820331_INSPECTIONS_20171231

NORTH CAROLINA
-�
Department of Environmental Qual

CUs (ft 13 t=om& ('6-
l7 C) Type of Visit: 0 CaHance Inspection U Operation Review U Structure Evaluation Technical AssistanceRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ;.3 Departure Time: County: Regio 1
Farm Name: � }' 1�A1l ) e,, -f Owner Email:
Owner Name: S iti &Je,, r Phone:
Mailing Address:
Physical Address:
Facility Contact: S' �[�"r Title: Phone:
Onsite Representative: l i Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
Design
[]-No jD-NA
De ign
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Gurrent
,Current
a. Was the conveyance man-made?
Gnrrent
i
Swine
Cagel ty , Popi::
Wet Ponitry
=Capacity
Pop.
Cattle Capacity
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
❑ Yes
❑ No
Layer
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
Dai Cow
Wean to Feeder
❑ NE
I
INon-Layer
I
❑ NA
❑ NE
Calf
Feeder to Finish
Heifer
Farrow to Wean
Design Current
DrvCow
Farrow to Feeder
tW
lNon-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[]-No jD-NA
ON E
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes
❑ No
;3-11A—
"A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3-5A
❑ 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
[210A
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
[3No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued
W

Faciliumber: jDate of Inspection: '
Ej'No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
&
Yes
,�,�g�
4. storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑
El -go
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in): b2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El"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
[K�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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
[a'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E31�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
ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2"'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /� ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): ,� j' !;- L 0
13. Soil Type(s): , 6 CU IJiti
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,p -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3`90 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'Po ❑ 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
Ej'No
❑ NA
❑ NE
❑ Yes
[TN_
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ej­No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2 -No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:)Yes ❑ NA ❑ NE
Page 2 of 3 2/4/7015 Continued

Facili umber: - j I I Date of Ins ection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ Vo
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g 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? ❑ Yes E "Io
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6__No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑-1�o
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2 -Ko
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
r
[2No
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
BNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Io
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E] NA E] NE
E] NA ❑NE
Comments (refer to gaestron #) ,Explain.any-YES:answers:an ouany additional reeommendationsi'or;anyioth'' eommeiats:"' , a
-y
Use drawings o%facil#y.to.better;egp[ain�:srtgahons(ase add�rhona� pages as necessary).;r'` lll:'k� i' m•
�-
cillltt c,&-4fon �_ ( �'
4e Iry
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:1 ,4 3 3--K
p�'T
Dater 0
21412015

1)
Type of Visit: (ff`C�,o/mpliance Inspection U Q Q Operation Review Structure Evaluation Technical Assistance
lJ I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: SO -K jk-lf f �'� Owner Email:
Owner Name: A0,44 d,44 �f Phone:
Mailing Address:
Physical Address:
Facility Contact: `at►V%-
Onsite Representative: y
Certified Operator: tj
Back-up Operator:
Location of Farm:
Title:
Latitude:
Region:f V
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes E444e- ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made'? ❑Yes ❑ No E]�
Den
st g Current Design Current
Design Current
CapacttyPop Wet?Pry; Capacity `` rPop
Cattle Capacity Pop.
'.
Wean to Finish
Wean to Feeder
llo
[] NA
❑ NiE
of the State other than from a discharge?
Feeder to Finish
Design Curren
1)..211140tC►.a aci Po
.
Dai Heifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
-
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
-
Turkeys
Other
_ ..—TurkeyPoults
Oth er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes E444e- ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made'? ❑Yes ❑ No E]�
Boars
-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) E] Yes ❑ No Q -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑Yes ❑ No [TNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes allo (DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes a
Phone:
Integrator: _ tc
Certification Number: YM
llo
[] NA
❑ NiE
of the State other than from a discharge?
Page 1 of 3 21412015 Con6nued

