820339_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

d (S t3EJ
Z 1133
Type of Visit: GIU Hance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: 7Roufine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tr - (Arrival Time:I Departure Time: County: s Region:
Farm Name: c , l� .e a-r� S L—ei N r r Owner Email:
Owner Name: C ci-,nj,es Phone:
Mailing Address:
Physical Address:
Facility Contact: Ci-e-ff S Zay i,1yGfc ` Title: Phone:
Onsite Representative: . I 1 Integrator: Pe L5 i- &4 -P
Certified Operator: h w.-SeS 7_"1 Certification Number: q 0q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�esDesign
Swine - Ccity
Current Design Current
Pap. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Design Cnrrent D Cow
D Poul ' . Ca aci P,o P. Non -Dairy
La ers Beef Stocker
Farrow to Wean
Farrow to Feeder
2 D G t+
2 ©cJ
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
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
EErNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
C3'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ f No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - 83J jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
❑� ❑ NA ❑ NE
❑ No 0-14A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
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 [2'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 Q o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [21No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ["No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [:]Yes dNo
❑ 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): n E e t ✓bt.u. , S6 0
Ee6w,f, 14
13. Soil Type(s): �o, ('t �p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ErNo ❑ NA ❑ NE
❑ Yes [/?No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[""No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Faci i Number: - 3 1 Date of Inspection- 02 S r,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [TNo
'k
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [2rf�o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [D, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [J] o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes [DNo ❑ NA [] NE
[:]Yes ONo ❑ NA ❑ NE
[:]Yes [2No ❑ NA ❑ NE
[:]Yes Ca'No ❑ NA ❑ NE
❑ Yes
C3'No
❑ NA
❑ NE
0 Yes
dNo
❑ NA
❑ NE
❑ Yes
[) No
❑ NA
❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C' r' �A i 0-1 `-' 10 -
CJt10-36$-6�sI
Reviewer/Inspector Name: t 1pLVjLjD PhonecL1 [3 -q Z 3 `3 3
Reviewer/Inspector Signature: Date:L a�
Page 3 of 3 21412015

S 1-7 A -.,,`I
(Type of Visit: (ErCliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: CrRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 1I
Date of Visit: I Arrival Time: Departure Time: County: JAW
Farm Name: 14 P . o4fn `NvA9 Owner Email:
Owner Name: 4.J• Ci- Phone:
Mailing Address:
Physical Address:
Facility Contact: C,".a�k-f[ S S0_eW rC& Title:
Onsite Representative: f
Certified Operator: l.ire.v�td� `LI
Back-up Operator:
Phone:
Integrator: p/r_)
Certification Number: 'I I
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Design- .Current Design Current -_,
Wet Poultry Capacity Pop. Cattle Capacity P.
Wean to Finish
11
Layer Dairy Cow
Wean to Feeder
JN22zl_aer
Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Dry Cow
Design: Current
Farrow to Feeder
D , P,oul Gaps P,o ,
Layers
Non -Daily
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
8�,
Othe111111
key Poults
Other
Others
_
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [' 1 iA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [!I'NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No • NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [l Yes [JNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters E] Yes Fn--N o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - s Date of Inspection: w
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [;.NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ug�Ido ❑ 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 Pko ❑ 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 i• '1Qo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Q Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑'No
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Q'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ED`�_o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EkNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Xo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[3-'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1['-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 Ef'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 R'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 21412015 Continued

lFacility Number: Date of Inspection.-Inspection.-Ek A
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EB N`6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L2-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 F;Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E;,N-o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes E;J-�o [] NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[]PNo
❑ 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
[TNo
❑ 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
[]J'I�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

