820336_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

• Dii=is`lon of Water Resources
FaCilitr ember - 0 Division of Soil and Water Conservation
� Other Agency
Type of Visit: Com liance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit:' ` Routine Q Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: $, Arrival Time: Departure Time: 4 ap County: Q a Region: r -0
Farm Name: �j tf TTb iT Jtl oy` 'Csy
Owner Name: i T+rn a d
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C& f -b,, Title: Phone:
Onsite Representative: ° t Integrator: Cyl 13 — s
Certified Operator: {� �y Svc+ �� �, _ Certification Number: q 402
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design_ Current
Design
Current
Design Current
Swine
Capacity .Pap.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
Layer
I
Daia Cow
Wean to Feeder
7 dj
90V
I lNon-Layer
I
Dairy Calf
Feeder to Finish
" "
y Heifer
Dair
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul s
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
of
Turkeys
Other
Turkey Poults
Other
IMI
AOther
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
[ - ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[EFN2V
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[:]No
❑ 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
E31TA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[] Yes
[3-55
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDateof Inspection: ' 6 = y1VF-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-N-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No CD-N�C- [j 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
0 ❑ 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
[§-Ko ❑ 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 l`o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ED 1.o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
Io ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
t:I ""' ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Ef 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):
13. Soil Type(s): p WGL
14. Do the receiving crops differ from those designated in the CAWMP?
Fes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
(—]Yes
[J V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
r] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
[] 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
E3"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
d o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
] No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - W,3 (a Date of Inspection: to .TzNA"!
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [j' o_ ❑ NA ❑ NE
25. Is the -facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []-Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ED-TTo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D-I a ❑ 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?
W�B- r L' lot- 1-1
a f �a
t T
,3
FUM
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
and/or any m
❑ Yes [DNar ❑ NA ❑ NE
❑ Yes R' 1qo [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [D W ❑ NA ❑ NE
❑ Yes
[ D-No
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
,5/� { su 7 _l' -e' 17
Phone:
Date: d`(�y�{,[ b
21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 3' %tij Region:�l�
Farm Name: (✓ Owner Email:
r�
Owner Name: r `�i +l u �` .f�-t ,., G Phone:
Mailing Address:
Physical Address:
Facility Contact: C-4-4-i s 4 &-tf Title: Pho'nelI:
OnsiteRepresentative: ,fit Integrator:
Certified Operator: ��.�/�2� 4fG4ny 1b Certification Number: `% Z 2. 2Z
Back-up Operator: T Certification Number:
Location of Farm: Latitude: Longitude:
n Design.Curredt
Design Current
Design Current
"b ct I?o
Swore- Ca p ty p.
Wet Poult , }
rypacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
770
3 6,09
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Design C>wrrent
Farrow to Feeder
" Dry P,oultry Cci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars -
Pullets
Beef Brood Cow
r
Turke sheImm.
Wol
Turkey Poults
Other Fu L 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �o ❑ NA ❑ NE
❑ Yes [] No [ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[) No
[ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWit)
[:]Yes
[:]No
NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
] No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: 5 PV
Wasi?e Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-NW--0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway.7:
Designed Freeboard (in):
Observed Freeboard (in): 37 q f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [jNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes [- No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7_ Do any of the structures need maintenance or improvement? ❑ Yes [r]'fio ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑'1qo_ ❑ 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 . o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0-'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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): KlJ
13. Soil Type(s): 9°
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L]"'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3"'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
[:)Yes
[] Yes rNo
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q 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? 1 f yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VflNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -3 ; jDate of Inspection: 5 A
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[R'i�]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
[a' —No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification?
❑ Yes
L.S no
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
CTNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[:2-90
❑ 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
Yo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑/IVo
❑ 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
[ r No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any adititioaafrecommendations or any other comments.
Use drawings of facility to Netter explain sltuations (use additional pages as necessary,).
lo-f5 s.
o _ r
P y 1 2
3 0-
Reviewer/Inspector Name: 1 11 U U
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` 09- 33-333�
Date: s �ko
21412015

Type of Visit: ®'Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: (?4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: l 1"t' Departure Time: R County: C' [[ Region:
Farm Name: IL Owner Email:
tkrOwner Name: P� �. Phone:
Mailing Address:
Physical Address:
Facility Contact: �,c y �� ���l Title: Phone:
Onsite Representative: t( Integrator:
Certified Operator:
Back-up Operator: �]
L _ S
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
D . P,©n1
La ers
Design
CaPaci
Cnrrent
P.o
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dal
Beef Stocker
Gilts
Non -La ers
Beef Feeder
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 ❑'go— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No E31qA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No ❑ 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 ffNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [a "'o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes eo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

•
FaciliNumber: Date of Ins ection:
1h•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E , Ne
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[: ",
❑ NA
❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in): J$_
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
La"N'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[iJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
C? 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
�o
D NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E Io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2' 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): ZI-AkaAA
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E2r*No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes goo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M.-Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Erl<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Q 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
E3 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
e No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

. .
Facility Number: - Date of Ins ection
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[.]' o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
C] Yes
[]-5_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?
0 Yes
hl o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Lj No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
fff�o
❑ 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
E] Yes
Flo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
do
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�Io
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
�(No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other camments p ;
r
Use drawings of facility to better explain situations (use additional pages as necessary}`
L4,1r,
L L4
New
3-7
A
Reviewer/Inspector Name:
b -I 5-- is
-M-1S
(9
C' L
�(s-7V
Phone: LA I-) ) F
Reviewer/Inspector Signature: `4 Ay�_ Date:
Page 3 of 3
21412011