Fqcility Number: jDate of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No LA [:]NE
Structure 6
Spillway?:
❑ Yes
[2"No
❑ NA ❑ NE
Designed Freeboard (in):
❑ Yes
[�No
❑ NA ❑ NE
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes gE No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
ff No
❑ NA ❑ NE
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?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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 �io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �o
D. 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<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [R"Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ®
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ofApprovedArea
12. Crop Type(s): 9 C /N[,c.c�p(� 44,x, 6.J�gme—
<54 wk
r
13. Soil Type(s):of
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 �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E31No ❑ 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 LE�fio ❑ NA ❑ NE
❑ Yes [--Wo ❑ NA ❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2"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
ff No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
D 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 YNo ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Fgcili Number: 3 31 jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
k No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
gl�o
[] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon.+
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[?*-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2 -No ❑ NA ❑ NE
❑ Yes [2"No ❑ NA ❑ NE
[] Yes [;3No ❑ NA ❑ NE
❑ Yes [;?'No ❑ NA ❑ NE
❑ Yes ENo D NA ❑ NE
[:]Yes [n No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations fuse additional Daees as necessarvl.
C,Jc% vo&"Ot-i —
Reviewer/Inspector Name:
Reviewer/Inspector Signatuz
Page 3 of 3
I �_ I' (-5
P- 3,7
Phone: i✓
Date:
2/4/2015

F
Type of Visit: (BrCoZoutine
fiance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: C 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: UMM & Arrival Time: Departure Time: County:ghw Region:��O
VV
Farm Name: 2 ,O�/` Owner Email:
Owner Name: �Gts�,� i Phone:
Mailing Address:
Physical Address:
Facility Contact: -56C Vi
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
1t
Title:
Latitude:
Phone:
Integrator: P/Nc�-4qeC
ertification Number: /0 r''
Certification Number:
Longitude:
Design
Current
[ rfl o
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity'
Pop.
Cattle Capacity Pop.
Wean to Finish
F7,Uer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Da Cow
❑ No
Wean to Feeder
I INon-Layer
I
Calf
Feeder to Finish
-
❑ Yes
❑ No
Datry Heifer
❑ NE
Farrow to Wean
❑ Yes
-Design
Current
Dry Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Feeder
D . P,oultrCa aei
_PRo
Non -Dairy
of the State other than from a discharge?
Farrow to Finish
La erg
Beef Stocker
Gilts
Non -La erg
Page I of 3
Beef Feeder
2/4/2014 Continued
Boars
Pullets
Beef Brood Cow
_
Turkeys
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ rfl o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[frlq-A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3 -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
/
[R<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E4-,I<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ElNo
❑ NA
❑ NE
of the State other than from a discharge?
r
Page I of 3
2/4/2014 Continued

Facility Number: - Date of Inspection: 111b I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET -go' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IS1"A" ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 ET<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 E§<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E2�&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 Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [xNo ❑ 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 Dryft ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
AMENUM
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
❑ Yes
E5'1 0
❑ NA
❑ NE
❑ Yes
0 o
❑ NA
❑ NE
❑ Yes
[3A*o__
❑ NA
❑ NE
❑ Yes Es <o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ea No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_
[]Yes
�No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!f2No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

[Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [_Jo ❑ 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 to provide documentation of an actively certified operator in charge? [:]Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g -19'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i -e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E441o' ❑ NA ❑ NE
❑ Yes [ ,No ❑ NA ❑ NE
❑ Yes Bio ❑ NA ❑ NE
❑ Yes [3''To ❑ NA ❑ NE
❑ Yes [!r No
❑ Yes dNo
[:]Yes ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explaw 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
I �__ 9 (s
t
Phone: J
Date:
2/4/2014

Structure Evaluation Inspection
Facility Number: �� - 33i Date: /?41�xc4
Time in: W61 Time out: 1 f 2-0
Farm Name:'1��� cz Farm 911 address:
Owner Name: wl2r!`(
Facility Contact: t�
Onsite Representative: Integrator: C-101
45
Operator:
[t
Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No. (,—
Structure: 1 2 3 4 S 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): -
v Are there any immediate threats to the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste managemen system need repair Yes No
t
Condition of field's Y i ` �ej _
Condition of receiving crop " "V-"
Comments:

(Type of Visit: 0170liance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit:utine Q Complaint O Follow-up O Referral Q Emergency () Other O Denied Access
f
Date of Visit: .�, Arrival Time: C Departure Time: (" County: `s yM Region:(--- D
Farm Name:
l wq
A
e q �a4^+ _
Owner Name:
��
jeyr
Swine Capacity Pop.
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: for`'P$`
Certified Operator: ` Certification Number: KPU
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design
Current
Swine Capacity Pop.
We# Poultry
Capaeity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
i
Dry Cow
i
Farrow to Feeder
D-Fy2MW
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
HOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [q -N`6__ ❑ NA ❑ NE
a. Was the conveyance man-made? []Yes ❑ No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes ❑No [ A Q 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 0-1 A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E3<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [n"No ❑ NA ONE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Face i Number: r�, -, -73 Date of Ins %AC75-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
[r'No ❑ NA ❑ NE
❑ No [3-ITX ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 31
❑ Yes
Qlo
❑ NA
[] NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
or'N""o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
❑ Yes
ffN o
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
�io
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0 No
❑ 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
UrNNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[-]Yes
EJ'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 EI N ❑ 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes to ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): y } elAj y_L S C7 M�
� i
13. Soil Type(s): (�a 0 1
❑ NE
v. _.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Qlo
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
' 10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ffN o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application'?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Ep o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Quo
❑ 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 .i 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 'E3 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes u No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes l_J No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

FacititayNumber: -4.3 jDate of Inspection: G
i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yesrj__No
[:]NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes DK ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [l'No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
C2rN'o
❑ NA
❑ NE
ONo
❑ NA
❑ NE
R: N_o
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
........ r , r
Date: L %
2/4/2014

J;A
Type of Visit: FCom nee 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: Arrival Time: , Departure Time: County&, RegionO I
;
Farm Name: G�f —i—`—
Owner Name: ff
Mailing Address: J G ,5(
Physical Address:
t A)c 7,t3,7-
Facility Contact: Title:
Onsite Representative: �C
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 it j�_
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design:_°Current
�.
C jl ❑ NA
Design
Current
Design Current
Swine
Eapac�ty .Pop.
Wet Poultry
Capacity
Copes.
Cattle Capacity Pap.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Finish
❑ No
D -KA -C
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
airy Cow
Wean to Feeder Non -La er
aity Calf
Feeder to Finish
❑ Yes
❑ No
/
L?KA
❑ NE
airy Heifer
❑ Yes
Farrow to Wean
[DNA
❑ NE
Design Current Cow
❑ Yes
Farrow to Feeder
❑ NA
D . P,o_ul
Ca .actty�P,o
Non -Da'
Farrow to Finish La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pallets
Turke s
Other
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
�.
C jl ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NoQ"
i�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D -KA -C
❑ 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
/
L?KA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
G<o
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑-Nk
of the State other than from a discharge?
I
Page 1 of 3 2/412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E�Xo ❑ NA ' ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [j j1 A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes L 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 IJ"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
IJ 'Yom
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-'Iq—o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
DTo
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
❑ YesNo
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑? o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �{ �I�L�.�� �� 0 xcrlll�`1 4116—e . - ..
13. Soil Type(s): 90 _ r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�To
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DTo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CJ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Vo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes Vxi'o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
❑ Yes [�f o
[—]Yes eNo
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm' it? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L D 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Ko" ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ejo< [:INA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:.
❑ Yes �No
r
[:]Yes Ej"No
E] Yes El"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Wo ❑ 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 [1f No ❑ NA ❑ NE
Use drawings of facility to better explain situations (use additional paaes'as.necessary) = , - ,f y �.
Comments refer, to question ,#): Explain an YES answers andlor an additional recommendations or.an other commen -„
a(% J-4 t pv� __1
sUkye�t.w,7—
Reviewer/Inspector Name:
ReviewerlInspector Signature:
la- IH3
g-31 -13C9-2. 9
i ( Uv
�► p� 1, A
Phone: o— 1 3 3_3 3
Date:
Page 3 of 3 2/412011