11 (� I yuks 2 j ft-djvA t L .�
rv'ision of Water Resources
Facility Number,] - ®Division of Soiland Water Conservation
� Other Agency
Type of Visit: 4D ?Routine
pliance inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: }�( Region: r
Farm Name-a1�_—L F� Ownere„rLLEmail:
Owner Name: �"� �LG�j/al Phone:
Mailing Address:
Physical Address:
Facility Contact: 6U-A-�U. Title: Phone:
Onsite Representative: L Integrator: ItnE16q
Certified Operator: Met, Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r-C-C�IwP 'l-P c6 oouq'L 00C Z.v(to - Pc-6l21.1
Swine = "_
Design Current Design Current Design Current
.Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
JLMer
Dairy Cow
Dairy Calf
" Dairy Heifer
Design Current Dry Cow
Caaci Po Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Non -La er
Feeder to Finish
_
- D . P,oult
Layers
Farrow to Wean
Farrow to Feeder
zwo
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
wi ' "w_NTurkey
Turkeys
Pouits
�f
Other I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [q.Mr-17] NA ❑ NE
[] Yes
❑ No
21 A_
❑ NE
[]Yes
[—]No
�NA
❑ NE
[-]Yes
[-]No
[3NA
❑ NE
[-]Yes
ErNo
❑ NA
❑ NE
❑ Yes
1[:j No
❑ NA
❑ NE
Page 1 of 3
21412014 Continued

IFiciiityNumber: - e Date of Ins ection:
r•
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gjbkr— ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [;I.NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in): �y
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 [! 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?No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�Jllo ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [3No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ r 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 (j ❑ Evidence of Wind Drift ❑�A�ppliccation Outside of Approved Area
12. Crop Typc(s): — `�-� _Fey cl- - &4411G J (P- 0
13. Soil Type(s): _--4'T'. -L p
f .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes9,0
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes 1_2Ko
❑ 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 2fNo
[DNA
❑ 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 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

i
acifily lyumber: -X Date of inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED M` ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D-W_ ❑ 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 ®-ice ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2"Ko ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[]Yes
❑'No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
L2fi'�o ❑ 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
2<0 ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[k 'es
o ❑ 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
E2"No ❑ NA
❑ NE
Comments (refer -to question # Explain an S answers. and/or an additional recommendations or an other comments
y t
.l.
Use drawings of facility to better explain situations,. use. additional pages as necessa' "
d2s,_
t(
�t
Reviewer/Inspector Name:
r-, 1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -lA3
Date: 2?1"
21412014

A r rh 3 gy �,s —t-, GCL 13ij�
Structure Evaluation Inspection
Facility Number: -- Date:
Time in: t ' S Time out: i O
Farm Name: An- P &xj FiL�K Farm 911 address: Itc [ If
Owner Name:_Ct,4,S Alewx Phone
Facility Contact: —LJLs &,`w,`U!,
Onsite Representative: �� Integrator: it � �
Certified Operator: Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No
Was non -compliant level reported to DWR es POA received
Structure: 1 2 3 4 5 6
Identifier:
Spillway?'
Designed Freeboard (in.):
Observed Freeboard (in.): 1S
Are there any immediate threats to a integrity of any of the structures
observed? I'es No
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste management system need repair Yes No
Condition of field's fid J-- 4 o 0 � Q4�,q Pk %
Condition of receiving crop 11
Comments:

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Water Resources
ENVIRONMENTAL QUALITY
April 26, 2016
Charles W. Allen
5479 Harrell's Highway
Garland, NC 28441
Subject: NOTICE OF DEFICIENCY
Charles W. Allen
Permit # 82-0339
Sampson County
Incident # 201606042
NOD-2016-PC-0124
Dear Mr. Allen:
Secretary
S. JAY ZIMMERMAN
Director
On January 2, 2016 staff of the NC Division of Water Resources (DWR), Water Quality
Regional Operations Section (WQROS) were notified by Curtis Barwick of a high freeboard
level in the #1 lagoon. We wish to thank Curtis Barwick and Mr. Allen for notifying DWR of
this incident.
As a result of this incident, you are hereby notified that having been permitted to have a non -
discharge permit for the subject animal waste disposal system pursuant to 15A NCAC 2T
Section .1300, you have been found to be in violation of your Certified Animal Waste
Management Plan and the Swine Waste System General Permit No. AWG100000 that you are
covered to operate under, as follows:
Deficiency 1:
Failure to maintain waste levels in your lagoon/storage ponds in accordance with the facility's
Certified Animal Waste Management Plan in accordance with Condition V. 2. of Swine Waste
System General Permit No. AWG100000.
On February 16, 2016 a lagoon/storage pond level was documented at 17 inches in the #1
lagoon. A level of 19.0 inches is the maximum level allowed by your permit and Certified
Animal Waste Management Plan.
Required Corrective Action for Deficiency 1:
DWR has received a copy of your 30-Day Plan of Action (POA) for the high freeboard
occurrence. Take all necessary additional steps to insure lagoon levels remain in compliance
with your Certified Animal Waste Management Plan and permit.
Stair of North Carolina J Environmental Quality I Waiter Resources
1611 Mail service Center I Raleigh. North Carolina 27699-1611
919 707 9000

