820343_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4* Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1,7 Arrival Time: Departure Time: " ounty: Region:
Farm Name: S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 3O.l'►"6 10-4-Jo Title:
Onsite Representative: U
Certified Operator: jiry S "" S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: L V
Certification Number:
Longitude:
-€Design
Swine Capacity
Cnrrent
Pop.
Wet Poultry 'h'SCapaeity
Design Current
-f Pop. Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�:°'
Design Cnrrent'
D . P,nal; . Ca aci 1'0
DairyHeifer
D Cow
Non -Dairy
11
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
I I
Othera1j'
Turkeys
Turkey Points
Other
Other
.:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes �No
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [:]No J�$NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes [—]No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collation & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 10
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
No ❑ NA ❑ NE
❑ No NA ❑ NE
Structlllurre"' 6
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 'P21 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 11�_fj 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? 4
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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 /W'innd Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Gnskillt� L�».$5 C YCI47--t, . _5�11, o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
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
T®�
❑ 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.
T�
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping; need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. (lid the Motility fail to calibrate waste application equipment as required by the permi . ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rM No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes j No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T� 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 [:1 Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes �No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: RrU '33- 3 O
Date:
121412045

S %
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820443 . Facility Status:
Inpsectlon Type: Compliance Inspection
Reason for Visit Routine
Date of Visit: 0312212017 Entry Tlme: 10:00 am
Farm Name: Farm #141 3514
ActiVe Permit. AWS820443
Inactive Or Closed Date:
County: Sampson Region:
Exit Time: 10:30 am Incident S
Owner Email:
Owner: Murphy -Brown LLC Phone:
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 1959 575 Shanghai Rd Rose Hill NC 26458
Facility Status: ■ Compliant ❑ Not Compliant
Location of Farm:
At dead end of Shanghi Rd. approx. 2 miles E. of Delway
❑ Denied Access
Fayetteville
910-296-1800
integrator Murphy -Brown LLC
Latitude: 34' 46' 24" Longitude: 78° 11' 52"
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone:
Primary Inspector. Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820443 Owner - Facility : Murphy -Brawn LLC Facility Number: 820443
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Feeder to Finish 12,595
Total Design Capacity: 12,595
Total SSLW: 1,700,325
Waste Structures
Designated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19,30
37.00
Lagoon
3514
page: 2

Permit: AWS820443 Owner - Facility : Murphy -Brown LLC Facility Number. 820443
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for visit: Routine
Discharges & Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ 0
❑
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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
MEI
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
yes
No Na Me
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
00
❑
maintenance or improvement?
Waste Application
Yea No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820443 Owner - Facility : Murphy -Brown LLC Facility Number: 820443
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yee No Na Me
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Com, wheat, soybeans
Crop Type 3
Small Grain Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autrolle loamy sand, v to
6% slopes
Soil Type 2
Goldsboro loamy sand, 0 to
2% slopes
Soil Type 3
Norfolk loamy sand, o to 2%
slopes
Soil Type 4
Rains sandy k3em
Soil Type 5
Wagram loamy sand, 0 to
6% slopes
Soil Type 6
Woodington loamy sand
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ 0 ❑ ❑
Management Plan(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 acre
❑ 0 ❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑ ❑
18. Is there a lack of property operating waste application equipment?
130011
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
[]
page: 4

4
Permit: AWS820443 Owner - Facility : Murphy -Brown LLC Facility Number. 820443
Inspection Date: 03/2?J17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yee No Nx Ne
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
E ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non-ompliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-omplianoe:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Ne Me
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
E ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑0
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑0
❑
❑
If yes, check the appropriate box below.
Application Field ❑
Lagoon / Storage Pond ❑
Other ❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ 0 ❑ ❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with on -site representative? 1101111
34. Does the facility require a follow-up visit by same agency? ❑ N ❑ ❑
page: 5

