820328_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

Type of Visit:om iance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: J'," L County: -�d 144
Farm Name: ..L cc S 1 T Owner Email:
Owner Name: 7'k- 11C1�05 - Phone:
Mailing Address:
Physical Address:
Facility Contact: baq"t " 'Title:
Onsite Representative: C
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:FW
Phone:
Integrator: Pfcs
Certification Number: �e' S m
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ ]
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Design
Carrent
❑ No
i3esign Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pap.
Will
W,
i knA
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
, i16miW
Wean to Finish
❑ NE
Layer
❑ Yes
[i]'fVo
Dairy Cow
❑ NE
Wean to Feeder
❑ Yes
Non -La er
I
❑ NE
Dairy Calf
Feeder to Finish
Ij'
Dairy Heifer
Farrow to Wean
161R,gn
Current
Dry Cow
Farrow to Feeder
D , Pt►uIt , k
Ca aei
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_�'
Ot
_I
ITurkey Poults.
Other
I
I 10ther.,
nixiln. IU .... nuu6mi.:..":a
hu Yna.W.n.. .:__. wtiu Yuq:•:• P�vl»I
i:wl Y.wMI*�INk:'.:".WnuW6,._.+&uuutnu
a:. ':.I.is'.If'.luh••'.•••.�'••
,
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ ]
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
-ETNA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
ffNA
❑ 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
©'1\IA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[i]'fVo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
U No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility Number: ;, - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes []'_9o_ ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
❑ Yes
E3 No
❑ NA
❑ NE
rl
Observed Freeboard (in): 2 �-
❑ Yes
0<
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q X6
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[:J o
❑ NA
❑ NE
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
Q'igo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Cg -?do
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q -ado
❑ NA
❑ NE
maintenance or improvement?
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D -go ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;j'llo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /644q'Au--11 96 D yu.0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0<
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'1 0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E] 11-o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:J o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ fo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o
E—]NAE]
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E][ Yes
!!
1/No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility Number. @L - Date of Inspection:
�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ED<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0IZ— ❑ 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 LJ 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 E2-116- ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAW IP? ❑ Yes []rl o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes EB<c ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E31No ❑ NA ❑ NE
Comments (refer to question #):. Explain any YES answers, and/or any.additional recommendati s or.any other comments: y a
gs ty p pages ecessry).
Use drawin offacili to better ex lain situations use�sildit�onal"`as n
. ,� S� JAG r- ,�.~- � f - 1 � •- � - `f l � � - 'f � � .. '-7 �
r
Reviewer/Inspector Name: l � � �?EG� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

ivi"sign of Water Resources
Facility Number - O Division of Soil and Water Conservation x =
® Other Agency1111 110
Type of visit: (5 -Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: .QiRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I A Departure Time: County: J `f�i Region -R&
Farm Name: �jyiti,ty %l �Q ss �'? ✓o'S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: OXA"S„ 50-15 Title: Phone:
Onsite Representative: i Integrator: Ir�t
Certified Operator: (� Certification Number: I�3s"-.3
Back-up Operator: Certification Number:
Location of Farm:
as _1-3 3 L' '?)
Latitude:
Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 25 -N -o ❑ NA ❑ NE
❑ Yes
Design Current
k3 -NA
DesignCurrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Popes , Cattle Capacity Pop.
=.-
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
2S�
,.�'*'�. Dairy Heifer
Farrow to Wean
Design
Curr'ent'' Dry Cow
Farrow to Feeder
D . P,oult ,
Ca scity
Pa x= Non -Dai
Farrow to Finish
La ers
= Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPUIlets'`
k}
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 25 -N -o ❑ NA ❑ NE
❑ Yes
❑ No
k3 -NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes L2 -No
❑ Yes 2'No
CINA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/412015 Continued

Fa 'li ;4urnber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R-N-6—.
❑ NA
❑ NE
a. If yes; is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
l
Observed Freeboard (in): .�
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E51No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
PNo
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ff"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑1 o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L;Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C2"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes FerNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G /?ITI�S Pei j-&<-
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. F] Yes [TNo
El Waste Application [j Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �]l o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
13. Soil Type(s): llrb
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L�-<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[21qo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
❑allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
PNo
❑ 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. F] Yes [TNo
El Waste Application [j Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �]l o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