If you have any questions concerning this Notice, please contact me at [phone]
Sincerely,
Belinda S. Henson
Regional Supervisor
NCDEQ-Division of Water Resources
Water Quality Regional Operations Section
Fayetteville Regional Office
cc. Sampson County Soil and Water Conservation District
Prestage

ivision of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other AgencyAPI
Type of Visit: omp nce Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint p Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: I el D Departure Time: ' County Region:
Farm Name: `A*'--F 4.ff + FQrjres Owner Email:
Owner Name: C'7"'- 4 _ dz '411"." Phone:
Mailing Address:
Physical Address:
Facility Contact: r r A9. Title:
Onsite Representative:
Certified Operator: W"
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current
Capacity Pop.
A20o
Wet Poultry
Layer
Non -Layer
4
D . P..oul
Layers
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,o ,
Design Current
Cattle Capacity P.
Wean to Finish
Wean to Feeder
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Ocher
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
0 Yes la No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - _1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure-4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K 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
E71 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
[N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C 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
C,Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes S[ 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): A21_" �D�r!`S ,r /l' /'n Lr/��.1— A
k8� ,�.•--
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
❑ Yes E@ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes RNo
❑ 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 D�LNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ELNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Co 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 CB No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Jallo ❑ NA ❑ NE.
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality. representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® 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
[ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
2—Yes
o
❑ NA
❑ NE
Comments refer to question.,_ Ex lain air YES answers and/or any additional recommendations or; any otherjcomme�n
Use drawingsof facility to better explain situations use additional
ty � ( mar! pages as necessary). `70'� �. �; '"�•+-
77 rrlr, f
AAD7�i ul�s L�•�;•br
Waj /lof != rs� 4+­ '2.sszV�-&1 i` 10T 74 e mod«-kjV'.
/!I c� i Sj k � Gv r'✓� �i x r-� �� ��1 ���
OP w'r i i b = ;.3s Kral
A-6D A -9- Y-k KU-4 e-' — IV -,I— 15—
Reviewer/Inspector Name: 'D p �� �j Phone: �fp--�3�
Reviewer/Inspector Signature: Date:
�� '
Page 3 of 3 21412014

i
' wiiiion of Water Quality
Facility Number ®- O Division of Soil and Mater Conservation
0• Other Agency
type of Visit: ompliance Inspection 0Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: utine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: _ % Arrival Time: :,3 t7 Departure Time: 0 1 County: Region: {�
loor
Farm Name: �` P JEQL r ivt s Owner Email:
Owner Name: (-ri +�LYs 11.0 A - Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: /+ ,r�- pp I``r—
Certified Operator: `iA"It-1 }-1 tj ) A'�z-v.
oG. Phone:
Integrator: e�nL�
11 Al
Certification Number: / / ay"J
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current :PF'-_,
esign Current
Pop. Wet Poultry: Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
_
"
_ T Design Current
D �P,oult . _... !:Ca ace P,.,o
DairyHeifer
Cow
Farrow to Wean
Farrow to Feeder
Non -Doi
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other Turkey Poults
Other Other
Beef Brood Cow
Discharres_and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes FNo ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 214/10I1 Continued