7-3 1 l0 51+6, -
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: �/ Arrival Time: Departure Time: a County:
Farm Name: I , 2 � pi- ]�Urr;�i j Owner Email:
Owner Name: ��`0� L222" Lr �• Phone:
Mailing Address:
Physical Address:
Facility Contact: 4-✓Y- ,, loldwtc-- Title:
Phone:
Region: r� a
Onsite Representative: Integrator: /�F
Certified Operator: xg,Certification Number:�jr`
Bach -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
PWean
Design -Current Design Current Design
-Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
to Finish Layer Da' Cow
Current
Pop.
Wean to Feeder r�
Non -La -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D P,oWtr Ca aci P,o P.
DairyHeifer
Cow
Non-Dairy
Farrow to Finish
Gilts
Boars
La ers
Non -La ers
Pullets
Beef Stocker
Beef Feeder
Beef Broad Cow
-Other -_ '
Turkeys
Turke Poults
NJ Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CE[ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
Page I of 3 21412014 Continued

acili Number: - j 3 b IDate of Inspection: —
Waste Collection & Treatment
d. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 171
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5. 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
Q 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
E] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
(2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Apoiication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[::]Yes
allo
❑ 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 ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
Window
lye,
12. Crop Type(s): �ir' 'runt yr Q /5
13. Soil Type(s): f A04 L 4 kva;;�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo
❑ 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
a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
UNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
QNo
❑ 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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EANo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes JZ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IlPacilityNumber: 3 to Date of Ins ection- s
_J4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes allo
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes Ej No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
[-]Yes allo ❑ NA ❑ NE
❑ Yes [RNo
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any. additional recommendations oranyFother comments=r
ieft­
Use drawings of facility to better explain situations (use additional pages as necessary).
�YL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91w -q3' a-33 o-ic)
Date:
21412014

ai /0—is--/z(
M
Type of Visit: O'Cliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: ; pfl I
Departure Time: O
County:
FarmName:
Owner Email:
Owner Name:
�f e`t't` raznu �T:—,ye—
Phone:
Mailing Address:
Physical Address:
Facility Contact: ��ry/ a Title:
Onsite Representative:
Certified Operator: U u 4 `fm&
Phone:
Region:
Integrator: Pk, —
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
an to Finish
�y
Ca aci aPo F t Poultry
..
JLaXer
@apac ty Pop -
I
es*
Dgn Gnrrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non La er
Dairy Calf
Feeder to Finish
;�i
DairyHeifer
Farrow to Wean;
Design �Cii renter
Dry Cow
Farrow to Feeder
. D , : Poul
Ca acl
Non-DaiTy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-- -
"' Turkeys
Othe
urkey Poults
Other
Other
Discharges and Stream Impacts
Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NLNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
Yes ® No
❑ Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: -13 to Ds ection: -Z>—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rXI 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: t✓w
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No
❑ NA
ONE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
% No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�Z 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 [F�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.CropType(s): 'x'6 da fi��iGrs��d
13. Soil Type(s):
14. Do the receiving crops differ from those desigated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
®No
❑ NA
❑ NE
0-Yes
[:]No
❑ NA
❑ NE
[:]Yes
(allo
[] NA
❑ NE
❑ Yes Q§ No ❑ NA ❑ NE
❑ Yes ja No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists [:)Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [-]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes &No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EKNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

" Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EK No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
jj4 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
2a No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M 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, frceboard 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 CAWW?
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 6nk No ❑ NA ❑ NE
❑ Yes FA ❑ NA ❑ NE
❑ Yes 5.No ❑ NA ❑ NE
❑ Yes Pi No ❑ NA ❑ NE
❑ Yes
MA No
0 NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any:,other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
If- 041-1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

1
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q xoutine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: /a ;3 r'7
Departure Time: D 0
County: 4�s0-
�—
Farm Name: P 2,
T-
Owner Email:
Owner Name: ;�
�/ e �ar'i•�- KG •
Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: —Jrf"'z
Ousite Representative:
Certified Operator: U�
Region:
e— phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry -,
. >Capacity
Pop.
Cattle Capacity Pop.
_
Wean to Finish
Layer
DairyCow
Wean to Feeder
rQ�
Non -La er
DairyCalf
Feeder to Finish
-
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oult . .
Ca acii
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ke s
TirkeyP
Other
oults
Other
Oer
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
2�.No
❑ NA
❑ NE ,
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
QR-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

]Facility Number: jDate of Inspection:
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
[:]NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �h�r?� ��� �� ►1
Spillway?:
Designed Freeboard (in):�_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[g 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
JK 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
K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C, No
❑ NA
❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CKNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _g=�m U.12L 4 ve-/srr-ol
13. Soil Type(s): l ku'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
�gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O_No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3�,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5� 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 �o
❑ Waste Application ❑ Weekly Freeboard [ 1 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes §Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes CNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

'[Facility Number: - 3 & I I Date of Ins ection:
3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C3,No
❑ NA ❑ NE
a
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ 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
allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
EgNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
54 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0,No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1, No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L&No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5�_No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
§�gNo
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any..o#tier comments
Use drawings of facility -to better explain situations (use additional pages as necessary).`'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:%frT3�
Date: ��/r✓��
21412011