IFUMity Number: Date of Inspection: _/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4n Tio ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f]'Ko ❑ 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 RE'1�'o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Flo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�r'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
[allo
❑ 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
[trNo
❑ NA ❑ NE
❑ Application Field D Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �10 ❑ 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 [allo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
2/4/2015

Type of Visit: (LKompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: QHCOutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:' 1� L Region:
Farm Name: �G� $ Owner Email:
Owner Name: A Phone:
Mailing Address:
Physical Address: 7
Facility Contact: DA 1J 4,55 Title: Phone:
Onsite Representative: r Integrator: P J�:n 6 VP
Certified Operator: "` Certification Number: 1 2r3 Si�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigu Gurrent
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pog.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
CurreAt
Cow
Farrow to Feeder
D . P,ot
Ca ac'
1'0 .
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
-TurkSZ 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes Yom''- ❑ NA ❑ NE
[-]Yes ❑No
[—]Yes ❑No
[-]Yes ❑No
❑ Yes E"No
❑ Yes ❑ No
[EIT1A ❑ NE
[:f'NA [] NE
ONA ❑ NE
NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Favility Number: Ds ection: In
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
❑ Yes�TTo
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑'moo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[ErK-A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes []To
❑ NA
0 NE
Spillway?:
❑ Yes [yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2' o
Designed Freeboard (in):
❑ NE
acres determination?
❑ Weather Code
Observed Freeboard (in):
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
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.)
❑ NE
Page 2 of 3
2/4/2014 Continued
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
[D -N -o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
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
ETNo
❑ 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
[]bio
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[QrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes�TTo
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
❑ NA
12. Crop Type(s): � ta,y�d 5 G 0 _
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]j<o
❑ NA
❑ NE
the appropriate box.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes []To
❑ NA
0 NE
1 S. Does the receiving crop and/or land application site need improvement?
❑ Yes [yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2' o
❑ NA
❑ NE
acres determination?
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes�TTo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2To
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]j<o
❑ 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
[t 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
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E, -Vo
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Faeility Number: 1WI Z Date of Inspection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �io
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U<o
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 cbarge? 0 Yes dNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R*<o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]Yes OR"'Ro ❑ NA ❑ NE
❑Yes- F] NA [:]NE
[-]Yes [�o [] NA ❑ NE
❑ Yes [!fNo ❑ NA ❑ NE
[:]Yes
EfNo
❑ NA
❑ NE
[:]Yes
eNo
❑ NA
[] NE
[:]Yes
dNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers; and/or any additional recommendations or..any other comrnents� " F
Use drawings officility to befter-expiaw situations use addrtronal: a es as necessary).
w SwY� 10-2-44 L(, 2 Z
(s5c�tbf'�JfItOV"- 11!-� o-13
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
%n,
Phone: C— 33 3 4
Date: 1" FA l J
2/4/2014

Type of Visit: (D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (Yfoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
p S I
Date of Visit: Arrival Time: Departure Time: County Region:
Farm Name: a KbG 11 —41 Owner Email:
Owner Name: kN. Phone:
Mailing Address:
Physical Address:
Facility Contact: - �j �� _Title: ZPAV _ _ Phone:
Onsite Representative: {� integrator: POC411*19
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [3'No ❑ NA ❑ NE
[::]Yes ❑No D -9A ❑ NE
❑ Yes ❑ No ffl�A ❑ NE
❑ Yes
Design ent
�A
❑ NE
[:]Yes
esign CurrenSwine
❑ NA
1P0P
Capacity.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
" 'Design
u
Dry Cow
Farrow to Feeder
Dr. P,oulh.
Ca . aci#y
Po P.
Non -Da -
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
ITurkeyPoults
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [3'No ❑ NA ❑ NE
[::]Yes ❑No D -9A ❑ NE
❑ Yes ❑ No ffl�A ❑ NE
❑ Yes
[:]No
�A
❑ NE
[:]Yes
RNo
❑ NA
❑ NE
E] Yes
❑No
❑ NA
❑ NE
Page I of 3 2/412011 Continued

o?_)
Facifity Number: Date of inspection://
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes nr oo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [D -14o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): h
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2-1Go
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Z-1 6
❑ 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
[3,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Fj_W6
❑ 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
�lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
to
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑'leo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tpL� Sr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ 1"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E;.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[B'R'o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]'Ro
❑ 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?
E] Yes
,__,,
Lttl o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[;�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gTNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes dNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