Facility Number: -_3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 54 No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): r �—
Observed Freeboard (in): N
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑NA ❑NE,
Structure 5 Structure 6
❑ Yes EA No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a 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
[2 .No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LKNo
❑ 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
ja No
❑ NA
[3 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? I f yes, check the appropriate box below. [] Yes f2f 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 ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
[K No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rLL71 No
24
❑ NA
❑ NE
acres determination?
`
17. Does the facility lack adequate acreage for land application?
❑ Yes
J4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&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 [K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ®, No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ 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 [RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �&No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [&No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
❑ Yes Lk -No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes No
_
❑ Yes MNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments - 7-
Use drawings of facility to better explain_ situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gZA-9-133 �D a
Date:l
21412011

Type of Visit: 4Compl' nce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: ® Arrival Time: c`3 C7 Departure Time: County:
Farm Name: A ip Fat 1Y4 4 Owner Email:
Owner Name: rl.21 1 L�4 u1 A 11Yw Phone:
Mailing Address:
Physical Address:
Facility Contact: 6ezr -.r /lirjsT-e- Title:
Onsite Representative: Ste,
Certified Operator: 1 � _ w
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator:
Certification Number: /�}� N
Certification Number:
Longitude:
s Design Current
# :'
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry.Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
, : _....: - .
:,
,.
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 23 No ❑ 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: - Date of Inspection: y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 25 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):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E5 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 CKNo ❑ 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
5 ] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fi� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[VI -No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 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): eve^ A 1n S' 4a� ��i`i1't i rr
13. Soil Type(s). /` j ; & /*a
14. Do the receiving cropirdiffer from those designated in the CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V No 'DNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
'❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®, No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&I No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EENo
❑ 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 US -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �5 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EjgNo
❑ 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 ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes to No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [Z No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
[-]Yes � Na ❑ NA ❑ NE
❑ Yes EK No
❑ Yes (Z No
❑ Yes [,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer. to. question ft Explain any YES answers and/or any additional recommendations or any other�comments 4 F
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: }lD-6{33`.3�Dc7
Date:
21412011

t —t
Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up Q Referral Q Emereenev O Other O Denied Access
Date of Visit: / Arrival Time: ! 3 D Departure Time: O: 3 D County: r•.
Farm Name: Faepv t S Owner Email:
Owner Name: dGrI`l�,s I,U 4 11 Phone:
Mailing Address:
Physical Address:
Facility Contact: (30-r-E-r— My&,r_ Title: TGd. 5 mac. Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: z-3�._._ .
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity on.
Wean to Finish
Design Current.
Wet '10 Wry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Daig Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D
Design Current
D , P,oulir Ca aci P.o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes RLNo DNA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes RNo
❑ Yes ZNo
❑NA ❑NE
[] NA] NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®, No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): t
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
01 No
❑ NA
ONE
(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
r;J1 No
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[PLNo
❑ 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 of Approved/Area
/Outside
12. Crop Type(s): t�d� A06—/ _3 l-7 �._ -� / ZG 2n
iar�1
13. Soil Type(s): ,` 4t
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
FLNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[.]Nlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
M-Yes
M—No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fo No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 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 Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[FacilityNumber: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes B No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes E2�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 ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ANo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document ❑ Yes LjjNo ❑ 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
® 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
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
E4 No
❑ NA
❑ NE
Comments (refer to question ft Eaplam any'YES answers and/or any additional recommendations or any -other comments;` {
Use drawings of. facility to better explain. situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 7 /16: L2
21412011