01HS Jvl 51a111a.
DRJiion of Mater Quality
Facility Number Division of Sail and Water Conservation
Q• Other Agency
Type of Visit: 16 Compliance Inspection Z3 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: j Q County: Region: f'xo
Farm Name: Pin T p of V_/e y Owner Email:
-
Owner Name: �ir� Tfof T I Phone:
Mailing Address: y� y� K
Physical Address: 9113 A aI Yyi � te K . M( Yt lk d, ._
Facility Contact:
Onsite Representative:
Certified Operator: 0 Vd V El";
i {�
Back-up Operator: ��� Sm j I 1 h
Location of Farm:
Title: ©tyl) er Phone:
Latitude:
Integrator: 04
Certification Number: '7 (?.q 3S(0
Certification Number: a 93
Longitude:
„...
Swine
i nCurrent
g� T
Ca achy - Pop.
p..
O
Wet�Poultry
La er
Non -La er
-
r
Design
Capacity
Designs
Current
Pop
Curren
Design Current
C►attle Capacity Pop.
Wean to Finish
Dai Cow
Wean to Feeder
Feeder to Finish
Dai Calf
Dai Heifer
Farrow to Wean
Dry Cow
Non -Dairy
Farrow to Feeder
D , P,ouIt . Ca �aci P,o .
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Co —
Qther
Other A
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Vi No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit ' Number: ,�. - 33 6 jDate of Ins ectioms
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I q^
Observed Freeboard (in): 3 Q
_ZVr
U
5. Are there any immediate threats to the integrity of any of the struuves observed?
❑ Yes
E�r 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
g 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?
KYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�? No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
&�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops dttler Irom tnose designated in the UAWMY"!
U Yes
L�!fNo
U NA
U Nt.
15. Does the receiving crop and/or land application site need improvement?
F�_-t Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
N 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.
C'Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
fo 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
CR'No
❑ NA
❑ NE
23. [f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
%NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - ;�j,3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t�jNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
RNo ❑ 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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [a NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E[ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
to No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�jNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
&-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ 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
N-No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations'or any other comments'"'
Use drawmes'of facility to better explain situations (use additional pares as necessary/. ".
Vjj
7, �'�ta Vor ry b�� s �&S ray p L 1~cle ) ined 1� oo7 -Par ono 1cr, `� , p ��
q 61-0-T a
yri uc�} m pro tod Cn
I a e old lu tx�r P�e� �,ea�, +ro��, a -+off 1
S as �3
be veryy ceo1*1 has a
0f Q'crfS1 ryas 1 rr► ��``�Y�e�����
s -Fi eir ` was be�j ne�krrt a 't
Please lime �1Lr�r;�epdJ f
al, P(�g,e tew� ry� _00y7s,m�- a 1) , Pol) ol" o b �d lad lal r i
w 1] -ex( ear' how���i,
NV O of aeff ar o e
�;]me.
to 9 ��gyc�` f/ /f f /"'dam J a b
•' Ogle c I 1 �'X' � 1J �
yea 5
� s e s���>° ' ���
S�S1tdStXve c[fi
have how �ps . PrDba b I eiQq' bl� `F'or lt,d 9 /
Role �hl % U.,�,� cd lid.
I L
rna �� � eccP a r h oil a �P,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Qi I
12011

+ Facility No.
»�
Farm Name o
Date 5) 1-7h
Permit
COC
OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway
10
2
,,
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
I
Sludge Depth ft
t
Liquid Trt. Zone ft
r
Ratio Sludge to Treatment Volume ifs 0.45
Date out of,com liancel POA?
- • - • . - -
. m©©■ram©����
Soil Test Date
pH Fields
Lime Needed r"
Lime Applied
Cu-I ✓ Zn-I
Needs S (S-1<25) )VQ
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp. ✓
--• ' ; fleat er Gev•-
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Arnt
-
5
S�
JAC-,
C �
Verify PHONE NUMBERS and affiliations
Date last WUP FRO
FRO or Farm Recor�! ta'
Date last WUP at farm
Lagoon #
G'�
Ap
Hardware
Top Dike
1
Stop Pump'}'
y`
Start Pump
` q
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
qom
i 4-F
fVCI5,91 `W
i OAS -
q�,

rP rh s JvT 7 f7It/
- ivision of Water Quality
Facility Number ®- 3 3 O Division of Soil and at Conservation
® Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit: O-Routine O Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: 11 11:j Arrival Time: g' Departure Time: Q; County. —,"Region: Pie,Q
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: ` n?2 Mtv I/i�
FacilityContact: h, & Title: ©mfl- Phone:
R
Onsite Representative: V Integrator: q�.�
Certified Operator:1ldV S�n� J� Certification Number: -(7c�3
Back-up Operator: 06/ _so S t;+ Certification Number: a�2sh
Location of Farm:
Latitude:
Longitude:
_.
Design CurrentFRLN_'c
Design
Current
Design Current
Swine Capacity Pop.et�Poultry
Capacity.
.Pop.
Cattle Capacity Pap.
We to Finish
er
Da Cow
Da Calf
can to Feeder n-La er
Feeder to Finish
-
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1) PoieItr
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
w
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facilitf Number: Date of Inspection. -711111
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Old� New
Spillway?:
Designed Freeboard (in): 19^^
Observed Freeboard (in): 3 4-�L^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
E] Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
to 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
0 Yes
13 No
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �}1
fl
13. Soil Type(s): A k .D J ' ti/15 y/ B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
-J�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
J�g Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5d No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists [:]Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
15g Yes
[—]No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
® Waste Transfers
[a 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
J�j No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CR NA ❑ NE
Page 2 of 3
21412011 Continued