it s C(2 -ti -19
Type of Visit: ('CoZuntine
nce Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access ��
Date of Visit: Arrival Time: Departure Time: V County: Fx� RegionFvo
Farm Name: S WAF /14 Owner Email:
Owner Name: Sew, r� Phone:
Mailing Address:.
Physical Address:
Facility Contact: S ,
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: Phone:
Integrator:
Certification Number:
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?
[:]Yes E3 o ❑ NA ❑ NE
[:]Yes ❑No [JNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
PTNA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pantry
Ca ty
Pop.
Cattle Capacity Pop.
❑ Yes �
Wean to Finish
E] NE
La er
❑ Yes Vo
❑ NA
Da' Cow
of the State other than from a discharge?
Wean to Feeder [Non -Layer
Feeder to Finish
Farrow to Wean O De 'gn O r.
s� Cu
Da' Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
D , P,oul
Ga aci
1'fl
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts.
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
P-MOtherr
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes E3 o ❑ NA ❑ NE
[:]Yes ❑No [JNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes ❑No
PTNA
❑ 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
�lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �
0 NA
E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes Vo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

44
Facili Number: - Date of—inspection. 'I ju 5fi-9
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 210 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
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 [;R'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 IP4 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ey<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
Udo
❑ Yes
O N
❑ NA ❑ NE
Q NA ❑ NE
❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�
� 'Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
V -N-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
[C] -iia
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2'go
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
F "'o
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [R'14"o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I ` ,No' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [[R'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q -<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [B -N-5 ❑ 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 ga'V V ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) I
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [a�-N6 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M-tlro—E] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes [j � ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes O o ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
21412011

(Type of Visit: QCom lance inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: f }- Arrival Time: Departure Time: County ••�AT Region: F%Z6
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: '50.1n, A r\p (ZS Title: _ 6 Wyui rZ � Phone:
Onsite Representative: �qrnIntegrator: I fiEsI n4,6 FgQ,+5
Certified Operator: S�A rAC)E �5 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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
g
Desi gn,
Current
Design Current
Swine
Capacity Pop. t'. it
Capacity
Pop.
Cable Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
:... .' `" " ..
Dairy Heifer
Farrow to Wean
'' ''+
Design
Gurrent
Dry Cow
Farrow to Feeder
D „Poul
Ca aci
Pa
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyFoults
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ 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 EZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E;rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facili Number: - 3 I 1 Date of Inspection: 107]
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: $4 a_
❑ No ❑ NA ❑ NE
[—]No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y�5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes 0�'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes [ "No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [f No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [y No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): `M PA -T 0'£
13. Soil Type(s): V) T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ 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 [1rNo ❑ NA ❑ NE
❑ Yes E+ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21 No Q 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 E4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [3(N
23. If selected, did the facility fail to install and maintain rainbre.akers on irrigation equipment? [:]Yes [] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
• NA ❑ NE
Page 2 of 3 2/4/2011 Continued

L _
Facili Number: 'J1 - jDate of Inspection:
1-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ef 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 M No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes �No ❑ NA ❑ NE
❑ Yes 4NO
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [(No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E�No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
IComments (refer to question # : Explain any_YES. answers and/or any additional recommendations or any, -t} er comments.
.Use drawings of.facilityto. better explain situations (use additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]-[e O
Date: (]
21412011

Type of Visit Grtompliance inspection O Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i [� ; O� Departure Time: ; p p County: Region:
Farm Name: '5a-kn Ar al t.'Cs aha r m- Owner Email:
Owner Name: .a a�'�'l �`.S Phone:
Mailing Address:
Physical Address: ff
Facility Contact: Sa-,...-._ apjS Title: Own YL— Phone No:
Onsite Representative:'— Integrator:
Certified Operator: Ste_ Operator Certification Number: I�-jy3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
="
Longitude: = ° =' =
Design Current
ineacity PopulatyCapacity
Wean to Finish
p
Design Current
Population
❑ La er
Design Current
Cattle Capacity Population
❑Dai Cow
Wean to Feeder
❑Nan -La er
airy Calf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
Feeder
PE3Boars
❑❑Beef
Puiiets
❑ Beef Brood Ca
❑ Turkeys
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑ Other I
Number of Structures:
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
QNo
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
QNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[21No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/28104
Continued