jType of Visit: .QJCoce Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1�Arrival Time: ' i7 Departure Time: ; 3 County: * Region:
Farm Name: / ` ci-,ZF Owner Email:
Owner Name: eAA4"�� IDS 7� keyt— Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: 19-CzAl i - Phone:
Onsite Representative: 9dYY-1'' /%70prm-- Integrator:
jj J/I T107
Certified Operator: dp!/-_' I �![��� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design) ;Current
Swine Pop.
EDOMgn Currents ....
MetMoulffltrw ' -Pop Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Non -La er
" �'
Design i@urrent.:
D E P,oultr Ca c Pro
Dairy Cow
Wean to Feeder
Feeder to Finish
DairyCalf
Da' Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
_
Beef Feeder
Boars
Qtherg
Other
Pullets
M 113eef Brood Cow
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes [:]No
[-]Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection: —'/
Waste Collection & Treatment
A 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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2jNo
❑ 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
E&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
ANo
❑ NA
❑ NE
maintenance or improvement?
Waste Aon6cation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[!I No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
P, 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 differ from those designated in the CAWMP?
❑ Yes
(aN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
Ro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design [ 1 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
0 No
❑ NA ❑ NE
u` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0,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
[ RNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Yes CS No ❑ NA ❑ NE
❑ Yes MNo
[:]Yes ®,No
❑ Yes ®. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any: YES answers and/or any additional recommendations ovary other comments. l
Use ,drawings of.facility to better explain situations.(use,additional pages as necessary} O
;
�7 "%a/ 1�z�re� rc��rz—�2 G�-� r,� ,�cc� G'/�%P
3L co
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,I� Departure Time: �� 00 County: Region:
Farm Name: _ 4 0 2- 2 artm Owner Email:
Owner Name: Cj��e �fh�n �1 r Phone:
Mailing Address:
Physical Address: �1
Facility Contact: 6LZ46 Title: &Vew Phone No:
Onsite Representative: Integrator:
Certified Operator: ",- �f��� — Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f 0 Longitude: [__1 o =1 = u
Design Current
Design Current
Design Current
Swine
Capacity Population
I
OR ftltr.Y Capacity Population
❑ Layer
ID Non -Layer I I
C«attie Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
1
❑ Dairy Heifer
® Farrow to Wean
40oa
Dry PouiEry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
.
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
❑ Beef Brood Co
Ot e
❑ Other
ID Turkey Poults
ID Other I
umber of Structures:
Discharees & Stream 1 mpacts
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 5? No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
EA No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 9.1— Date of Inspection
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 12 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 ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [a -No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [& 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 5a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ca No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind /Drift ❑ Applliication Outside of Area
12. Crop type(s) I erwie'- /D cr-reeSz-�-j /�;�r✓t �llNv��b�'ar--�S
13. Soil type(s)
'V01
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?
C.Yes
❑ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
<33-33� o
Reviewer/inspector Name i;.� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1Zi160iu4 4urrrsnueu

Facility Number: — Date of Inspection
i Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IR 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 RNo ❑ 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 allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JR 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
[4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E, 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
J] 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
+Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fZ No
❑ NA
❑ NE
oAdditional Cmments aiZdlbr Drar�rn �
"� r :.
,a
Page 3 of 3 12128104

Type of Visit 0pliance Inspection O Operation Review f�ructure Evaluation ,,cO Technical Assistance
Reason for Visit outine Q Complaint O Follow up C) Referral Q Emergency 5 her ❑ Denied Access
Date of Visit: l� Arrival Time: / i Departure Time: : D D County:, Qa Region: iFX 6
1000,
Farm Name: _,/CL F �Emr1w- f Owner Email:
Owner Name: C� /Iio`/1-s 'd //W P% - Phone:
Mailing Address:
Physical Address:
Facility Contact: Po�iL�,����r Title: da2tJ" Phone No:
Onsite Representative: Integrator:
Certified Operator: ��'//-Y�.�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = , 0 Longitude: 0 0 = I Q "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Populatian
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
I
❑ Dairy Cow
❑ Wean to Feeder
I JE1 Non -La er
I
❑ Daia Calf
❑ Feeder to Finish
-D Dry Poultry
❑ Daia Heifer
R—Farrow to Wean
❑ Farrow to Feeder
1674900
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Finish
El Layers
El Beef Stocker
❑Beef Feeder
❑ Gilts
❑Non -La Non -Layers
El Pullets
❑ Boars
❑ Beef Brood Cow
Number of Structures:
Other
❑ Turke s
❑ Turkey Poults
❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
[I No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Dumber: - Date of Inspection X7_�
i
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):_
Observed Freeboard (in): `7 ;7_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
jo 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
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5d 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
[0 No
❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[KNo
❑ 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 CAWNP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
$o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ER No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ANo
❑ NA
❑ NE
Ti�.5L[Je�S �O /`yirW J�.- Trj
.1n1`
Reviewer/Inspector Name y Phone: ��/Ot� �?3= , 360
Reviewer/]nspector Signature: Date:
Page 2 of 3 I2/2&04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 14 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
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fO No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addtt,onal�Coinmeuts anWlo� r ags s
i
w
Page 3 of 3 12128104

