Date of Inspection
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0- 3
5. Are there any immediate threats to the integrity of any of the structures observed? ( e/ trees, severe erosion,
❑ Yes
To
seepage, etc.)
Reviewer/Inspector Name
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
0 yes
l_9 o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
Blfo
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
21 o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ErKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[1'9'0-
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
E]'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
7 "e Su
12. Crop type &e �r, v r .r,r
' 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWN0)?
❑ Yes
2 -No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
2-M
b) Does the facility need a wettable acre determination?
❑ Yes
Flo
c) This facility is pended for a wettable acre determination?
❑ Yes
BVo
15. Does the receiving crop need improvement?
❑ Yes
BVo
16. Is there a lack of adequate waste application equipment?
❑ Yes
M4qo-
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
2No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ETNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑-No
Air Quality representative immediately.
'Cotnme s (refer to qiikfi #);'_PExplatin any YFS answejrs aawor any reconimend=oas or afiy_other Co a
'Use drawings;of fsciltty to better explain swtaa�ons. (arse addrtzonal pages as aecesxa_.-
W [al~leld Copy 0 Final Notes
--t
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12/!2/03 Continued

FAciiity Number: 71 Date of Inspection
r
Required. Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P�Ko
22. Does the facility fail to have all components of the Certified Animal Waste Management Pian readily available?
F'4co-rA9 ed /fir_
e �vcr
!�
(ie!"Way, chlydis�u, d�sig3i, maps, etc.)
❑ Yes
o
ffm
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EWo
❑ Waste-Applicat ew ❑Fmobeaid- ❑ lysis ❑ Sell -Set ing
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
BVD
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Bwo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
19No
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on-site representative?
[:]Yes
S -W
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NMES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
❑ Yes
S446-
31.
31. If selected, did the facility fail to install and maintain rainbreakeeis on irrigation equipment?
BKo
32. Did the facility fail to install and maintain a rain gauge?
- Jwa
Mwo
33. Did the facility fail to conduct an annual sludge survey?e
0.1<o g�'y
34. Did the facility fail to calibrate waste application equipment?
;Ss
QR46
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ SUddal; wm ❑ tM i� ❑ ❑ inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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-Same
12/72/03