Facili umber: - 3 Date of Inspection: -71111
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 NJ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No 5] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[5No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
eTNo
❑ NA
❑ NE
Us draAwint~s o1 f LCHUV to tietter explain s'►tuats (refer to question:4): Explain any ha s (u a additional al pages -as neces ary). wers and/or any additional mendahons or ainy other coinm...eiits.
�/ K-ee p YV& ki� &� bo-e, :9 f6i-S On
15, P1 ePae, hare_ 1Nfd-
both mo> l a�.S, 600 fires 6) od l ojo1)
Plea e. mi, Het -Clop• (PlIA-C
re rds .
T_ P P,&iS Gre in 300 Y� of e.
Ov1 YVe0 fflyi*mek -@�,,� 49 re(cxds .
�t2JQ� Yy& '�iAt file_ Cri Che- r4�to
�Claf nei-e- 06e, POI 4^E ffedvc-el-coq),
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
4/2011

Date
Facility No. f�Farm Name r
Permit -�COC ./ IC NPDES {Rainbreaker PLAT Annual Cert)
Pop.
Type
Design
Current
9 M-MM Illlr
Iftserved freeboard (in)
�A������
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. -Ratio
Sludge to Treatment Volume
117W.170
MGM H
NOR I an
Soil Test Date hln &I Wettable Acres � RAIN GAUGE
pH Fields ✓ WUP ead b or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I ]Q��L Zn-I 120 min Insp.
Needs P Weather Codes ✓
Crnn Yield / Transfer Sheets
. t+ -
�l
fly
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
S-
1
�
5
ti
128 c
7-0
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3451V5-? Date last WUP at farm
�FRO or Farm Records �1a3[d
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 iblac
App.rar ware

r
Type of Visit Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -'Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: << Departure Time: 11X50Prf1 County: SiZVfJOIRegion: FRO
Farm Name: P'', Owner Email:
Owner Name: b �1 to Srn 1 I Phone: _
Mailing Address: PD Dox 5 C�l� ttt� _ _ ag3aq
Physical Address:
Facility Contact: L-W S/)•t Title: pPhone No: ✓�-� -�174r
Onsite Representative: udL, ski Integrator:
Certified Operator: b s/n 6 Operator Certification Number:
Back-up Operator: Sm 13 Back-up Certification Number: 94a3
Location of Farm: Latitude: = u ❑ ❑ Longitude: ❑ ° ❑ ' E:] "
Design Current
Swine Capacity Population Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish 10 Layer I
❑ Dairy Cow
Wean to Feeder OD ❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder Layers
❑
❑ Farrow to FinishEl
❑ Gilts ❑ Non -Layers
❑ Dairy Heifer
❑ Dry Cow
El Non -Dairy
Beef Stocker
El Beef Feeder
❑ Pullets
El Boars
❑ Turkeys
Other ❑ Turkey Poults
❑ Beef Brood Cowl
Number of 5truetures:
❑ Other ❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number!&� — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
p Structure I Structure 2 Structure 3 Structure 4
V Identifier: i 1 P
Spillway?:
Designed Freeboard (in): I�
Observed Freeboard (in): 3 5-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure'5 Structure 6
❑ Yes IRI No []NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes jo 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 19 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question #):9Explain any YES answers and/or any recommendations or any other comments.
Wise drawings of facility It better explain situations. (use additional pages as necessaryj:
Reviewer/inspector Name [� 4 �� Phone: w
Reviewer/Inspector Signature: jAiPJA4 Date:
) r ? 12128104 Continued

f
Facility Number: —`S3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
"i,
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pernvt?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JK] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[$1NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5a 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
JRNo
❑ 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
19 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings` `
�TII� aVj4r'_ IJo a known-
plpnblo
ay, �v p 1 r)ffd -o ea (4 brine b*re- ®fiPa,
1nrij l nfPl as f vd9e slrrvP berve o`F ,
a �, CUr���` sa re cods r'��acP (on �he��r-iron Mal }
'aPcn VvaII coJe' aVCA 'I in ro'd ch lor OIL Iaj06 , 60A wo-k �
ms-}o re��O IC o P:zc � 0/�rl�r- Ghd cIan�©► jW.S6 ~}o�cor�rx ��►.
well rnd �+'APc_ -.06lm,
Page 3 of 3 12128104

( `r( s-V7 -60, apa
r
Facility No. a�.-33� Faarm Name Date i0
Permit ✓ COC OIC� NPDES (Rainbreaker PLAT Annual Cert )
Pop.
Type
Design
Current
FB
VDrops
�----
r- s ii-g-n---••_ r •
Observed - - .. _ •-��----
Sludge - Date
E�� .
MINIM
-
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
Actual Width
Soil Test Date Wettable Acres ✓ Portality
AUGE
pH Fields y� WUP x or incinerator
Lime Needed Yre Weekly Freeboard Records
Lime Applied a� �n 1 in Inspections
Cu-1 Zn I 120 min Insp.
Needs P��� Weather Codes -�
Crop Yield Transfer Sheets .�
rm
Pull/Field
Soil
CropAcres
PAN
Window
Max Rate
Max Amt
11 - Sl
i`'
i�r
/
r
3
br r
c
P
La
Se t
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 7^513T{ DT-- Date last WUP at farm�4-
FRO or Farm Records UeW
Lagoon # tp�-fir
Top Dike IbT))"
Stop Pump }OLY-
Start Pump fb33(
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac
App. Hardware