_ti
Type of Visit 0,e6mpliance Inspection Q Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit "Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other El Denied Access
Date of visit: ®Arrival Time: I %d; CZ) I Departure Time: County: " c„ Region: '5 `�
Farm Name: A= / arl�?S Owner Email:
Owner Name:i�,rr��•S ! �r�c 1¢!%n. �e 18� Phone:
Mailing Address:
Physical Address:
Facility Contact: Lj!j2dsue G-"4i7_1-- Title: Phone No:
41 Onsite Representative: ��r�t-ter /%�1'�7r Integrator: /T9,
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=] e = ' = « Longitude: = o = ' ❑ +1
t
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
1
7771
IE] Layer
❑ Non -Layer
I 1
❑ Dairy Cow
F-1
El Dairy Calf
❑ DairyHeifer
Farrow to Wean
QDry
Dry Poultry
ElCow
❑ Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Non -La ers
ElBeef Feeder
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Wean to Feeder
Feeder to Finish
El Farrow to Feeder
❑Gilts
a
❑ Boars
Discharges &Stream Impacts
1.
Is any discharge observed from any part of the operation?
El Yes
09.No
❑ NA
❑ NE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
HNo
❑ NA
❑ NE
other than from a discharge?
11/28/04
Continued

Facility Number: — ` Date of Inspection
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes (XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Stnucture I Stnteture 2 Structure 3 Structure 4
Structure 5
Structure 0
Identifier:
Spillway?:
Designed Freeboard (in): / T
Obsmed Freeboard (in).__ _c3 f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(it/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? '
❑ Yes D4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [XNo
❑ 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 JFK1 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes (KNo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes [9No
❑ 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
® 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
EKNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-N0
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
-4--0f
y� y (;Yl
a
u r
dr Fr��
Reviewer/Inspector Name ,�,�,� Phone:
Reviewer/Inspector Signature: Date:
' lZaHl" Continued

r
Facility Number: — Date of Inspection $'T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ 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
9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
($ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
12128104

Type of Visit Z)o`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 ❑ Denied Access
Date of Visit: r Arrival Time: -r Departure Time: (, ) County: Region: 0
JIF
Farm Name:IIG2l-►YI S ____rp �- Owner Email:
Owner Name: [ic 14:j l c+ I-h�f Crt j)/�/ct-Si�"" Phone.
T _
Mailing Address:
Physical Address:
Facility Contact: (�/drl p5 d I t9 VN - Title: Phone No:
Onsite Representative: CS r/ NDr?= n Integrator: ��-r s ieo:.�-
Certified Operator: dI /V..S �t�l Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I 0 Longitude: E--] ° 0 ' 0
Design
Swine -Capacity
C►urrent Design Current Design Current
Population Wet Poultry 'Ca ci Populat on` Cattle Ca act Po uiation
:... _P ty .�._.
❑ La er
❑ Dai Cow
Feeder
a er
❑ Non-Lto
❑ Dai Calf
Finish
'''
��Dai Heifer
VFinish
to Wean
oK❑
D Cow
to Feeder
—
❑ Non -Dairy
to Finish
w❑Beef Stocker
�a_;on-a ers❑Pullets
❑ Beef Feeder
"�
❑ Beef Brood Co
❑
4
herElTurke
Turke s
Poults
EE=OOer
❑ Other
s-i- Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Pz. o
❑ 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
[R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
U No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