�Facility Number: Q -Z, ]r 0 i Date of Inspection_# Tj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2,K-5 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E&No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Ido
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[r]Xo
❑ 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
Q46
❑ 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
[jKo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
1P,110
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[a"N' o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
[33 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any,othiehrcomments.
Use drawings of facility to better explain situations (use additional pages as necessary). x ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone V — i
Date: OL
2/4/2011

(Type of Visit: �Kom Hance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: vti & 5_S Owner Email:
Owner Name: r ( Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact:y,�� 5c< SS Title: Phone:
t(
Onsite Representative: f Integrator: p�
Certified Operator: 1 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: latitude: Longitude:
Design Current
❑ Yes
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cittie Capacity
Pop.
[3<A
Wean to Finish
La er
❑ Yes
❑ No
gDN'A
Dairy 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)
Dairy Calf
❑ No
Feeder to Finish
"° '
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dairy Heifer
❑ NA
Farrow to Wean
"-".
Design
Current
Dry Cow
❑ NE
Farrow to Feeder
D , �P4oiilt :
Ca aci `
Pio
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Q#her
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
gDN'A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
eNA.
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
-Wo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Eio
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2014 Continued

Fac2ity Number: - Date of Ins ection•
Waste Collection & Treatment
d: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g4 -N6— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑No E 1 A ❑ NE
Structure 1 Structure 2 Stricture 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 E o ❑ NA ONE
(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 [q.Ne ❑ 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 r:LX5 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�b ❑ 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 E2�<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q-1Go ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2'l�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Q� E] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i9 e f V�G�-`t gXq I P�t
13. Soil Type(s):
❑l'
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[ E No
❑ NA
❑ NE
[:]Yes
[ No
❑ NA
❑ NE
❑ Yes
[2rli'o
❑ NA
❑ NE
❑ Yes [ <o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
[:]Yes QNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below, ❑ Yes [�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo
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
[DNA ❑ NE
Page 2 of 3 2/4/2074 Continued

F'r
Faci ' Number: - Date of Ins ection:
24.i Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �i F]NA ❑ NE
�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 -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 �"T E] NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [2,tT ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ NA ❑ NE
❑ Yes [31No ❑ NA ❑ NE
❑ Yes E],N6— ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [-]Yes E3 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [/rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [fNo ❑ NA ❑ NE
Comments (refer to question #) Explain any;• YES answers and/or ,.any, additional recommendations or any other commentk
Use drawings of'f icility to better exp lainsituatrons (use additional` pages as necessary).:. P. , .
Reviewer/]nspector Name: 1111 Phone: q3,3-
Reviewer/Inspector Signature: , Date:
Page 3 of 3 2/4/2014

I
Type of Visit: omptiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (!Koutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: —/3 Arrival Time: $'"! p Departure Time: / ; County:`��
Farm Name: f - ,� herr%_ 1-3 Owner Email:
Owner Name: ��y r,,� t -C K'4.4 Phone:
Mailing Address:
Physical Address:
Facility Contact: a Title: , ZZh Phone:
Onsite Representative: _ j��,.� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: 4(2
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current 0"
❑ No
DesignCurren#
Design Curren#
Swine
Capacity.: Pop.
Wet Poultry
Capacity�Pop.
Cattle Capacity Pop.
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[]Yes
❑ No
❑ NA
❑ NE
Wean to Finish
❑ Yes
La er
❑ NA
Da' Cow
Wean to Feeder
❑ Yes
EH Non -La er
❑ NA
Da' Calf
Feeder to Finish
p
" �
D ' Heifer
Farrow to Wean
Design�Current
D Cow
Farrow to Feeder
D . Real
.'CCa aci k �Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
s . ,---, , _ .
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eg No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C.No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - Date of inspection:
❑ Yes
DQ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
j Waste Collection & Treatment
Z�No
❑ NA ❑ NE
the appropriate box.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I&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
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Identifier:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 No
❑ NA ❑ NE
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
;�J_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
2kNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
2 jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;gLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): h1D j}"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes [&No [DNA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
DQ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
❑ Yes
Z�No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design [:]Maps ❑Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[54 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
[2 No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ANo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: r- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IN No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 21 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2[ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes KNo ❑ 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 [:INA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes a'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 CR 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 Pq No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Wo --j4-5_-r"Dr_T ao
Date: Sm -42- / 7
2/4/2011