Facility Number: j Date of Inspection SIJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RNo ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ts -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ NA ❑ NE
(tel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes EffNo ❑ 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? [KYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes
B No
[INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any park of the waste management system other than the waste structures require ❑ Yes
94 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
g[No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 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) a p o
_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
El No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
14 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
QZ-No
❑ NA ❑ NE
Reviewer/Inspector Name '0 Phone:
Reviewer/Inspector Signature: Date:
mage t of s 1 uloivq uununueu

Facility Number: — Date of Inspection
Rtguired 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 (4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers (Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P 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
L,No
❑ NA
❑ 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
allo
❑ NA
❑ NE
Other Issues
28.-
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ 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
C4 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
EN No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0,No
❑ NA
❑ NE
Additional Commenti and/or Drawings _
tA
Page 3 of 3 12/28/04

I
Type of Visit QLGOmpllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit -outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Z, J97 Arrival Time: �: O� Departure Time: �D ; Ot7 County: .S Region: EL12
Farm Name: __57,z,= A- -t j =t g iia"rl- - Owner Email:
Owner Name: ', al.j - A A J Z�. e- 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Title: _ DtL)net' Phone No:
Onsite Representative: •S�'—�� Integrator: .1 r�
Certified Operator: • Operator Certification Number: L K3` -3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
= u Longitude: =0=1 ="
1INIDesign Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Q Feeder to Finish D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Current
Wet Poultry U-0apacity Population
❑ Layer
❑ Non -Layer
ililliDsy Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
I❑ Beef Feeder
D Beef Brood Cowl I
Number of S#ructures:
1. Is any discharge observed from any part of the operation?
❑ Yes
IkNo
[:INA
❑ 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
O„No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
11/18/04
Continued

Facility Number:f
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:
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure.5 Structure 6
Spillway?:
Designed Freeboard (in): J g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IN 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 ESNo ❑ 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 [9 No ❑ NA ❑ NE
8. Do any of the stuctures 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 &No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes K No ❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑I Evidence of Wind Drift ' ❑ Application Outside of Area [�
12. Crop type(s) ��'1"i'►u9�c /BT/t�S rd /f1C1�917��1if!i r�lt7J/iy6cL L -- -
13. Soil type(s) �L,c�•,/t g -`r`' - - - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 8No [:INA ❑ 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 tack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to:question #E): Explain ani YES'answers and/or any _recommendi ibi or any other comments
Use drawings of facility to better explain situations:: use additions! Pages as necessa _ -s-
p ( F g r-' )-
kp F� < « A71���-tom �s
3 i �� u FDr r or�
•
Reviewer/Inspector Name ��
Phone: `f70`1/53- 33 1O
Reviewer/Inspector Signature:
Date:
12/28104 Continued

Facility Number: —33 Date of Inspection
r`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ ATUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
&Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
13 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
59 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
25No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
ffNo
❑ 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?
R.Yes
❑ No
❑ NA
❑ NE
Mn! nts--i
12/x8/04

•
Type of Visit QLGampliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit:/ (i `1`1 Arrival Time: Departure Time: County: S+- Region: L 'W
Farm Name: A'e s Fa {nom. Owner Email:
Owner Name: yam— 74 n C S Phone:
Mailing Address:
Physical Address:
Facility Contact: �� -�^— 4"1"« Title: �U �� �r Phone No:
Onsite Representative: Integrator:
l%
Certified Operator: Operator Certification Number: I Z 3 43
Back-up Operator:
Back-up Certification Number:
Location of Farm: i Latitude: [::] Q 0' E::] Longitude: � o
Design Current
Design Current
Design. Current
❑ NA
Swine Capacity Population
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
a. Was the conveyance man-made?
❑ Dai Cow
❑ No
❑ Wean to Feeder
❑ Non -Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dai Calf
❑ No
® Feeder to Finish O
❑ NE
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Farrow to Feeder
❑ No
❑ Non -Dairy
❑ NE
❑ Farrow to Finish
ers❑
Beef Stocker
Gilts
rLa
Non -La ers
❑Beef Feeder
L,No
❑ Boars
Pullets
❑ Beef Brood Cow
❑ Yes
No
❑ Turkevs
❑ NE
other than from a discharge?
Other
❑ Turke Poults
Number of structures:
❑ Other
❑ Other
12128/04
Continued
Discharp_es & Stream Impacts
I _ Is any discharge observed from any part of the operation?
❑ Yes
.0 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
L,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