1
i
Facility Number: — g Date of Inspection �rl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ 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): /
Observed Freeboard (in): 31D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J.-No ❑ NA [:]NE
(ie/ large frees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes M.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? laYes 490 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I&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 E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) %t�f" )W da_ /i9'1:rr512r_ /
13. Soil type(s)
14. Do the receiving crops'differ from those designated in the CAWMP?
❑ Yes
J0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
Al Oo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
-
�� �T 7XI-7
Reviewer/Inspector Name �y Phone: 9/0 —4/3� 5Z3D
Reviewer/Inspector Signature: Date: g
r-ugc c uj I.ss.cur

d
�f — Facility Number: Date of Inspection
r Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
2 i . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LZ 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 $4 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[YNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E.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
S No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Page 3 of 3 12129104

Type of Visit t')'_Compllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: rli; t7� Departure Time: �,�
% i County: Region:
Farm Name:6 /"fr7L-rn It—ari/71� Owner Email:
Owner Name: —h Gt r IDS f � t, K /T I 1 ni / �E7tts v, Phone:
Mailing Address:
Physical Address: _-r ,79 Z , a&V- L 2i w /VC L
Facility Contact: 6-1-Cee- Al ow- -e _ Title: �7 Phornee No:
Onsite Representative:-S�'f''� Integrator: T I—n! 0�
Certified Operator: eh ar`-1 �s - 1 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = , = Longitude: = e 1::] ,
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
I' ❑ Non -Laver
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
Beef Brood towl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes K No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
9� No
El Yes
Lq No
❑ NA
❑ NE
❑ Yes
PjNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EqNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure i 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 23 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 N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M 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 kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )�j No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)S/1rrQY�'G %k 1JYta+Str1/4 (�' r z / �SGur
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
O,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
L r �zrrrrtr 4 c}- �zs -c�
Reviewer/Ins ector Name ` Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: r,, — Date of Inspection I—¢-6R]
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �SNo ❑ NA ❑ NE
the appropiate box_ ❑ WUp ❑ CheckIists ❑ Desig
n 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
tK NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,V No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
A`ddihonal Comments;and%o�`Draw"m&ng - T ., r 4 ,
5« fir« 1
61
12128104

a/r-/.' r
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - t]— j' Arrival Time: Departure Time: :lDa County: Region: ego
_� , a�"� s Owner Email: Farm Name:
j—k00A--
Owner Name: ��L �.. .� t�d�� - -- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: e: 4441C1 /41leI
Certified Operator: e4v,/I �%e �, _
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: e
Operator Certification Number: �Q
Back-up Certification Number:
Latitude: 0 0 0 I= Longitude: = o==
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
t ❑ Layer
❑ Non_La et _
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
aaO 0
go ?"'t?
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Murkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current-
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: J
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 E? o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑,, NNo
El Yes
9N11 o
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

d
Facility Number: ' C
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo
❑ 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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
_��/
IJ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,,��,,//
[3 o
❑ 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?
ElYes
0thNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[9'Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[9-<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
B<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 Area
12. Crop type(s) &eA v, d�� �irpp�rA c sir,../� r�w -► /�s7w �r•��
13. Soil type(s) [12' A Zq "id •
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L3 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
[9�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[9 tvo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2<o
❑ NA ❑ NE
Comments {referyto gteesttaa # Eiglarntany YES71n_ s" ers andlor any recommendaf.ons or any otlter;eomments.
Use drawings 01.[actftty to better explain situattoas `{use sddihonal Qsgesaas�+necessary,
Reviewer/inspector Name 'dq � 4a^ A n _� ` ; � � w, Phone: /a An 1X411
Reviewer/Inspector Signature: Date: d.-
12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes <o ❑ NA ElNE
E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 94,ro- ❑ 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
Egl�o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[9'<E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Df4o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�INo
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge? '
❑ Yes
o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,�L93
Le o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ErNo
❑ 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?
ElYes
/
2 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
El Yes
�,/
L7 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?
El Yes
El NA
[I NE
33.
Does facility require a follow-up visit by same agency?
ElUYes
,+L�No
'No
❑ NA
❑ NE
12128104

r
ivision of Water Quality S
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &t�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: .� 3fl County:
Farm Name: A d-P _ Owner Email:
Owner Name: a�rr Z ���'� / K �rrdE r'-'3 10� Phone:
Mailing Address:
Physical Address:
Facility Contact: �-�1 a✓� /�� Title: Phone No:
Onsite Representative: { Integrator;
Certified Operator: ��}--
Back-up Operator: ��� �c✓ �r�
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
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 s= Longitude: EDo= 1= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ -Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©1
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 JR No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
12128104 Continued