type of visit: Curcom trance inspection V uperatton xevtew V btructure hvatuation V Iecnntca� Assistance
Reason for Visit: Woutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: _ rn 01V Region: _r/Z0
Farm Name: i'c . �A55 rA kff) !`3 T Owner Email:
Owner Name: Any 4( 'R) FiSs Phone:
Mailing Address: 'agzjy lAmAc& -9pa f? -
Physical Address:
Facility Contact: Nay % • ZA5G Title: Q Phone:
Onsite Representative: Integrator: RF ---A 4 q £
Certified Operator: $ D ns Certification Number: 1835 D
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Co No ❑ NA ❑ NE
❑ Yes ❑ No P NA [] NE
❑ Yes ❑ No 5Q NA 0 NE
[:]Yes ❑No
❑ Yes] No
❑ Yes No
]NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 214/2011 Confinued
Design Current
Design Current
Design Current
Swine
Capacity Pop.
- WetPoultry
Capacity Pop.'
C*attle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
ago! a.
_
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D , 1?aW
Ca _aci P -.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Co No ❑ NA ❑ NE
❑ Yes ❑ No P NA [] NE
❑ Yes ❑ No 5Q NA 0 NE
[:]Yes ❑No
❑ Yes] No
❑ Yes No
]NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 214/2011 Confinued

r
❑ Yes
® No
❑ NA
❑ NE
Facility Number: - Date of Inspection:
?
® No
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
171 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]No
R] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Identifier: A�
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[V No
❑ NA
Spillway?:
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[1] No
❑ NA
Designed Freeboard (in): �q
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[4] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): f—CD
13. Soil Type(s): Ub
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 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 [j] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[4 No
❑ NA
❑ NE
❑ Waste Application p 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
[V No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[1] No
❑ NA
❑ NE
Page 2 of 3 214/2011 Condmued

1
Facility Number: - a Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes � No [] NA E] NE
❑ Yes � No ❑ NA [:]NE
❑ Yes " t'' No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes [V No ❑ NA ❑ NE
❑ Yes (4 No ❑ NA ❑ NE
[:]Yes [ No
[::]Yes [� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers: and/or any additional recommendahons;or' ,any other co_mmeOts.
UseArawines of facility to better explain situations fuse additii nal pates as necessary).a�NO
ReviewerAnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
. �u Q.tZS
_.t N 0 4n On �.
Phone: R%0- Uj%- U'%51
Date: IA dL.l a,C \'a.
-T�
2/4/2011

Type of Visit: 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 O Denied Access
Date of Visit: — j Arrival Time: ; p Departure Time: ,'fit County: vr, Region:
Farm Name: ��ygY f�� S act -
--Owner Name: ,n rt •�— �j�t s t
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: pac-rn - y �{ `R i<s _ Title: w 49wo r e-- Phone:
Onsite Representative: ���e.��- Integrator:7/Z'�'��
Certified Operator: �Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design : Current
Dry Cow
Farrow to Feeder
Ca acity_ Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
--
Other
Turkey Poults
Other
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes (& No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Rt No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

FaciliNumber: - I Date of Inspection:
/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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
[ 4 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2g 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 rV1 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 I ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): >R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [::]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [& No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [[ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes n No
❑ Waste Application p 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA [j 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 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 fait to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
❑ Yes 0No ❑ NA ❑ NE
[:]Yes CR'No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes JNo ❑ NA ❑ WE
❑ Yes ES No
❑ Yes�No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question s): Explain any YES answers mmd/or:any additional recommendations -or.- aii other comments:
Use drawings of facility to better explain situations (use: additional jYdg& as necessary)..-: ...
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:gjry— GJ3�--33 ov
Date:
2/4/2011