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
'
Departure Time: Z;fX?
County,,�S&- Region:
Farm Name:
'J 14.5 l_
Owner Email:
Owner Name:
yQR
✓5
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Sa.n,es 1"
Onsite Representative: y
Certified Operator: 7W^1 - L
Back-up Operator:
Title:
Phone:
Integrator: ! f�
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
D�00,eut� Design Currents Design Current
Swine EaWetPoulf"ry. Capacity P,op� Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder 0"'I iNon-l.aver Dairy Calf
Feeder to Finish ySEN Dqja Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder _ DryRPoul Ca -Dairy
Farrow to Finish �La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars ' ` Pullets 1pmf Brood Cow
F Turkeys = - -
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ONA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[—]No
N NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
tp No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
7
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 9No PTNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4. Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): tr Z L1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ftNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) Lf
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes /M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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 Acee table rop Window ❑ Evidence of W' CD Application Outside of Approved Area
12. CropT s : =S 6 5� 1 _�� 9aj�'_ nw1wi
13. Soil Type(s): a'o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ 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 I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili 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 P No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes f 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[??No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
Phone:
Date: d
21412011

t ype of v 151t: W S.ompuance inapecuoa %-! vperanon xeview v aLTUCaure r,vaiunnon 4J 1 ecunica[ Assistance
Reason for Visit: • Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I l Arrival Time: Qr� L Departure Time: County: S� 4711 Region: �o
Farm Name. — S Owner Email:
Owner. Name: F S-161e, Phone:
Mailing Address:
Physical Address:
Facility Contact:
V k �,� L-a",,L Title:
if
Onsite Representative: f
Certified Operator: P4r"C L- A) e-Q1
Phone:
,�
Certification Number: `r3S
Integrator
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design
Capacity
Current Design Current Design
Pop. Wet Poultry Capacity Pop. Cattle Mcapacity
Laver Dairy Cow
Non -Layer Dai Calf
,_ Dai Heifer
2,6 ' ._ W - Design Current Cow
D1?,oultr Ca aci Po Non-Dalry-
Current
Pop.
Farrow to Finish
-
Layers
Beef Stocker
Gilts
Boars
-
Other
Non -Layers
Pullets
Turkeys
Turkey Poults
Beef Feeder
Beef Brood Cow
Other
Other...:-:
_�
_.........
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P§ No ❑ NA ❑ NE
❑ Yes ❑ No � NA ❑ NE
❑ Yes ❑ No [y] NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No A NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ONo ❑ 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 I of 3 21412014 Continued

r
aJ .l
Facili Number: - Date of Ins ection:PI IW.,oO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 9
X No ❑ NA ❑ NE
❑ No K?q0&1 ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):j� y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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
$2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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 W' Drift ❑ Application Outside of }Approved Area
12. CropT e s : oask-� f��-j v�SS � � /y1, . (J'-+'M- V)'�
yP(} � ,] �n
13. Soil Type(s): C-0-13
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 �0 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facffi Number: Z e,347 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
®No
❑ NA ❑ NE
the appropriate box(es) below.
TT''
❑ 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
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
EP 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 W No ❑ NA ❑ NE
❑ Yes I" No ❑ NA ❑ NE
❑ Yes (P No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes (5] No
❑ Yes No
❑ Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 1 1 /3
Page 3 of 3 21412014

i ype of v isu: iw i.ompillance inspection v operation xeview lJ atructure Evaivanon lJ i ecnnicai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County2� Region: IFQ
%
Farm Name: - C 'IC Owner Email:
Owner Name: �'i �` y ` at( MS _ 1- Phone:
Mailing Address:
Physical Address: 1
Facility Contact: �- L�� Title: Phone:
K
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
IJ
Certification Number: ? 79
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
@specify
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
iry Cow
Wean to Feeder
Non -La er
I
i Calf
Feeder to Finish
airy Heifer
Farrow to Wean
406b
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
$oars
Pullets
I
113ecf 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 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 N No ❑ NA ❑ NE
❑ Yes ❑ No in NA ❑ NE
[-]Yes [:]No Z)NA ❑ NE
[-]Yes [—]No
[:]Yes ® No
❑ Yes jr�unl No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