,A i,. n —" .. I r I
Type of Visit I$Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �k Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:] Arrival Time: Departure Time: County: -50,mef6i Region:_
r
Farm Name: 7{klvierz Owner Email:
Owner Name: Bbbby 6le— SM 1 th Phone:
Mailing Address:
Physical Address:
Facility Contact: a) 4 SmLh3 Title: [JWr i9 Phone No: 3$5!` 57
Onsite Representative: Integrator: Uf O
Certified Operator: D �m� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = . 0 Longitude: = ° = 6 = L6
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Caw
Wean to Feeder
❑ Non -Laver I
I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to FinishEl
❑ Layers
Beef Stocker
❑ Gilts
❑ Non -La crs
El Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Pullets
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
I IEJ Other
Number of Structures: 01,
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
X—No
❑ NA
❑ NE
12128104 Continued

Facilih Number: s-),-336 I Date of Inspection WaKJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NrNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i qa Ow (Old
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in): �C� IQ
Observed Freeboard (in): 3S R3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1)? 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
IRNo
❑ 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
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IR 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
1�No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CqNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) C .OMO I Aei' IL I Ad , 'G
13. Soil typc(s) NOS IS
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E`No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
'tallo
❑ 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
I!3No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name S e7te Phone: ,33 :3_-t xc��
Reviewer/inspector Signature: Date: 3 3 Qt7
72/2 4 Continued

+ Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No aNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�tNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
[INA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1�jNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tKNo
❑ 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
tRNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
: — g
AddifionaljCommerits and/or DrawiagsT r '"-- r�rC ' 1,
had- +o fsoll a�M pti_ ),,a sey t 4 -(b, 40Ir- M i� 51icue ban�f, S'fitj
d _r s ,r G N k L/ l./fi Pfte'�� r 1 3 // 1 �� 7 /!1
n �
ae sane Ire 10,3 T&vlac)� PH =_5-'4
Exc�f zf6t 4 Pye recads,
El
Page 3 of 3 12128104

Facility No. Farm Name
Permit COC
I11 Dai.1
OIC_ NPDES (Rainbreaker PLAT Annual Cert)
FB Dro s
Design - - ....
---_---
Observed freeboard (in)
Sludge Survey Date
..1
Sludge��—�--
Depth .
x
►
—�--�
Liquid. -
rrrc����■�■�
DO
Calibration Date
MM Tirplin
r - .
Actual Flow
Desi.n Widffit»Li
P41"
---
`-1��------
Soil Test Date Crop Yield '✓
pH Fields,W0( Wettable Acres v
Lime Needed r5-�o WUP -�
Lime Applied Weekly Freeboard
Cu L-,,- Zn L Rainfall >1" !—
Needs P 1 in Inspections
orrl.Cho1 a
120 min Inspections �,/
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
•e r_`
PulIfField
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
j
.yI/�/
! YJ�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3 iiJ Ip3 Date last WUP at farm App. Hrrdware
a ��J
FRO or Farm Records
Lagoon # I!
Top Dike 50.0 SG D
Stop Pump :z
Start Pump-Z

1 I _
1
Type of Visit JR Compliance Inspection ()Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: S Region: PRO
Farm Name: NVrS Owner Email:
Owner Name: � y o�n� So, f Phone:
Mailing Address:
Physical Address
Facility Contact: U-6444 Sm I _._ Title: 0 }'hg- Phone No: 3f s-57 qS
Onsite Representative: .rV V SM f -bl Integrator:
Certified Operator: S+u1+ Operator Certification Number: a$3S4
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = I =1 Longitude: = 0 01 0 11
we�
rre � �-Deg Ce+rrent
Design Cuerent
Swin"111_.
Capacity
Populat+n-, Wet,Poultry
£Capacity pulatiOn
Cattle
Capacity Population
Vean to Finish
❑ La er
❑ Dai Cow
ean to Feeder
., ❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
n
Dairy Heifer
❑ Farrow to Wean`��
t�Dryl?ouitry$R�_
�.
❑ D Cow
❑ Farrow to Feeder
`4 "
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-La ers
ElBeef Feeder
PO Boars
�
El Pullets
❑ Beef Brood Co
.:.. ❑ Turkeys
Other _
❑ Turkey Poults
❑ Other
.4❑ Other
N umber of Structures: �3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
UNo
❑ 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
C9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
19 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: a —M& Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ff No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: B14 New en -
Spillway?:
Designed Freeboard (in): 9 _
Observed Freeboard (in): L41 30 ly f r_�w
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
(a 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
W 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?
9Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)l 196 Bpfm �/� i R) ' S G oSto
_
13. Soil type(s) Niventk Wo doram
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ 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 JR No ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t@ No
❑ NA
❑ NE
❑ Yes
5�No
❑ NA
❑ NE
+ nts (refer to�q�estaony#} �FgPlatn attiy�YiESTanswers and/or�'aoy�,rccommendations or any other comments.
Use drawm of facilr to better�ex lam sttuahons�(use addthonallpages as necessary):
Reviewer/Inspector Name Phone:3'33X
Reviewer/Inspector Signature: Date: a00
Page 2 of 3 V 12128104 Continued