A
Type of Visit iP<ompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit vutine Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit:--L=L-U Arrival Time: ; DO Departure Time: ; ] D County: Region:
Farm Name: ,I)e2an x h ���4 �a/� 1-3 _ Owner Email:
Owner Name: t4_ ass Phone:
Mailing Address:
Physical Address:
Facility Contact: Q"= K Br"ss _ Title: Phone No:
Onsite Representative: Integrator: Er z S
75
IF
Certified Operator: 5�4—� Operator Certification Number: 1635_D
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=t =it Longitude: 0 ° =I = u
DiiIiiii
esign Current
Design Current
Design ►urrent
Swine Capacity Population
Wet PoultrYM apacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ NA
❑ Dairy Calf
IRFeeder to Finish Q -f- / D
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
%No
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turke s
Othe
❑ Other
10 Turkey Poults
❑ Other I
Number of Structures:
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)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0[No
❑ NA
❑ NE
[:]Yes
%No
[:INA
❑ NE
Page 1 of 3 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): j 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E[No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes J9 No ❑ NA ❑ NE
❑ Yes RNo ❑ 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 9No ❑ 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 94No ❑ NA CINE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 04No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes bio ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 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) _l,2t/�iC_S,er J
13. Soil type(s) a -'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ISNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [SNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes B No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
Comments (refer to''guestion##). Explain any'YES ansvters and/or any�recommeudations or, anyxother comments. .
Use.'drawings',-Of tacili. to better explain situations use addtttonal pag as ne
ty p cessary) _ M
lw Ti
Reviewer/Inspector Name ! .✓� u �.,. #"� . i - .;f hone: 9joj!L_ 3'3
A MIN
P
ReviewerfInspector Signature: Date: g--'
Page 2 of 3 12/28/04 Continued

Facility Number: —3 Date of Inspection
k
y
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 9 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 B No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
54 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
GS.NO
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
n No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
18 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Addttio 'iV&6ments and'Jor`;Dra
m -
7
Page 3 of 3 12/28/04

Type of Visit QK�outine
ce Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: I`�
Farm Name: �n.?rrN S.S 7�/�r/Y!^� Owner Email:
Owner Name: IV n- _[�_ -{ Phone:
Mailing Address:
Physical Address:
FacilityContact: f K Title: Phone No:
Onsite Representative: Integrator: �2't'�a i _
C -
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I ="
Longitude: = ° ❑ I = u
Design Current
Swine i Capacity Papulation
❑ Wean to Finish
"
Wet Poultry
❑ La er
Design Cnrre Design Current
Cap acityP,opulahon Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
Layer
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Calf
Feeder to Finish
'g"#
❑ Dairy Heifer
❑ Farrow to Weanfirms
Dry Poultry
❑ NA
El Dry Cow
❑ Farrow to Feeder
:4
`P
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
ers
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
ElBeef Feeder
❑Boars
❑ Pullets
❑ NE
❑ Beef Brood Co
• t
El Turkeys
❑ NA
�
Other
-�
❑ Turkey Poults
X No
❑ NA
❑ Other
❑Other
Number ofStructures;
Page I of 3
12128/04
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation'?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
X No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
[KNo
Spillway?:
❑ NI:
15. Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in):
RNo
❑ NA
Observed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
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.)
®.No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
t4 No
❑ NA ❑ 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
KNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
5dNo
❑ 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
R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
IQ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Pq No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NI:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® 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
(9 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any:other comments. �.
Use drawn s;
r
g of facility to better explain situations: (use addittonalpages as necessary)
Reviewer/Inspector Name f - - - ,. Phone:
Reviewer/inspector Signature: Date: -vzZi

Ll
Facility Number: — Date of Inspection
Renuired 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[ob( No ❑ NA ElNE
the appropriate box. ❑ WUP [] Checklists ❑ Design g El Maps [:1 Other
21 . Does record keeping need improvement? if yes, check the appropriate box below. []Yes [?t No [INA ❑ 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
(gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[SNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[a No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
34.
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
[d 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
[R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
%No
❑ NA
❑ NE
Page 3 of 3 12128/04