4
Facility Number: -33 f Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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. ❑ WDp ❑ Checklists ❑ Design ❑ Maps p [:1 Other
❑ Yes [allo ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes;
© No
❑ NA
❑ NE
❑� Ye§s
[g No
❑ NA
❑ NE
{ ❑lYes,
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
[:1 NE
❑ Yes
IF] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
©.Yes ❑ No ❑ NA ❑ NE
12/28104
:."' a"

L`
Facility Number: e0_/ 7ff 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?
Stnicture 1 Structure 2 Structure 3 Structure 4
Identifier.
Spillway?:
Designed Freeboard (in): f
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 [XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE _
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E![,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
.® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
s
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
1 l . 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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptablee! Crop Window ❑ Evidence of Wind Drift ❑ Appli/cation Outside of Area
12. crop type(s) ` »^m fr I-J+irl�lS1ir�li
14n/Ltk
�. .
13_ Soil type(s) fj�r,�,,]��-,�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2FNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
© No
❑ NA ❑ NE
17. Docs the facility lack adequate acreage for land application?
❑ Yes
9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© No
❑ NA ❑ NE
Comments (refer to giiesteon #): Explainany YES'ansHers and/or any recommendations or°an)-rvther cowmen#s , ,A�Dom Use'drawin s of facility to better explain situations: use additional es as necessary =
g t p ( pages )-
y\ ��Reviewer/Inspector Name -«— .� "Phone: 'T H Reviewer/inspector Signature: Date: 4D j/- {a
12/28/04 Continued

Type of Visit^�ommpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(dleoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: --i- � Arrival Time: > Departure Time: County: Region: V
Farm Name: ��+�+'_-AAA. r q !Brrels_ Owner Email:
Owner Name: f4zaa�_ ��� /I ___ Phone:
Mailing Address:
Physical Address:
Facility Contact: e 5� It/t d co r-3 Title: Phone No:
Onsite Representative: Avse— _ Integrator:
Certified Operator: �7�i�.-4� Operator Certification Number: 14t3e%z
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=g Longitude: = o = = „
Swine
❑ Weanto Finish
Design Curreaf; - Design Current
Capacity Population ' - Wet Poultry Capacity Population
❑ Layer
Design Curren#
Cattle�i='Ubnazi!mp.��Upufftion
❑ Dai Cow
❑ Wean to Feeder
❑ NE -
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
10 Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Yes
_ .m. ❑ Turkeys
❑ NA
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
9!�Vo
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
29,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
9!�Vo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C.No
❑ NA
EINE
other than from a discharge?
Page I of 3
12128104
Continued

12. Crop type(s)
13.
Soil type(s)47J-3
+ Facility Number: — Date of Inspection
•
Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZNo ❑ 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:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ISNo
Spillway?:
❑ NE
17.
Designed Freeboard (in): 9`
❑ Yes
® No
Observed Freeboard (in):
❑ NE
18.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J;No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[9 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
KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LE�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
E9 No ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'p; No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)47J-3
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
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ISNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Reviewer/Inspector Name— Phone: gj fr- •i/-3Joo
Reviewer/Inspector Signature: Date: Oc7
Page 2 of 3 12/28/04 Continued