r
Facility Number: s2k I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CR No ❑ NA ❑ NE
the appropirate box.
❑ WLTP ❑ Checklists El Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ER No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ 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
5?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
27No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments andlorrDrawmgs:,_'--
- s .
7. Pl e- c0'[k*of 11 *kkl 61 9w -Pof old idye. �� bg93), Plalh�f �O
r 6k- add di+o sfno ou sto
Rf_* new l i nf, r1a1o1I �-a a f (!V lade_ s�'n,m$'.
r k] hl 1) &007j
ry. by I 1 hfaL --o cali h mQ 'I,) aoog --old rf-e j, New ree j °L
Page 3 of 3 12128104

. f
Facility No. Sa-3-76 Time In la Time Out Date
Farm Name
Permit COC �, rI�PL ES (Rain breaker PLAT Annual Cert )
Pop.Type Design Current moO S0, PT` Sao FIB Drops
III&-r s�o r 4-)-a sk*-c
q_,r ao.
,p y a
- A"�z
saJ1.
Freeboard
1
2
3
4
5
6
7
Design
BIMS
Observed in
Sludge Su ey Date Perm Liquid f#
0.
(9.$
31 Sludge Depth ft
3.
.l!
-vn#f f I" At%* ae Tww
Calibration Date
Uffn
Design
�_�-------,
Actual Width
63 NJ .0 " "M a007
Soil Test 4110- s Wettable Acres Rainfall >1"
PH Fields !�="H Lagoon_ Crop Yield 1 in Inspections c/
Lime Needed ✓ Rain Gauge 120 min Inspections
Cu ✓ Weekly Freeboard ✓ Transfer Sheets
Zn
?I" -bible -"Ib ye^ 11,16 1.1
Pull/Field Soil Crop Pan Window
tad I

Division of Water Quality
Facility Number 3 Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: i0 Arrival Time: Departure Time: County::E4mP50AJ Region:
Farm Name: pl . 1 }tI�.v Owner Email:
Owner Name Ste, 7"4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ste,` &AA-iYvl I -&le:
Onsite Representative:
r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
PhoneNo:
Integrator AUArO h
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i = Longitude: = o = 6 Q «
Design Current. Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1 % 00 1 bL I ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current:;:
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 51,
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 [ 4No ❑ NA ❑ NE
❑ Yes
❑ No
[ONA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
KNA
❑ NE
❑ Yes
EPNo
❑ NA
❑ NE
❑ Yes
�gNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection r l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ZNA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 St cl 6
Identifier: Chn
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed? NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) El Yes No El
6_ Are there structures on -site which are not property addressed and/or managed ❑ Yes [BNo ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
r'-3 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
7�
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ NA ❑ EVE
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
No
4
[INA ElNE
ElExcessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evideenc�e of Wind Driifi
A� pplication Outside of Area
f 1
12. Crop type(s) COQ$ &zmtJa GnSS t►i Si►+l`"'1 t 1��
13. Soil type(s) - Wag
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
IV No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
r%No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
10 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
'No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: �D 3s'`3�Dfl
Reviewer/inspector Signature: Date: v d
12128104 Continued

Facility Number: — 6 Date of Inspection /4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
`� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EONA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
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)
11
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
T
No
❑ NA
❑ NE
Comments and/or Drawings:
1212RI04

Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
-- Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1.2 1 Arrival /Time: F07Departure Time: i o ; County: SAI"► P50**1 Region: OCAO
Farm Name: _ AnT7" tLi'So.� Owner Email:
7
Owner Name: sp.`,f� � `� Phone:
Mailing Address: Po 4oZ2 ! Cf gin`& n ^) C-20 3
Physical Address:
Facility Contact: Bob Sftv'/4 Title:
Onsite Representative: it
1r
Certified Operator:
Back-up Operator:
�hh
Phone No:
MIntegrator: I.I/IV k.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11
Longitude: = ° 0 ' 0 u
Design Current Design Current
Swine Capacity Population_ Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder 7000 (DO
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars �.
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharires & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structu
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes P No ❑ NA ❑ NE
[:]Yes
[:]No
[$3NA
❑NE
❑ Yes
❑ No
[ NA
❑ NE
[�;NA
❑ NE
❑ Yes
❑ No
❑ Yes
fp No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
12128104 Continued

Facility Number: $9L, 336
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?
El NA ❑NE
PNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d"Z J-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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 P 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, notifybWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
❑ Yes 1PNo
❑ Yes ❑ No
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 Jig No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EP No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Q9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or i 0 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAccerptableCrop Window ElEvidenceof Wind Drift ❑ Application Outside of Area
12. Crop typeC-rrqs) 5& 1 � - C�l , fm . 6;-, zVte,�
13. Soil type(s) pJVA A4Q,3
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
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No ❑ NA ❑ NE
®No El NA El NE
[4 No ❑NA ❑NE
Comments (refer to question #): Explain any -YES answers andlor any recommendatEons oroauy other comments,
Use drawings'of facility'to better explain situations. (use additional' pages as. necessary): , a
'�, �¢,� o�-ass w-e.a.�t5 S v►�a.(f
L(a�c�o ►� �
r_aJ��
Y'(� ,� rorJ`£nR) S6Y,&
t
S`ZA✓�-til,�, JrQ bEA,# 1 ova D&I -(-oy o
1.g6,J 0 or
J
�
Reviewer/luspector Name
Phone:
Reviewer/Inspector Signature:
Date: f
% 6JP
Page 2 of 3 12128104 Contdnued