0_15ivision of Water Quality
I MFacility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit ID-Co'nipliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — 07 Arrival Time: l) Departure Time: �nD County: Region:
Farm Name: DCUrf h fQ+1" #*Y� Owner Email:
Owner Name: ^ r1r1 Al Y r 13A,4,5 _ Phone: I/ C) �S, I�y— C�21 ' b
Mailing Address: O� / y 1"} cc tj±, rr_ d _ c -►. 7�7 `' N �` ��� ��
Phvsical Address:
Facility Contact: y 2645 Title: Phone No: 2LI-'
Onsite Representative: In#egrator:7VX
Certified Operator: ^ _ S'�--.-� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Sack -tip Certification Number:
Latitude: =0
=4
Longitude: =0=1 ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I E��]
❑ Non -Layer
Other
❑ Other
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [U]
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 RNo ❑ NA ❑ NE
❑ Yes
49 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [K No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection �D
4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in):
ly-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes R] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes fR No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R No [--INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Kfo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)r%�t4I�-/Yfu J. /
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 acre determination?❑ Yes
ES No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
k9 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 Nance Phone: 3 3
Reviewer/Inspector Signature: Date: 450-- 3D
12/28104 Continued

s Facility Number: tfg3 Date of Inspection 'J^
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Do No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (_No ❑ NA ❑ NE
the appropirate box. ❑ 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?
❑ Yes
E& No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality 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
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit [O Compliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit 016utine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Arrival Time: Departure Time: County: ,,, y!I 7M Region:
Farm Name: Da 11 b U t'C Dai 4 r17 r' ►"' Owner Email:
Owner Name: J20 ki 12
% S Phone:
Mailing Address:
Physical Address:
Facility Contact: Do" n te J544 5 __ Title:
Onsite Representative: J�itr_
Certified Operator: S
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 325`o
Back-up Certification Number:
Location of Farm: Latitude: = o ='
= Longitude: = ° =' =
Design Current
Design Current
Design Current
❑ NA
n
Wet Poultry Capacity Poapacity
Population
Finish
M7�ee7er
❑ La er
a. Was the conveyance man -trade?
❑ Yes
❑ Dai CowFeeder
❑ NA
❑ NE
❑Non -La er
❑ Yes
No
❑ Dai Calfo
❑ NE
Finish
❑ Dai Heifer
w to Wean
Poultry
❑ D Cow
® No
w to Feeder
""`Non-Dairyw
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
to Finish
s❑
Beef Stocker
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
La ers
Beef Feeder
❑ NE
other than from a discharge?
❑ Pullets❑
❑ Beef Brood Covd❑
Turke s
12/28/04
Continued
❑ Turke Poults
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
❑ Yes
q No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
® No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JU No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number. — Date of Inspection
Waste Collection & Treatment
13.
Soil type(s) QA
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
4 No
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
R No
❑ NA
❑ NE
Spillway?:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
RNo
❑ NA
Designed Freeboard (in):
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Observed Freeboard (in):
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
pq 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
;4 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1 ] 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
p Yes
90 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I0 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) IS,rn4 u of 471a1 /.S.sy�,l.E' [�rG;n 19✓rr,
F�DO� �cz�lyL.
Reviewer/[nspector Name 1+�/i'p. „%/pati ,, ..r Phone:
ReviewerlInspector Signature: Date: P6
12/28/04 Continued
13.
Soil type(s) QA
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
RNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
q No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
qNo
❑ NA
❑ NE
F�DO� �cz�lyL.
Reviewer/[nspector Name 1+�/i'p. „%/pati ,, ..r Phone:
ReviewerlInspector Signature: Date: P6
12/28/04 Continued

Facility Number: g' Date of Inspection w
Rewired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
KNo
[--INA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
N No
❑ NA
❑ NE
the appropirate box. ❑ WOP ❑Checklists [3 Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
FCA No
[INA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rVi
tq No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JaNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
r---q No
[INA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
jpi No
El NA
[:1 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[]Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RQNo
❑ NA
❑ NE
Addtttona.E Coaiments'and/or`Dra�`viiigs �� � � j `��`� k�'� t
11/28/04
11/28/04