'I Faciliq Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
j5 No
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
S re 1 cture 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
r y��
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
""No
[DNA
❑ 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
)K3 No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
PNo
❑ 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 Apulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accentable Cron Window n Evidence of Wind Drift n Annlication Outside of Annroved Area
12. Crop Type(s):
13. Soil Type(s):
❑ NE
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ 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
® 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 KI-No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes 0No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

JlFacilityNumber: - Date of inspection: I/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�Ji No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
7T��
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
6EI No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question ft lExplain any YES answers and/or any additional recommendations or any_other commeet`s.
,. r
Use drawings of facility to better e=plam situations (use additional pales as necessary):'
�." .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i 2/iy
21412014

Dims 3/biZC✓TG1,)
Date of Visit: ^yl Arrival Time: Departure Time: 2! County: r f
Farm Name: r1 Cy Owner Email:
Owner Name: 1r t'L°S4 N � Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: laplies lamb _ Title: Phone:
Onsite Representative: it Integrator:l�J'ftt�
4'_ J,
Certified Operator: Pa4— ��0..� _ � Certification Number: 11935
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
11
Design Current Design Current
R'et Poultry Capacity Pop. Cattle Capacity Pap.
La er
Dairy Cow
Wean to Feeder
INon-La er Dairy Calf
" "' DairyHeifer
Design Current Dry Cow
D . P■oul _ Ca aci P,o Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Points
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
prp'(j
3q%
Gilts
Boars
Other
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [—]No i] 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 reacbed waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑_No] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes] No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

-IFacili Number: `�- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A A-
PNo ❑NA ❑NE
❑ No P.NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �j 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 V No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? IP
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P
No ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence off
CWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5ra�t �Ay� 6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EP No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ 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

FaeilfNumber: $Z -=2213 Date of Inspection: [
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes f g No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes �q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fait to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/]nspector Name:
Reviewerllnspector Signature:
Page 3 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes rM No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
M No
❑ Yes
[�o No
❑ Yes
W No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
rA� - Phone: g119-
V aN Date: �r /117
21412011

type of visit: IM Compliance inspection V Uperation Review U Structure Evaluation U iectinical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 Z %3p Departure Time: County Region:?}
Farm Name P—ffl 11S 13 Owner Email:
Owner Name: Pre 5`6 Phone:
Mailing Address:
Physical Address:
Facility Contact- Title: Phone:
Onsite Representative: Jo-yV Q5 li041�0 Integrator:
Certified Operator: ,-.7 i I Certification Number: q90 S�9
Back-up Operator: �l IV M. Certification Number: 2gg35
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
wine" Capacity; Pop+ Wet Poultry F'Capacl��Pop Cattle Capacity Pop.
2 �.��.
.H Wean to Finish �La er Daia Cow
Wean to Feeder Non -La er Dat Calf
Feeder to Finish " F
a: r Dairy Heifer
D. � e_..r
Farrow to Wean Design Current D Cow
Farrow to Feeder P,o.ult'' Ca aci P.o Non -Dairy
Farrow to Finish Layers Beef Stocker
NJ Gilts Non -Layers Beef Feeder
El Boars 3 Pullets Beef Brood Cow
r
Turkeys
Other - Turke Poults
Other her
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Stricture ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
[:]No
NA
[] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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
❑ No
[n NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -543 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Qq NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:1 _ _ k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 k 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.) T
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? T
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 j q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes TT No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) I
9. Does any part of the waste management system other than the waste structures require ❑ Yes E] 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 4 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): �a$�u C GY455' �a5 , 151V1, G�V­ ©lam
13. Soil Type(s): L4LO _
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.
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[-]Yes `�j No ❑ NA ❑ NE
❑ Yes E�j No ❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes [3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ io No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Inspection: Z t 2
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
`� No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
TT
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
P 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_
T
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
EP 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
DD No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
© No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (irefer to question #: Ezpl`ain any YES answers andlor any additional recommendations or any other comments.
ise drawings of faei6ty to better explain situations (use additional pages as necessary,).
Reviewer/InspectorName: May
Phone: q—3W
Reviewer/Inspector Signature: 4.t�-�
Date:
Page 3 of 3
21412011