` Facility Number:— Date of Inspection '--t---�-�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Cg.No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps F-1 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
[9No
❑ 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
[4No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JD No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ffNo
❑ 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
B 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
�3No
❑ 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
E,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional,Cori►ments and/or Drawings
2
Page 3 of 3 12/18/04

ivision of Water Quality
Facility Number �3) O Division of Soil and Water Conservation t�
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit EY01ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: = , t o Departure Time: r % County: Region:
Farm Name: l5'!z-0" A^ d rcl rs�Gzl►'�'� Owner Email:
Owner Name: . Sdm- R PL 61 e ifs Phone:
Mailing Address:
Physical Address: /
Facility Contact: �2. '4-w 'r£ Title: Phone No: T0_ �_ 00 0
Onsite Representative: _ S� Integrator:
67
Certified Operator: S'�+-� Operator Certification Number: Ze?_113.i3,
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I =1 11 Longitude: = ° =' ED u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�' ❑ La er
❑ Non -La et
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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 JKNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
1
771
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — 3 Date of Inspection �7
' 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z&C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo [:1 NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed ❑ Yes (-No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�KNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[:INA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes (XNo ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) ti;E.62"—, 0 V_eY2S2!-- 1
13. Soil type(s) '3,p -
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 RNo [INA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ &No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ='!P-- Phone:
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: — 3 3 Date of Inspection ®-7!7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
Ed No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tg-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PSNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
56 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
KNo
❑ 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
X No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ESNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;allo
❑ NA
❑ NE
Comments and/or
12/28/04

Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: © Arrival Time: I D'. [7 Departure'rime: County:Region:
Farm Name: S Ct m_ „n_01 e#-! rae ri-- Owner Email:
Owner Name: .a &--. A- n J Qe3 Phone:
Mailing Address: 3o-79 A) u r, Ya! H4 4 -- eZ-30;,Lk�
Phvsical Address: !
Facility Contact: -5,"-". 4 /7 rt r t< Title:
Phone No:
Onsite Representative: Integrator: .:9 r r*3=__�—
Certified Operator: Operator Certification Number: 3t��
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: =0
❑ , Longitude: [__10=1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder j 10 Non -La ei
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys___
❑
Turkey Pou Its
❑ Other
Discharp,es & 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 jC
Cattle Capacity.,, Poll
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
3. 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?
latiou
❑ Yes [9,No ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
EINE
❑ Yes
4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
gNo
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
®.No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �K-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ '
7. Do any of the structures need maintenance or improvement?
19 Yes
to
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[NNo
❑ NA
EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
CANo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[14 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area JJ eA
12. Crop type(s) mj:.-r'rfl–ellGrJi +�}'r ll�ss -
13. Soil type(s) �`T44
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination':[] Yes No ❑ NA ❑ NE
IT 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 [&No ❑ NA ❑ NE
Phone:
Reviewer/inspector Name:: Q ♦ ._.... ;Y-# . r
Reviewer/Inspector Signature: Date:
12/28104 Continued

Facility Number: — Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EX No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, j$ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ;g 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
CK No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Sa No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
I@ 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
C[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IR 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
DZ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewedlnspector 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
El NA
El NE
A" ddttional;Coutments`sn+j/or Drswiings ' -
ft�darc�f�', d2 �,v i k 4rtct �s�s
22/28/04

4
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: y - $', c Time:
Q Not O rational Q Below Threshold
E"ermitted G<ertified t3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ---
Farm Name: m Ancle_!',�......County:
Owner Name:... ... !?')----........_. c� ....�.. Phone No.- J/..�...:
S _ lqn cr �...............
?Mailing Address:.. �� �. 9 .1 �.... �% �. `! � 1.. .1`���g/a!,� C �,� r� orJ_ _N L...... �.�� . d�? �........ _. .... .
Facility Contact:sA -------- _.......
Phone No:9 �re-
Onsite
LOnsite
Representative:.._. S4?!h _ /Qnc�?f_ ......... Integrator: SG .... _. _ _
I�. _ _�..__... r C
Certified Operator:.......... �9j-11------ /� njht . Operator Certification Number:._ L_93
Location of Farm:
a.97W—Ine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 < " Longitude ` `
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EY -No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes 9N6
c_ If discharge is observed, what is the estimated flow in gal/min? r-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes (g -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9344,
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes d'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_......_._.�.................. -.� .__- ---- ................
Freeboard (inches):
12112103 Continued