Division of Water. Quality
—) Q Division of Soil and Water Conservation
- Q. Other Agency
,
F eilriyy Number
2
❑ NA
❑ NE
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: $ Arrival Time:n: !a Departure Time: � County: .5 "—dam d OW0
'J Region: F
Farm Name: _ Oda V%!A V, IJ
______ _4.4+i Owner Email:
Owner Name: a Phone:
Mailing Address: _ 7 9 y y eqUddGr RCK G �•I- �/ C �8
Phvsical Address:
Facilitv Contact: Title: ,]Phone No:
Onsite Representative: _ C)!&V%v.�I C.i_,.i Integrator: e....+ % r_
Certified Operator: 9L IP% esSJ Operator Certification Number: 1EJX0
Back-up Operator:
Back-up Certification Number:
st
Location of Farm: Latitude: ❑ o = i ❑ Longitude: ❑ o =,
❑ "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Laver
!❑ Wean to Feeder 1 10 Non -Layer
Other
❑ Other
Dry Poultry
Non -L.
Pullets
jJ 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'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy hleifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 [X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
III No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
11/18/04 Continued

ti
Facility Number: Date of Inspection G a3
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R1 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:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
60 No
Observed Freeboard (in):
❑ NE
5. Are there, any immediate threats to the integrity of any of the structures observed?
El Yes
® No El NA ❑ NE
(ie/ large rees, 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 pian?
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
Ft No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[A No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ ] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside
of Area
fJ
12. Crop type(s) B�,tM�4r�e� �f �u / S 4�� Cs ra i +.. k. h
--
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 acre determination
-❑ Yes
❑ No
IN NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
60 No
❑ NA
❑ NE
Reviewer/Ins Name "_�
p e':t Phone:
ector
Reviewer/Inspector Signature: Date: t* DS
12/28/04 Continued

S
Facility Number: $r2 — 3 Date of Inspection Z 1 -""
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [--]Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No [INA ❑ NE
the appropirate box. ❑ WUP 0 Checklists
❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ErYes ❑ No ❑ NA ❑ NE
❑ Waste Application 0 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
FXI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[B No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
V 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
C9 No
❑ NA
❑ NE
Addihoua!''Co`mments'aud/jor Drawia ` �r * r �►�; ¢ � ,
J�rCIr— �pbaVlek CT 4-0 V 4"k iaRalc_ k C. RDV_11w
d._ 1 tr tyt l n r 1
O t k.w► c qJ'{ i�'L Q y�-}-l. W a c F z s f n ►'. �t N t G7� i 064.c.
12128/04

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit fo Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number oZ Date of Visit: y i y Time:
Not Operational Q Below Threshold
(Permitted ©<ertified © Conditionally Certified © Registered Date Last Operated or Above Threshold: -•---._. __ ..
Farm Name:�
------LLa .....
f -140n � ..» _. ..F/? U _.
6y-MaOwner Name: ----....._.. PP 122 y ............. .....��?�S _.. Phone No. �� v` 96'1-
Mailing
iling Address:... Vit. ` ...........H vtT.. fe.r Rd. ... .. ----------
Facility
--- -----Facility Contact: `------oL 1.... 6Q.0 ................. Title: Phone No: �9/ S9 9 G
Onsite Representative:0_92.4.n Gr
......Inttor• ~` • 1
Certified Operator:.... --..,...,,.,,,fir a 4..._...._ aaI j ............ Operator Certification Number:._.J-93.r-0.....
Location of Farm:
❑.Bwine ❑ Poultry ❑ Cattle ❑ Horse etude • ' u Longitude ' ' «
D_ischames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑'lTo-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ['NNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E1'Qo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0-1Vo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Qqo-
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes i_ -N`6
Structure l Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .................................... ........................... ---... ..... -•-•-...................... ........................ ...........
Frecboard (inches): rj
12112/03 Continued