Facdity Number: $a- 33(o Date of Inspection
Required Records & Documents TTTTTTTT���
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [59 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IS] No
❑ 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
F No
❑ NAB' ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[PNo
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�o
[N NA
El 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
[1[ 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
Ep No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�] No
❑ NA
❑ NE
General Pennit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[0 No
❑ NA
❑ NE
AdditionalComments and/or Drawings u ^ w
• Q��Se S;S�n atl ARIL �. -t'8r►�-s. ..
Page 3 of 3 12128104

I
Type of Visit I♦ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S S'o Arrival Time: Departure Time: r'� County: Region: F/PO
Farm Name: - p.� Teoff AlLakc7% Owner Email:
Owner Name: Phone:
Mailing Address: P• O, I?OX /✓G _ -?83-7 S'
10
Physical Address: r. -kv S-V.> - BSY j
Facility Contact: Title: Phone No: Do- 3&S- S7�S
Onsite Representative: Integrator: %Nvraw - i3/`dw.2
Certified Operator: .Sn, Ila Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =' El Longitude: = ° = I =
Wlesipn Current Design Curren -a " rDesign Current
SwinepecifyPopulation Wet Poultry Capacity Populahoflxh tl Cattle r $. �: CapacityP,opulatiou
z..-
❑ Wean to Finish ❑ La er ❑ Dai Cow
[t�-Wean to Feeder ❑Non -La er i ❑ Dai Calf
❑ Feeder to Finish
❑ Dai Heifei
❑ Farrow to Wean D , Pohl. ❑ Cow
r5 tty
❑ Farrow to Feeder ` �x
'`� � n-Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
PE]
Gilts Non -La ersPulletsBeef Feeder
Boars ❑ Beef Brood Cowl I
❑ Turkeys - F
Other �,yY.
:-3 ❑ Turke Puults }
}
❑ Other El Other �'."v NUT. be of Structures`
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
U i%ro
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[?,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I
Facility Number: 2H33G 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: �1
Spillway?:
-
Designed Freeboard (in): e�5/-9 ',
Observed Freeboard (in): --3c7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [r -No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [ONo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O'flo ❑ 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 a&o ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
/ — _w /— Sv
12. Croptype(s) 46Orinyc!!t !�n'L_�ur,
13. Soil type(s) N, o JAI,,,_(�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Plyles ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
❑ NA
[;�NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ERNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M 5ro
❑ NA
❑ NE
dations or any other comments.
Comments (refer W gnestioa #,): Explain any YES answers and/or any recommenav
tTse drawings of facility to better explain sitnatiotts (nse additional pages as necessary):
4:tls; %Ae Rye overseer,/ Crc/O neeJS lio 6e Ae�++vj,,e f15A10
Oeeve,14
5►!oo<<h0� 67nr� �Q�+a9f fd f%e COus ' Cpc?lop l lease co" I",
Tirh �ia/t' �uf
bell �n r,n�otov�'� CouSTa! [rap, lole-,, &W11 I'me accor4yq
fv Sei/ /"ePo.•�,
Reviewer/Inspector Name 7u
Phone: `f/0- '18b-JS'y/ 10
Reviewer/inspector Signature:
Date: S - 5 , 05
flF 12128104 Continued

•
Facility Number: —3 (® Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 01 Flo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 19-Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ `x ❑ Che tsts EKesign ❑ ps ❑ pr
21. Does record keeping need improvement? If yes, check the appropriate box below. >h „7 ❑ Yes 01�0 ❑ NA ❑ NE
❑ Wttstc hpplietttitm ❑ ❑ -fima1y&is. ❑ sei�❑ ❑
❑-Rsinfai E34u=kiu8_ ❑ s ❑ Weather -
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?
andlt'rDritwings -
ad. �iLSPt[�c?r
❑ Yes
©fqo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
&NE
❑ Yes
❑ No
❑ NA
[j1QE
❑ Yes
❑ No
❑ NA
[13CE
❑ Yes
❑iTo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[4+�E
❑ Yes
[;PNo
❑ NA
❑ NE
❑ Yes
[a -No
❑ NA
❑ NE
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
[rNo
❑ NA
❑ NE
❑ Yes 9-1Qo ❑ NA ❑ NE
orcJ ,,, ti a9 a.: n � s
�uhj ttrlr� lr-� new � u/ �+
,vc .� Rr�d frur� t< � L 1
1 r /'<.�arc<S
6<<r, r17av/i u �S�a 6�5�
12128104