i Facility Number: g - 3 3 Date of Inspection c -0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, -"design maps; etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NsPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 9 -Ko -
0
-K
❑ Yes Flo
❑ Yes ❑ No
❑ Yes ❑-No
❑ Yes O -NO
❑ Yes O -NO
❑ Yes 9No
❑ Yes 9 -Wo
❑ Yes M19'0
❑ Yes [lNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditi&- CdtnIIientS-
:,:::.,...'.c._:ts-��r_.�..�.a'�..T...___:.----.... ..�`.»•--�`=-.�€..:,.-"�5.::�-':_.>_...�_..-�_..._--_..__.,z_s.:-.cx.,.--�.w � u.-_�. �`�_ �-$';�"....c..�.�.._-.., �.�.,...x-.,..-'�t•�? tip
y� / I I `/ 1
/'r% �nG1E�5 S ic ��eG1T Gi Sf Orm �Oj ye,_ (7dX !f7, ;"3)
k/ll J/ 1+�rlc
elt� �1�5 pZ' .�vribi.•�j� Grl(/ �lr'.5 %FSU✓G'S, �4/�rC yG/npGf�� �Op��.s U7�
G✓G-S�E te�+q /yS+S GnCy Srlrll TFi� CGv, �c' p17ur�nPd 7�rorr, ,�r�Lei� ��,�j.
An de-,,, + 5 A
CifO n T U s .r� u Ls cs1C Grnl.+ 5's Cr� fDai�,
/!rr res �vf �ivc'.Pub �t i7trr. rrfG,uF?
12112103

Facility Number: 82 —.3 31 1
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9-14-0
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 01 -40 -
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Eal o-
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Eg-No
elevation markings?
Waste Application /
10. Are there any buffers that need maintenance/improvement? ❑ Yes O'No
I 1 _ Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes EJ -No
❑ Excessive /
Ponding/ ❑ PAN- ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 6e; Myile.4 r , 4 (gjra2ge S%na l! � rn o',h (g: -az e) _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes QW0
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ NO_
b) Does the facility need a wettable acre determination? ❑ Yes ❑No
c) This facility is pended for a wettable acre determination? ❑ Yes &IWO
15. Does the receiving crop need improvement? ❑ Yes ©-NO
16. Is there a lack of adequate waste application equipment? ❑ Yes Q -No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of property within 24 hours? ❑ Yes Q
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes EINo--
Air Quality representative immediately.
Comments (iefeir to gneshoii #) Expisin any YF5 aaswets and/or, a p recomm_ en oas or,any other com memtw fi tT
-Use drb of facili toobetter lam situatioias nsc addtdoaai as necessa w. 4 . T ;
tY e*p { p$la� rY) [3-Reld Copy ❑ Final Notes
ReviewerAnspector Name !f
Reviewerflnspector Signature: Date: 0
12112103 Continued

r7
Site Requires Immediate Attention: _
Facility No. g'- • 33
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7: , 1995
Time:
Farm Name/Owner: iy1 /TJ�/�E� if f/`�LJ�E.eS C -5%2�
Mailing Address:
County:y;
Integrator: Phone:
On Site Representative: Phone: —sem —4t 7p
Physical Address/Location: o / �a yy .mv r ,✓� s7
Type of Operation: Swine - Poultry
Design Capacity: /7 Number of
DEM Certification Number: ACE D
Latitude: Longitude: ° _
Circle Yes or No
Cattle
Animals on Site: / 7U
EM Certification Number: ACNEW
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches es r No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? e r No
Crop(s) being utilized: T
Does the facility meet SCS minimum setback cri
Actual Freeboard: :1- 5 Ft. Inches
Yes or Teo Was any erosion ob ed? Yes oR
Is the cover crop adequate? o
r No
teria? 200 Feet from Dwellings? &is) or No
100 Feet from Wells?er o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o<
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N&o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acWage with cover crop)? Yes or(9�)
Additional Comments: S .207 -
Inspector Name
Ig4gnature
cc: Facility Assessment Unit Use Attachments if Needed.