{ Facility Number: — L
Date of Inspection ®O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes 0 -No
❑ Yes �
❑ Yes ❑-W
❑ Yes U -No
❑ Yes [TRo
❑ Yes �o
❑ Yes B No
12. Crop type U er.�+�r%R �t/a jm&ll
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes B -No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [3 -No
❑ Yes UNo
❑ Yes [J -No
❑ Yes 8 -No
❑ Yes Eg-No
❑ Yes ❑ No
❑ Yes GW6
❑ Yes [3Xo
❑ Yes 13 -No
'Comri encs {r`efer to gnest;on;) F.ikpianq,any YE5 answers a d/or i�ecommeniiations ar as other oom_ments. =
:Use dEra•�'-}( of fg toterpla:n simatioas. (use-tt al pages as r9? teld Copy ❑Final Notes
-
•
� 7
Reviewer/Inspector Name
.�
Reviewer/Inspector Signature: 227., A Date:
12112103 Continued

Facility Number: g2 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9.90
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
p 1
6GSs /7pS �vrn� ��5 Loay/a� F.'E/�S �Q ��Mp rout f'i �s
(ie/ WUP, checklists, design, maps, etc.)
❑
p'ivo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Bl�o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
Fa r 0) ,'S we leelo
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑-N'o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑'1-(o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
UN6-
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
QXo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑14o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑-Wo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35) ❑ Yes UNO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddittnaal:(:cimments-
p 1
6GSs /7pS �vrn� ��5 Loay/a� F.'E/�S �Q ��Mp rout f'i �s
yCar' f
rM/',
)7 65 5 c ocj rcCorUS
Fa r 0) ,'S we leelo
12/12103

Facility Number. 12 ---f 2
S
Division of Environmental Management Se, pj%e_- µ (Ales L;s+}
Animal Feedlot Operations Site Visitation Record
Date: Z -13 -y 6,
Time: / 3 5
General Information:
Farm Name: rba N N Y, 8 ct s s Favi.,. _County:_54a P so Al
Owner Name: D o N 13 a s s Phone No: (WO-) 56 4L - z s' F
On Site Representative: k . Ross Integrator. rc �' c Fg ,,•�
Mailing Address: Z'19-4 H4"4e-r Rd .
Cly-i7Lcntj `d 3 Z.8
Physical Address/Location:_ 4,-A -7 o l u o. -j, -I-Z, SR_1 Z /* t-� � d N d 50 e- 0
5fL 1'15'9 -6-v"-6-v"ie_Ff- amJ 5o 4� '51L 1731.a - PVvr- �Z INIC _ S /NYE SGi i�
cC4- _
Latitude: 1 1 Lon 'rude: 1 I
Operation Description: (based on design characteristics)
Type of Swine No. of AnimaLt Type of Poultry No. of Animals Type of Cattle No. of Animals
0 Sow 0 Layer 0 Dairy
0 Nursery 0 Non-Lqa ❑ Beef
Mfeeder -Z.-2- O S
01herType of Livestock- Number of Animals:
Number of Lagoons: 1 (include in the Drawings and Observations the ficeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man -trade Q Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvasent)
Crop type:"a_ Nta.,_ Acreage:
—7
z Yes 0 No Gf'
Yes 0 No ar'
Yes 0 No i"
Yes ❑ No 3-'
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled, within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI - January 17,19%
Yes 0 No t'
Yes 0 . No M-'
Yes ❑ -Noce/
Yes ❑ tNo ar .
Yes O No
Yes ❑ No iY.

Maintemwce — /
Does the facility maintenance need improvement? Yes © No Cr'
Is there evidence of past discharge from any part of the operation? Yes 0 No O"-'
Does record keeping need improvement? Yes ❑ No l'
Did the facility fail to have a copy of the Animal Waste Management Pian on site? Yes L'No ❑
Explain any Yes answers:D4 e raJ-,aN /gnu S � obta� r1 �! W r'o ✓e cl
(�LLSK LkQ lu ft CAMLw.a 1 ' CL l�.l� [.C� N R� -Dt-c--"tom✓ 3 7 r
Signature:
cc Facility Asse nsent Unit
Drawings or Observations:
L: tji:
AOI — January17,1996
Date: �L - c2 - 9 6
Use Attachments ifNeeded
-. ♦�.:: :{:1 ^:_.t.%ii �•�-••w._r1�r.. .. �, _ ......