Facility Number. Date of inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spi ilway?:
Designed Freeboard (in):
Observed Freeboard (in): Zq
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes KNo ❑ 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? .4 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tK No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 29Jslo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 [XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
jjZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Eko
❑ 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):
L
inuc �Or7�i <541^e'qj Dn_ a -.� �� 77—/-off k
�
T
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

4
Facility [dumber: —3 Date of Inspection 3 —l3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ yes 5,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DINo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f-No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes J-No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JqNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Ir V,
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 03 Time: � 3U
Facilin� \umber $a'L 3
Not Operational 0 Below Threshold
Permitted ( Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: / 1� = �- ��nic� County-: __/54 �^ psa r• F2�
Owner Name: ,5,,,A7 LL , :4+'4/c.' ,DPC+'-�
+ VGDn Phone No: S. �7 ►b] rua - -t 79
Mailing Address: A a Qa k ��!% Cacs� lia.tcil _ AL C.
Facility Contact:
Title:
Phone No:
Onsite Representative: La 14 l i c to Integrator:. Pr- ea+e4 e. r ­- v-- J _
Certified Operator: C 1lGr Operator Certification Dumber: `t � i8pff
Location of Farm:
9 Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ' 9 0 " Longitude ' �• j
Design Current
Swine e-9naAf , Pnnnl.finn
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
2~
a O.PL
❑ Farrow to Feeder
❑ Farrow- to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Ca acit' Population Cattle Calpacitv Population
❑ Laver I FEI
Dairy
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ID Subsurface Drains Present ❑ Laeoon Area
Holding Ponds /Solid Traps 0 ❑ No Liquid Waste Manage ment'Svstem
❑ S ray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
El Yes
No
Discharac originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notify D WQ)
El Yes
❑ No
c. If discharge is obse v-ed. what is the estimated flow in palimin?
A/Xlq
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2_ Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus stoup storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches): G2
05103101
Continued

1' IFa&ity Number: g,2 --,33
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [� No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [ No
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? �j Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Y9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
l l . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload /❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type V erg u cln.g is /S a O l i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [A No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ;&No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes J] No
15. Does the receiving crop need improvement? ❑ Yes [,%No
16. Is there a lack of adequate waste application equipment? ❑ Yes 99 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ] No
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 �'J No
Air Quality representative immediately.

Facility Number: X.Z - 33 Date of Inspection
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes O No
❑ Yes No
❑ Yes No
❑ Yes ICJ No
❑ Yes No
❑ Yes ® No
❑ Yes IN No
❑ Yes JE1 No
❑ Yes A No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Site Requires Immediate Attention: NO
Facility No. Sz - 3 3,7
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S l 8 , 1995
Time: i4; 08
Farm Name/Owner:
Af P rGt r S/ C ka-i 1 �.5 A I l Q N £' C l Q Y Pz4x-Y 50 *v
Mailing Address:
County: a L- esq nr
integrator: tsto
On Site Representative:
Physical Address/Location:
Phone: C4/oJ S z - S 7 -7 /
Phone: �Z7- - Z i
Type of Operation: Swine Poultry Cattle
Design Capacity: Z000 5o. rve-kia4Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3� ° q 5' /5 " L.ongitude:_2$ ° i 9 ' 30"
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately 1 Foot + 7 inches) (y3lor No
Was any seepage observed from the lMr
(s)?
Is adequate land available for spray. No
Crop(s) being utilized: 1Qe_ymK A&-,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin,gs-?� t e or No
100 Feet from Wells? � or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o(No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o<9)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(�) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
Rewds
Inspector Name
nt freeboard of 1 Foot + 25 year 24 hour storm event
Actual Freeboard: 4 Ft. C Inches
Yes o No as any erosion observed.) Yes or(G)
Is the cover crop adequate) Yes r No
Signature
cc: Facility Assessment Unit Use Attachments if Needed.