Date of Visit: Arrival Time: ; Departure Time: County• �e&46
Farm Name: 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator: S
Certification Number: 99�
Back-up Operator: Certification Number:
Location of Farm -
Latitude:
Longitude:
Design Current k Dessign Current
Swine Capacity Pop Wet Poultry Capa.ctty P,op.
Design Current
Catue Capacity Pop.
Dairy Cow
Wean to Finish
La er
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder,..D
3
Non -Layer
Daig Calf
- `
Design Current
, PoW Glipacity, Po
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Boars
Turke s
Other
Turkey Poults
Other I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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
55 No
❑ NA
❑ NE
❑ Yes
[] No
[P NA
❑ NE
❑ Yes
❑ No
Q NA
❑ NE
❑ Yes ❑ No
❑ Yes 4 No
[:]Yes ED No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility umber: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�PNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 325' q 7 0
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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
Op 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
EP No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Rg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind rift ❑ Application Outside of Approved Area
12. Crop Type(s): G"I "56 CY
13. Soil Type(s): Gk
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes FO No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )2� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes D] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes Q] 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 FK] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [::]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili umber: jDate of Inspection: q1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [8 No ❑ NA ❑ NE
25. is the facility out of compliance with pen -nit conditions related to sludge? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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 On No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
(& C S Y'" t
C ,-..k %/ "t 5 t V-j- 0 1"
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes � No ❑ NA ❑ NE
[:)Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes P No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Phone: q/D_['33_ 33e29
Date: 1 ` g �r
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 19 Arrival Time: Z�D� Departure Time: 3: County: (;.41"h� Region: Je —_
Farm Name:4,141A ' Owner Email:
Owner Name: res MS Cr Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—] o = ' a Longitude: = ° 0 + ❑
Design Current Design Current Design Current
Swine
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish I
Layer
I
Da' Cow
❑ Wean to Feeder
I
I ILI Non -Layer I
I
Dairy Calf
Feeder to Finish
I
I
Dairy Heifer
Farrow to Wean
aCrD
Dry Poultry ❑ D Cow
ElNon-Dairy
El Layers
El Farrow to Feeder
El Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
Gilts
❑ Beef Feeder
FE]Boars
❑ Pullets
❑ Turkeys ❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other Dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 P No ❑ NA ❑ NE
❑ Yes ❑ No P)NA ❑ NE
❑ Yes ❑ No tV NA ❑ NE
❑ Yes ❑ No [�NA ❑ NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

r
Facility Number: 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 �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 S ructure 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 (PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes EP 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1Y 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 to No ❑ NA ❑ NE
maintenance or improvement?
Waste Amlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Pd 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) LOLL
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
$3 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
B No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�4No
❑ NA
❑ NE
I Reviewer/Inspector Name '� : �'�U T Phone: T I
Ij Reviewer/Inspector Signature: 1a Q<< Date: I D
Page 2 of 3
12/2AM Cmttinued

j Facility Number: — Date of Inspection rD
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 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 [BNo ❑ 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
[N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
()9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fig 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
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? (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
5allo
❑ NA
❑ NE
Additeonal Commentsand/or Drawings:
Page 3 of 3 12128104

V
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: �Q� 1rt Departure Time: County: s Region: Fr'-"
Farm Name: 1" ! (-` A J3 Owner Email:
Owner Name: Yes fay C S ���h G, Phone:
Mailing Address:
Physical Address:
Facility Contact: H ��— Title:
Onsite Representative: 1—ar—AQ S Law k
Certified Operator: n S
Back-up Operator:
Phone No:
Integrator:. 222L R_.01
—
Operator Certification Number:
Sack -up Certification Number:
Location of Farm: Latitude: 0 0 = « Longitude: F-1 o =1 , = u
liDesign
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry
Capacity Popnlation
Cattle Capacity Population
❑ can to Finish
❑ La er
❑Dai Cow
❑ can to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
Farrow to Wean
o
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
El Layers
ElNon-Dairy
El Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Tur ey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Fo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ElNo;NA
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
R NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if ves, is waste level into the structural freeboard?
Stricture I Stricture 2 Structure 3 Structure 4
Identifier: A
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
❑ Yes y No ElNA ❑ NE
ElYes ❑ No r NA ❑ NE
Structure Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
tw No El NA [I 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
r
through a waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
S
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
1No ElNA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window [:]Evidence of Wind Drift\ El Application Outside of Area
12. Crop h'pe(s) CM44V11i
�r
_ IMP M A I 501, &a�n AVASJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question 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):
a
W
Reviewer/Inspector Name { Phone: 00
Reviewer/Inspector Signature: Date: qi
12128104 - Continued

41
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 No ❑ NA ❑ NE
the appropriate box. 1
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EpNo ❑ 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No (PNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ 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
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ipNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P 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
[P No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
V No
❑ NA
❑ NE
12128104

Type of Visit .40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: M-q9
Arrival Time: /�: ry. Departure Time: ;/ County: SAlyfroN Region:Farm Name: A _j3 Owner Email:
Owner Name: rest e_ Far 5- Phone:
Mailing Address:
Physical Address:
Facility Contact: t .,, Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o ❑ ' ❑ Longitude: = ° = ,
p Eg -_ 5 P g ��Put r Design Current
Des' n . Current Desi n,
Swine r Ca actty. Population Wet Poultry Ca act. Po ulation K Cattl_e Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder Non -Layer
❑ DairyCalf
❑ Feeder to Finish ;° ❑ Dairy Heifer
Farrow to Wean ❑ Dry Cow
- DryP,au�ltry
El Farrow to Feeder `' ❑ Non-Dai
❑ Farrow to Finish ❑ La ers
a 0 Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Boars ❑ Pullets
Turkeys ❑ ❑Beef Brood Co
Other fi _ ❑ Turkey Poultsarw
❑ Other ❑Other Nu -
ber of Structures:
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation'?
❑ Yes ANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
10NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
(19 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
Q9NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 011 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PPNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
tA
[INE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
ure
6
Identifier: +
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 297CP .
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JRNo
❑ NA
❑ NE
(iel 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
�No
El NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
El Yes
�No
NA
[I NA
NE
maintenance or improvement?
Waste ARPlicatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
inNo
❑ NA
FINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of
Acceptable Crop Windowf�❑ EvidenceofWind Drift [:]Application Outside of Area
12, Crop type(s) �-O� s- arMW6 Ggss t- sT""� c✓�S1�1 � oye _SQ6
13. Soil type(s) (1,% 2-1 — ^
1
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
1p 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
E) No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fgNo
❑ NA
❑ NE
gUse drawut s of faciiipetoohetter a gpi situatia sa use add�tton ay eslas da tsaas or any othe �C� ( �« � � r comments.
y
Reviewerlinspector Name '^ Phone: t{33^33pp
Reviewer/Inspector Signature: 4A&T jAa0k Date:
Page 2 of 3 12/28/04 - Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes flNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J,No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 [S No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 00 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 5No ❑ 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
VbNo
❑ 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
KI 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
VTNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;!�No
❑ NA
❑ NE
Comments and/or Drawings:
IZ128104

r�
>t
Division of Water Quality
Facility Number, 3 3 0 Division of Soil and Water Conservation
-- - 0 Other Agency
Type of Visit -0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assis=Access
Reason for Visit Routine O Complaiintt 0 Follow up Q Referral 0 Emergency d Other ❑ Denie
Date of Visit: 19 IDE"l Arrival Time:I 11 this.., I Departure Time: County. Region:11LJ
Farm Name:
�^TTP��—I —fbOwner Email:
Owner Name: �� � Phone:
Mailing Address:
Physical Address-,
Facilitv Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
ow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o [� I = Longitude: = ° = L = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑Non -Layer
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 El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Populatioi
B
ec r o
Y
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 OLNo ❑ NA ❑ NE
❑ Yes
❑ No
p&NA
❑ NE
❑ Yes
❑ No
;9 NA
❑ NE
r--
❑ No JXNA
❑ NE
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ Yes
tgNo
❑ NA
❑ NE
12128104 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
o ElNA ElNEa.
If yes, is waste level into the structural freeboard?
ElYes
rNo❑ NA ❑ NE
Structure 1 Structure
2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: t�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�&No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 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
D�LNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo ❑ 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 ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ElApplication Outside of Area
12. Crop type(s) P ) SM C-1 r 6 _1CC
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Al No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name 7ikE 7 Phone: `1' V53
ReviewerAnspector Signature: Date: ohs
1212810 Continued

Facility Number: a Date of Inspection
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 0jNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
1EKNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U:�10
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Mlo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
gNA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I1No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
PNo
❑ 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?
El Yes
,y,
No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
1
1
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 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
�XbNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�ffNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

f
e
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0 Region: 1 &
Farm Name: P- A -6 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:_
Certified Operator:
Back-up Operator:
D Phone No:
Integrator: 1 t`PS't4P
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I = " Longitude: ❑ ° = t
Design Current Design Current Design
Swine Capacity Population. �Ploultjr_x_,Capacity Population Cattle Capacity
C■urrent
Population
❑ Wean to Finish
❑ La er
❑ Da' Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
Farrow to Wean
t)Ob
p'j
irk "
Dry Poultry. z�4
`� *
❑ Dairy Heifer
❑D Cow
'
El Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
❑Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Cowl
Other
❑ Other
❑ Turkeys
-
F"
Dumber of Structures:
j
Turkey Poults
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�,�
[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Wri
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
g
❑ Yes
El No
VNA
[3NE
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
bd NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
TNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structu;e I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes EKo ❑ NA El NE
❑ Yes [I No 2 A ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LJhrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O Flo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes UeNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 59 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) U& i 7U Xr-a
13. Soil type(s) CA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IP No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�3 No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Reviewer/Inspector Name �_" !'` ]' hone:
Reviewer/Inspector Signature: te: �p
Paee 2 of 12 04 Continued

i Facility Number: 2— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M 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 ❑ Designs ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 99 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 N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EN No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
99 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'?
El Yes
V 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
[�j 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
4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9) No
❑ NA
❑ NE
Additional;Commentsind/orDrawings:
Page 3 of 3 12128104

1 Division of Water.Qualitr%
Facil>Ity Number 3 y O Division of Soil and Water Conservation*
----� --- 0Other. Agency
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: 1 S 7-y-S71 Arrival Time: %/ : a Departure Time: County: " ot- i Region: 7 '�
p n 1
Farm Name: f 9 Y+ ! Owner Email:
Owner fame: t— 'EQr_r!s Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title:
Onsite Representative: CLU% aU r ar e_&o4
Certified Operator: S 1 ak e.�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 1 rtS
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: E::] ° 0 ' ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
F
La er
Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
ii 00i>
3 S oe
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
giurkey 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 I
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
5
b. Did the discharge reach waters of the State'? (Ifyes. 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 . [)9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
XNo
El NA
El NE
❑ Yes
QG No
❑ NA
❑ NE
12128104 Continued

r
Date of Inspection S 4�
Facility Number: ga— tE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to 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: cell? O �
Spillway?: 3
Designed Freeboard (in):
Observed Freeboard (in): 3;a1v 94J41*
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[$j No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[N No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
14 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ec %c VV%% eA2 a
13. Soil type(s) C. r6
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
[2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
© No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
© No
❑ NA ❑ NE
7- /semo,e_ we7od7 sap I'jj
b4.-,k.
CO rrt cr p � f a? oav
Reviewer/Inspector Name �_Q.' Phone:
Reviewer/Inspector Signature: Date: 26' o.r
12128104 Continued

Facility Number: 7,2 - 3ij Date of Inspection S of
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 ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X❑ 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
[19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[j5 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
[X 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
M 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 Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�a No
❑ NA
❑ NE
12128104

i
Type of Visit $ Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4P Routine Q Complaint Q Fallow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: O Tune: 'em
Q Not Operational Q Below Threshold
GWermitted Mk�ertified G3 Conditionally CertMed 13 Registered Date Last Operated or Above Threshold: ...... _.
Farm Name: ...... County: Q�a�Q 2/�t�1 ......------- — ---- . FiPO
Owner Name: -�Ipt �:SQ .... Fa�irl..5 .. __.... �. ..W ................... Phone No:
wiling Address:..
Facility Contact: ......... Ran 4..........sczrr. &_ i_. ... _... Title:.. ......._.............................. ..........ppPho_ne No: .. .� . � .
Onsite Representative: _._._!5 Qn d� ... �1� ..Q!?f _ „ .__ .... Integrator:
Certified Operator: ...... ...... S.r. n_ Pic .....1�..7,a_ c_k----------------- -------- ----- _--- Operator Certification Number:..:..,.??3�,4e... ......
Location of Farm:
MlSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • < «
Discharf_es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [tINo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 000
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes Q
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes E�No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E .No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes t.No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Flo
m &tructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifi........ ....� ..... .............................
r ;
Freeboard (inches): _;2
12/I2103 Continued

r Facility Number: —
Date of Inspection 3- O- D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes filwo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [moo
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 maintenancefimprovement? ❑ Yes D- o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes B<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes C-Fo
elevation markings?
Waste Aonlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
IgNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
SNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop'
type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
M-Ko
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[3-go
b) Does the facility need a wettable acre determination?
❑ Yes
MNo
c) This facility is pended for a wettable acre determination?
❑ Yes
Q'Ko
15. Does the receiving crop need improvement?
❑ Yes
E X0
16. is there a lack of adequate waste application equipment?
❑ Yes
EU?lo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
[]-Ko
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[a No
I9. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes
04,410
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
alto
Air Quality representative immediately.
'Comments (refer to ques�aa}�>y YFS answers and/or spry Yns or any other comments.
Use drawmgs�af f�ty to better racplasa srhta#�at�{ose. addrhai $pages as oec�sary}-�� ©old Copy ❑ Final Notes ��
r
Y
ReviewerAnspector Name
ReviewerAWspector Signature: w Date:
12112103 Continued

} Facility Number: ga — Date of inspection
'7Y,i w '0
.1',
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
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?
❑ Yes ENo-
0 Yes U Ko
❑ Yes [9-Ko
❑ Yes U-NO
❑ Yes Ub
❑ Yes E7 No
❑ Yes G No
❑ Yes ❑ No
❑ Yes L7 go
❑ No
❑ Yes [}hio
❑ Yes BI-No
des ❑ No
34. Did the facility fail to calibrate waste application equipment? MXes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes Do
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention: 240
Facility No. 92 -3 y -&
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: i 8 1995
Time: I D = 3 8
Farm NamelOwner._ P f 9 B % J�raq e Farb 1/i/G .
Mailing Address: PO BOX' 4-3S z $ 3 2 $
County: a*nP p__ _
Integrator: Phone:
On Site Representative: Phone: < 9lO� 592 - 57 71
Physical AddresslLocation:_
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Z_" rar-Wemnl Number of Animals on Site: 2 000
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: -7 Ft. QInches
Was any seepage observed from the la o m(s)? Yes or(l Was any erosion observed? Yes or N&
Is adequate land available for spray? es or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: y-wsS
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin
a s? or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or N�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ois)
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)? Ye. or No
Additional Comments:
1 ieK Jze.vejs
Inspector Name
RRe4-z -
Signature T
cc: Facility Assessment Unit Use Attachments if Needed.