820347_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

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 0 Denied Access
Date of Visit: 2 Arrival Time: D ' f Departure Time: County Region: "TJ
Farm Name: Iq G Owner Email: �'—
Owner Name: Res Phone:
Mailing Address:
Physical Address:
Facility Contact:[y�.Q� tf`--U Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: + �7
Certification Number: ryo
Certification Number:
Longitude:
Design Current
Design Current
Design CarreAt
Swine
Capacity -Pop. _
Wet Poultry
Capacity ,'Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
!
ii"
Dairy Heifer
Farrow to Wean
D
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult .
Ca aci
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other`'+
fir!;
Turke Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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 DWR) [] Yes ❑ No / q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes F) No DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 1P No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes IP No
❑ NA
[_1 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [] No
n NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 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 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 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops 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
P 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
[�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
1� No
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑Waste TrVsfers
❑ 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
Page 2of3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
21412015 Continued

Facili Number: - Date of Inspection: Ma
41177
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 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
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
(] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
1� 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
Wo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to questeooE#1): E paRya©wrdoranyaddinmna'dry ol'c niments'a'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: fIZ4
21411015

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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: d. t Cp County:1^' Region:
Farm Name: N
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ; J Integrator:
Certified Operator: �l `t-f" �i Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
iry Cow
can to Feeder
Non -La er
iry Calf
Feeder to Finish
airy Heifer
Farrow to Wean
-
Design
Current
Dry Cow
Farrow to Feeder
Dry 1'oult .
Ca aei
_P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
10ther
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify 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 'F" No ❑ NA ❑ NE
[:]Yes
[—]No
[�NA
❑ NE
❑ Yes
❑ No
[;4)NA
❑ NE
❑ Yes ❑ No
❑ Yes o
❑ Yes�i No
VyNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

IFaVility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Vn 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?
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
q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[4? No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 [�b No ❑ 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 Window ❑ Evidence(7q.
in Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C � sCJ �"` -"� Ddo'V4'eew
r^� r
13. Soil Type(s): &J
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 1h 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 �3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 [�D 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

Facility 1VUmber; 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 T® No
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 to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
(P No
`�'
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I
[�j No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other continents:
Use drawings of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name:
Phone: 110-Y3I '_3360
Reviewer/Inspector Signature:
Page 3 of 3
Date: _ q1���7
21412011

(Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance 1
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access I
Date of Visit: Arrival Time: QI'Q& Departure Time: ` ounty: Region:
Farm Name: P-1C Owner Email:
Owner Name: je- Phone:
Mailing Address:
Physical Address:
Facility Contact: �a'�'�S Cu �'�^'� Title: Phone:
Onsite Representative: Integrator: ReSAj
Certified Operator: 944- &W Certification Number: .2? 935
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Deslgn Current
Design
Current
Design Current
Swine
Capacity Pop,Poultry
Capacity
Pop.
@attle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
I
Dairy Cow
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Zztv 22-13
Dry Cow
Farrow to Feeder
D , �P,o_ul
Ca aei
l;o
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Qther
Turkey Puuets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes P No ❑ NA ❑ NE
a. Was the conveyance man-made?
[—]Yes
❑ No
OFNA
[] 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
E�j No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

6.
Facility Numher: $2 - y % 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
®No ❑NA ❑NE
[—]No §a 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
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
f�] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EP 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
K3 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?
tq
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 pWindow e❑ Evidence of and Drift ❑ Application Outside of Approved Area
12. CropT e(s : COQS! ✓Lc�dS ��
Yp )
13. Soil Type(s): CaP
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 E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Da 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 W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONO ❑ NA ❑ NE
the appropriate box.
❑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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E] No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [A 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 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor 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? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes T No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question # ):. Explain any YES answers and/or any additional recommendations or -any other�comments.��
Use drawings of facility to better explain situations (use additional pages as necessary): - ` - .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes EpNo ❑ NA ❑ NE
❑ Yes F] No ❑ NA ❑ NE
Phone: ?fP*j • o oo
Date: K I �/Jf
2✓anora

IType of visit: ® t_;ompuance inspection LJ tJperatron xeview U Ntructure Evamatton U recnnicat Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 114 V, t I Arrival Time: 03ro0 Departure Time: County: _%+"' PTS Region:
Farm Name: r1 61 C Owner Email:
Owner Name: ?1_Mk(W Phone:
Mailing Address:
Physical Address:
Facility Contact: YKt,& Lo-,,,b Title: Phone:
Onsite Representative: Integrator:
n � q
Certified Operator: j��A� AJ _ Certification Number: �7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Curren#
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Finish
La er
Non -La er
Dai Cow
Dai Calf
airy Heifer
Feeder
Finish
to Wean
ZPS
Design
Current
Cow
Feeder
KFwTow
D . Poul
Ca aci
P,o
Non -Dairy
Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
pullets
Beef Brood Cow
"
Turke s
Other
ffTurkey
Poults
Other
1111
10ther
Discharges and Stream Impact
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 No ❑ NA ❑ NE
❑ Yes
[] No
141 NA
❑ NE
[:]Yes
[-]No
® NA
❑ NE
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 ❑ No
❑ Yes .4P No
❑ Yes &q No
W NA ❑ NE
[:INA [] NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility 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 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
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 Q;�NA ❑ NE
Structure 6
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ 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 ,� 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) 10
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 1P
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 Evi nce f W-nd Drift ❑ Application
o-f�Approved Area
[Outside
%�❑
Coa5 4, �aQ,� s a �� �►
12. Crop Type(s): •-�-� c'3—+ � CJ
�/'
13. Soil Type(s): nQ7
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ 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 [El No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P-No [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []gjNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis []Waste Transfers
❑ Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
214120/4 Continued

Facili Number: jDate 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 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 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [!j; No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3] No ❑ NA ❑ NE
Comments (refer to question Explain any YES answers and/or any additional recommendations or anytother tomments;
Use drawings of facility to better ezplain situations (use additional pages as necessary).
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
Phone: ,J ]�/D r�? ? —>?�
Date: I % -Z/ ) r
21412014

IType of Visit: 40 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv O Other 0 Denied Access
Date of Visit:
Farm Name: F —1 R C
Arrival Time: Z`.00 n. Departure Time: County: _3 ►' S&J Region:
Owner Email:
Owner Name: �i.Ps Rim-s Phone:
Mailing Address:
Physical Address:
Facility Contact: —1_44s h` 79 6 Title:
Onsite Representative: #
Certified Operator: P ti'C�� Ad
Back-up Operator:
Phone:
Integrator: ep"�
Certification Number: 217 935-
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Design
Current
Swine Capacity Pop. Wet Poultry Capacity Pop...
Cat#le Capacity
Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
2flcD
Design
Current
Caw
Farrow to Feeder
D . F,oultr Ca aci
L',op
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Beef Feeder
Gilts Non -La ers
113eef Brood Cow
Boars Pullets
Turke s
Other Turkey Poults
Other Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? [] Yes QEJ No [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [:]No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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
❑ Yes J�g No
❑ Yes ED No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Imcility Number: 919 - 3 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 I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):3
S. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
PNo ❑NA ❑NE
[:]No W NA ❑ NE
Structure 6
❑ Yes W No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
;D 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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P 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
[>a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C �
� M f"L (�6qoft t C)
13. Soil Type(s): 00_(�
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 CAWMF 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 C] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tran'ssfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 LP
No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili .Number: Date of Iozf ns ection: i{ -A.f
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 [7] 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 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
LP
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [M No
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Silmature:
Page 3 of 3
Phone: 910:Y33
Date: it 24 /.3
21412011

I ype of visit: W Compliance inspection U operation Review U structure k;valnation L) recltnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p ) Arrival Time: 3iCQ Departure Time: County:sQ/�
Farm Name: 1 r t� Owner Email:
Owner Name:re3TG;utC FvLrM S ZR-vC , Phone:
Mailing Address:
Physical Address:
Facility Contact: PoclTitle: Phone:
Onsite Representative: w�,-,,.�5 I. Integrator: 0?ry'k Q
Certified
Back-up I
Location of Farm:
Latitude:
Region:D
Certification Number:
Certification Number: 2-7q 5,S� -
Longitude:
_ Design Eurrent _ Design Current
Swine Capacity Pop. " WetPoultry Capacity Po
Design Current
FV —ac i to-7VIMEPop.
Wean to Finish
La er
Da Cow
Wean to Feeder
-Layer
DairyCalf
Feeder to Finish
DairyHeifer
Design Current Cow
Dry P.oultry Ca aci Ro Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Farrow to Wean
ZZv
3
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes F No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): xx
3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
8 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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[)9 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
[A No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cca,-U &r.� G-ASS ,. �%, , D J
13. Soil Type(s): CaV
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
0 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
[�a 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 Q 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

Facility Number: MT -.1 Date of —inspection: 1120 11,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F9 No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Vq 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes G]Q No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendationszor any�other comments't�
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R /o-q33-33co
Date: �I 2— -
2/4/2011

Date of Visit: Arrival Time: b�•_/)Q Departure Time: �,����� County: 2�N% Region:
Farm Name: PA l C Owner Email:
Owner Name: G Phone:
kJ
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: AJ41�5
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: aJ3 I
Certification Number:
Longitude:
Design Current
pn:...
Swine Capacity Po "Wet
"� _Design Current
P.oultC�aaei Po
P tY P•
Layer
Cattle
Design Current
Cah' aci Po
P P•
Wean to Finish
Wean to Feeder I
Feeder to Finish
Farrow to Wean 2CC0
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Dairy Cow
jNon:sLayer
I
Dairy Calf
s "'
Design Current
D-,'Ga aci Pyo
Dairy Heifer
Dry Cow
Non -Dairy
Layers
Beef Stocker
Beef Feeder
Beef Brood Cow
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation?
0 Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[:]No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fiS No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FacHity Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
® NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S u
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
Ep No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No 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
5M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ANo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Q5 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 i
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[)a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EP 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
[P 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
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
IP 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 0 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 Number: jDate of Inspection: �4
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 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 R3 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
§d No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
55 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[51 No
❑ NA ❑ NE
Comments (refer to question #):. Explain any YES answers and/or any_additional recommenditwns or'any ottier comideitts.
Use:drawin_S of facility to: better. explain situations (use additional pages as .necessary).
w -
R.ec, j5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q M'(/33-35,>
Date: 9 lZ `//
21412011

Type of Visit 49 Compliance Inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ( JIB Arrival Time: Departure Time: County: SA7'1"1Cja^ Region: FM
Farm Name: p_j`1 G Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 2 Title:
Onsite Representative:�J
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No: r �
Integrator: !Z°. Ag, 7 GH'l+'l s
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ` = Longitude: = ° = 1 = "
pesign Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Cattle
Design C►urren#
Capacity Population
❑ Wean to Finish
❑ Layer I
I❑Dai
Cow
❑ Wean to Feeder
❑ Non -La er I
I
airy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Brood Co
Other
Number of Structures:
❑ Turkey Points
❑ Other
ther
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 FNo ❑ NA ❑ NE
❑ Yes
❑ No
(@--NA
❑ NE
❑ Yes
❑ No
MNA
❑ NE
�TNA
❑ NE
❑ Yes
❑ No
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
f�)No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

r
1 ,
a
Facility Number: — Date of Inspection O
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes [I No t� NA ❑ NE
Ctrnrture 9 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes allo ❑ 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 %I 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) �Q
9. Does any part of the waste management system other than the waste structures require ❑ Yes LJ 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? l
11 _ Is there evidence of incorrect 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 [--IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accep ble Crop Wind w %0 EvidenKbfNYind Drift 0 Application Outside of Area
ppu
12. Crop type(s) �{`"tb� ) r </t it &"f1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ 1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
Cl 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
[ff No
❑ NA
❑ NE
_Comments (refer #o question #): Explain any YES answers and/or any recornmeadattons or any other comments
Use drawn siof facile to better explain situations use addttio nal pages as nec se sary)�19
Reviewer/Inspector Name t is` Phone: /0
Reviewer/Inspector Signature: Date: kh 10
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 1�1 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
[9 NA
❑ NE
❑ Yes
y No
❑ NA
❑ NE
❑ Yes
11 No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE 1- .
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional :.Comments and/or Drawings: f.t.
Page 3 of 3 12128104

v'
_j
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
. I
Date of Visit: I C1 1310q I Arrival Time: Departure Time: Q,. /t't County: Region:
Farm Name: C Owner Email:
Owner Name: 11°s rhs G' _ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ &] _ Title: Phone No:
Onsite Representative: ter' Integrator: T-(y 460e,
Certified Operator: " Operator Certification Number: 996SX7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ` = u Longitude: = ° = t 0 "
0. Design Current
Swiae -Capacity Popnlafio'n
Design
Wet Poultry Capacity
Current Design Cnrrent
Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
-Laver
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Strue#ures:
Farrow to Wean
Farrow to Feeder
El Farrow to Finish
❑Non -La Non -Layers
'
❑Gilts
❑ Pullets
❑ Turkeys
❑ Boars
Other .i
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
!t
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y P P P
❑ Yes
� No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: — Date of Inspection
Write Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(,�No ❑ NA El NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
(
❑ No fA ❑ NE
Structure I Stricture 2 Structure 3 Structure 4
Structure
; Structure 6
Identifier: f
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 El NE
(ie/ large tress, severe erosion, seepage, etc.)
f
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
VNo ❑ 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?
El Yes
No NA NE
r El
(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
IF El 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
N040 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
l
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence otWind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ Ifrom 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 andlor 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 #): 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
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
IVZaVU4 Gonitnued

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
l 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 E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E) 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
1
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
JnNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V3No
❑ 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
0
❑ 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? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E§No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
Page 3 of 3 12128104

A
Type of Visit • Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ORoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 2:pp County: soAJ Region: r'1e9
Farm Name: Owner Email:
Owner Name: ` g �'4
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: S CrGt��'1 Integrator:�reS-A�
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' =, Longitude: 0 ° = I E] u
�esign
Current a Design { aCurrentHOW
FA
f�iD;sign04ugent
PItryCapac[tyPopulation
Cattlepacitpulation
rwineati'et
FinishFeeder
❑Nan -La er
❑Dai Calf
❑ Feeder to Finish
�" `'
❑Dai Heifer
A Farrow to Wean 'a.Q1p�
'�
Dry Poultry
= f
❑ D Cow
Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts
Non -La ers
Feeder
HO Boars
❑ Pullets
❑Beef Brood Co
-
❑ Turkeys
-
�
Other } ;❑
Turkey Poults
Number of Structures:
.� �. 1
❑ Other ; ❑ Other
T"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
PDNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
bNA
❑ 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
O NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
&o
❑ NA
❑ NE
3" Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12178104
Continued

Facility Dumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IV% No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
ElNE
StWture I Structure 2 Structure 3 Structure 4
Structure
5
tructure 6
Identifier: C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
( No
[INA
❑ 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? [ 1 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 !Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes PNo ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
19 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 44l &,-a s5 (Rq e� r5i4.'t
13.
Soil type(s) — C.6
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
X3No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
91 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
tg N"o
[I NA ❑ NE
17.
Does the facility lack adequate acreage for land application? El Yes
?No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
J�§No
❑ NA ❑ NE
Reviewer/Inspector Name t ' f Phone:!U��5
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IP 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 10 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IS No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2;No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VjNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
G
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
tpNo
❑ 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
6 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
PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I. Facility Number a
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Date of Visit: D'j Arrival Time: : 00 Departure Tune: -�0 County: d/'nfSaj Region: r-'2"
Farm Name: _1C Owner Email:
Owner Name: ► (TD ..P Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• sl7
Operator Certification Number:
Back-up Certification Number:
Latitude: F-1 o [=] ' 0 , Longitude: [—] ° =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
10 Wean to Finish l
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Ej Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I . Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curren#;
Cattle Capacity -..Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[ INA
❑ NE
_U@ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
f[�_
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: 3
Date of Inspection aZS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Wo
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 v
Identifier:
❑NA ❑NE
[I NA El 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 No [INA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA ElNE
through a waste management or closure plan? fQ
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 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 [4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
11 ❑!! Evidence of Wind Drifi El Application Outside of Area
12. Crop type(s) " JVk
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P' No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
t@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ballo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 103 —.33w
14
Reviewer/Inspector Signature. Date: 9 pI
12128104 Continued

Facility Number: Date of Inspection L�l�S1f�J
Required Records & Documents 1/ I
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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 11 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No Iq NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? [:]Yes ANo ❑ 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
❑ No A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ko
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
,k 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
j2DNo
❑ 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
,mod No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�3 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

==ja=ci1i.
ivisiao,ater Quality j'"3umber 0 il and Water Conservation
- — --- O Other Agency
Type of Visit o liance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Q 1=oliow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: d Arrival Time: 10 _ �j Departure Time: County: Region:
Farm Name: + e Owner Email:
Owner Name: 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 [= 6 = Longitude: Q ° 01 = "
Design Current Design
Current Design Current
Swine Capacity Population Wet Poultry" Capacity
Population CattleEgapaciyAPdpulltion
❑Dai Cow
❑ an to Finish
[E]Layer
❑ an to Feeder11I..].Non-Layer
I
alf
❑ Feeder to Finish
l
Dairy Heifer
arrow to Wean
a6b d
k ` ;°`l
Dry I'o�ul�try�
❑ Dry Cow
❑ Non -Dairy
El Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑beef Stocker
❑ Gilts
❑ Non -Layers
�
� ❑Beef Feeder
❑ Boars
El Pullets
..,
❑ Beef Brood Co
; ❑ Turkeys
Other
❑ Other
❑ Turkey Poultsi
❑ Other
N.
Number of Structures:
Discharges & Stream lmoacts
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
[2 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
LJ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
_ �
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
Ll NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
P
❑ Yes No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

s Facility Number: —, Date of Inspection
Waste Collection & Treatment ,��,,//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No UNH ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 01,
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 environmentalat, 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? El Yes 2No El 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 El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes Up/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ ApplicationOutsideof Area
12. Crop type(s) &n'11A {ir�llOr _ �Yf(Il O'l�d��n.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
er No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CJ No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(7No ❑ 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):
I
i
T
Reviewer/Inspector Name C, p Phone: 3 3 3<736D
Reviewer/Inspector Signature: Date: fix
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection
G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EAo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Designs ❑ 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?
❑ ns
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
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P�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
93'lNo
❑ NA
❑ NE
Other Issues
�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E14o
❑ 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
E�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
EI 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
CJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
HW
Page 3 of 3 12128104

m e Division of Water Quality,:
�Ft ctLty`NuEnber 3 `f O Division of Soil and Water Consen adon
„ - O Other Agency's
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Comptaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ISH10%51 Arrival Time: T Qii I Departure Time: County: Soy—IQ>os_ Region: F�
Farm Name: ____�_ �� C _ _ ___ Owner Email:
Owner Name: P,.4, s 4 m !q z ea•-_x2. s _ Phone:
Mailing Address:
Phvsical Address:
Facility Contact:
Title:
Onsite Representative: avt eQ .as r. ^ sa ± _ ._
Certified Operator: S, Gnc i 0
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: --pl-e-SA Sir.
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = , Longitude: ❑ o = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
R1 Farrow to Wean
1900
o.L
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy lieifei
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: Ell
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 [jd No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: 8aZ -31i7
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: I
_
Designed Freeboard (in): } 9 0 T
Observed Freeboard (in): `�ii / - .2.p-SV_
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 No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes [� No
❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [d 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 [V No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [jj No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) Re, rise, u .e6— !a r,. z ! D s
13.
Soil type(s) cam_
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
Q9 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
$a No
❑ NA
❑ NE
.. -..'-. . a.;
Reviewer/Inspector Name I
Reviewerfinspector Signature:
Phone:
Date:
I212&04 Continued

1
Facility Number: 8'�— 3 Date of Inspection / d
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
g ❑ 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
® 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
(� 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
r-_1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
An No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
��'d'derion omments and/or.Drawit
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12128104

•
!Type of Visit 0 Compliance Inspection O operation Review O Lagoon Evaluation
Reason for Visit dO Routine O Complaint O Follow up O Emergency Notification O other ❑ Denied Access
Facility Number hate of Visit: © Tune:
Q Not Operational Q Below Threshold
[Permitted GKertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ........ �...... ..
Farm Name: ....... ...--....... -- —_.'_ L� c- _.. _ County: — sd
Owner Name: J ! f's!u�� ._ FR1 s _ .. _ ._ .� .. Phone No:
-Mailing Address:..
Facility Contact: A-qce.L`.11.vY-------.---Title:....... �.. .
Onsite Representative:..-.rl�[� _grs�_. _....- ...............
Certified Operator:......sl.'d.�.P.�... t.�C�4l�......--•--............................
Location of Farm:
Phone No:
Integrator. . pr �slg�If
Operator Certification Number: ....... �g,yy ..........
EIZ/wi'ne ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��
DischMes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes GINO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes [rP<To
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [g-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [U-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3
Idemcifier: p`l . j� ......
Freeboard. (inches):
Structure 4
❑ Yes [JNo
Structure 5 Structure 6
12112103
Continued

Facility Number: g;t, —lei 7 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 ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [}i �o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [ -No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes EiWo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes UlNo
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenance./improvement? ❑ Yes M-Ko
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONo
❑ 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 MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑-1'Qo
b) Does the facility need a wettable acre determination? ❑ Yes [-No
c) This facility is pended for a wettable acre determination? ❑ Yes [i
15. Does the receiving crop need improvement? ❑ Yes [moo
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes [9-No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [g-No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ETIC
Air Quality representative immediately.
Commeia� (refer to questan #) Explainy YFS aasw�is and/or a� immcrsdatsous or any oilier counts. '�
;yT � � gs � sty � _ expl�n sitaata . ( taona! pages as oeressary) s Geld Copy ❑_Final Notes �� ,• -
_ ."' -r_ _,_ � _. _� :_� �." .. y..��u .s^:,.—•-:x'. S�xE:.�_��.:s_ a-._..... r�rs_....�.;x•.�-...--^.-'.--r., �...e : tom_ S .�'�."'..��._ '�`.�
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3- /o - O
12112103 Continued

$1 Facility Number: —3y7l Date of Inspection p O
Required Records & Documents;
21. Fait to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes �
❑ Yes [2 No
❑ Yes ErNo
❑ Yes 0-ITo
❑ Yes ETNo
❑ Yes EYNo
❑ Yes 9NO
❑ Yes 0-fqo
❑ Yes BNo
Bems ❑ No
❑ Yes a No
❑ Yes PtNo
O-Yes ❑ No
Iles ❑ No
❑ Yes [1Io

Site Requires Immediate Attention: N 0
Facility No. S Z - 3 q-Z
12- 3y.7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S+•1►�, 1995
Time: 10 - 19
Farm Name/Owner: t' - I `7 C- Z 1 rC_5 ra C_ t-O rM S .1AvL .
Mailing Address: PO &,r 4t i S
County:_ SQWtP sa N
Integrator: Phone:
On Site Representative: Phone: 0/0) .59Z - 5-77/
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: /ZOO Sow F-w Number of Animals on Site: /2400
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3* ° 5o ' *8 " Longitude: 78 ° Z 7 ' V7-
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately 1 Foot + 7 inches) Yes or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray. es or No
Crop(s) being utilized: to-m ct-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' s? Yes or No
100 Feet from Wells? es r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oz N� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
R;cKy R -yt-(S
Inspector Name -
nt freeboard of I Foot + 25 year 24 hour storm event
Actual Freeboard: 4 Ft. C Inches
Yes o No Was any erosion observed? Yes OZ&
Is the cover crop adequate? es or No
RR Uja-,
Signature
cc: Facility Assessment Unit Use Attachments if Needed.