4
Type of Visit ID Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 9-�.d"� Tune: 8� O
Facility Number _ -
rO Not Operational 0 Below Threshold
Permitted (�'t ertified [r Conditionally Certified Registered Date Last Operated or Above Threshold: _.
Farm Name: __ . C., _ r. �/V __ . _ . _ .. County: -5d-m soh „ 2.
Owner Name:
Phone NO: Q o' G ' 8.? ...
iat�ing Address:
Facility Contact: _... _ 624 S __ Title:
Phone No: / t?__3,9 S
Onsite Representative: _ 'da 6 -- J 7 .d �„�.- h Integrator. /00- 09A v
Certified Operator: _ _. 2aaq z... 6 zb , % Operator Certification Number. _ .. ._.
Location of Farm:
GWv�ne ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �" Longitude �• �Ou
Discharges & Stream lmvacts
1 _ Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes allo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 2�o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 010
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes [RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- _ _,[ _ ..
Freeboard (inches):
12112103 Continued

s
t FaciIityNumber: B,2 — 3 3G Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 21 o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 09O
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9140
9. Do any stucuues tack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelfmprovement? ❑ Yes [3-1;fo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes D'N�o
❑ Excessive 3 oondin,7 ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [I Copper and/or Zinc
S'D
12. Crop type fio rm-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ef i' o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E3No
b) Does the facility need a wettable acre determination? ❑ Yes [allo
c) This facility is pended for a wettable acre determination? ❑ Yes 9-No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes EP46
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [3-90
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes ❑
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
Air Quality representative immediately.
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[44;1er Copy ❑ Final Notes
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Reviewer/inspecttor Name
Reviewer/Inspector Signature:
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Date: el - 0 "(?
Cowed
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•
Facility Number: — G Date of Inspection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0].Aio
77. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 5beeklists, dfsigiI7,pmpf, etc.) ❑Yes ❑.Id'
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (a -No
❑ Waste Application ❑F=ebeard- ❑ waste Analysis ❑ &v;l SaMpFamo -
—
L/ -�fi 7 113
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes E3-M
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes G-No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes [2-No
27. Did ReviewerAkspector fail to discuss review/inspection with on -site representative? ❑ Yes ES
28. Does facility require a follow-up visit by same agency? ❑ Yes EaNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 10 '
NI FOES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes &Rd.,
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:)No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

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Division of Soil and Water Conservation 0 Other Agency <
�43'e2�A°i'M.ef -s ,$ V'YpW •g.ny, 4 �, P, �..`,k
®Division of Water Quality
O Routine O Com lain[ O Follow- up of 1) WQ inspection 0 Follow- up of DSWC review O Other
Date of Inspection
Facility Number Z ,33
Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified 13 Applied for Permii�© Permitted 10 Not Operational Date Last Operated
Farni Name: ............'t'`!�...... S ssUs Yr��?%-�-. County:............ ��
"..............................
-7� �9�0)sr3�
Owner Name: �! G i .... ,�, S JO�'s .. Phone 10: ..,...
Facility Contact: .! ......., %. ,r Title:...............Phone No: ....... -........
........ l
Mailing Address: /�l/7 %. . P-A [!fz ,� '.',.......,.,... Y�� �.�....... Z.t311�..... ..........................
............. ......... ......
Onsite Representative:........ .1>r ....._ F 5�`'`.i'.............................. Integrator: ......
!k.......... /
Certified Operator; ........... ) ..-. ,E. e x............................ Operator Certification ///Number:.......... _.............................
Latitude ' =' « Longitude • 4 "
Z.D&ign'7 Current
,,,.
rrent r
Desrgn Cu n k R xDesrgn� Currents
Swnie r Capacity Popufateon Poultry
Capactty P© ulahori; Caitle�C >= cr I'o ulati^<
t? apa P one=
_,
❑ Wean to Feeder < ❑ Layer
_ .... n
"
10 Dairy
❑ Feeder to Finish ❑ Non -Layer
❑ F Non -Dairy
y ❑ Farrow to Wean
® Farrow to Feeder 5',Z D ❑ Others
n s
Farrow to FinishDesEgn
Capacity
r' ❑ Gilts
~
❑ Boars
T©ta! SSLW
p. •N :.:p uo. .. .k-- .'
' ..... 1 AAA �y.k4'ti �k. dv+�� i.eit
Nnmberof,La ooxzs! Holds Ponds Z ❑Subsurface Drains Present Lagoon Area
❑Spray Field Area
g0
❑ No Liquid Waste Management Systems
s
General
I. Are there any buffers that need maintenancelimprovement?
❑ Yes
9No
2. Is any discharge observed from any part of the operation?
❑ Yes
NNo
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
allo
b. If discharge is observed, did it reach Surface. Water? (If yes. notify DWQ)
❑ Yes
ffNo
c. If discharge is observed, what is the estimated flow in gaVmin?
X)/A
A. Does discharge bypass a lagoon systetn'? (If yes. notify DWQ)
❑ Yes
q No
3. Is there evidence of past discharge from any part of the operation?
k
❑ Yes
19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
RNo
5. Does any part of the waste`rnanagement system (other than lagoons/holding ponds) require
❑ Yes
No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
] No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97 Continued on back

Facility Number 2 —3,34
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
;4 No
Structures (Lagoons,Holdine fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
X Yes
❑ No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..............
Freeboard(ft): ...27�V(:/�.............. r..................... ................................... ...................... .............. ....................................
10. Is seepage observed from any of the structures?
❑ Yes
'KI No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KI No
12. Do any of the structures need maintenancelimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
X) Yes
❑ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 1V¢r.✓..jL..........................................................................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes]
No
18. Does the receiving crop need improvement?
,E Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes] No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
[3. No.violations:or derkiencie's.were-noted-during this.visit.- Noudwili ike' i'v`no ftirther
Oirts 6itdek-0 about this visit..'.
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7/25/97
Re%iewer/inspector Name
Reviewer/Inspector Signature: r.-! �7_' ,/i Date: