820356_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

N
MUM of Wa#er Resources
Facility Number ®- ® C•a Divisian of Soil and Water Conservation
do. Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
[season for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: —5;raa Pt r e* k Hw) Farr, r, Owner Email:
Owner Name: ,e L ! �g ; rt-r _ '�`„ 'e - Phone:
411
Mailing Address:
Physical Address:
Facility Contact: Title: 0 rr Phone:
Onsite Representative:
Certified Operator: s—
Integrator: Cazyhn,Britt �+�
Certification Number: / 9 31.Z
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
D RO Curre t r: Desigir9� Current
Swine Capacity , Pomp. Wet Poultry Capacrty , P:. p '�
Design Carrent
E Cattle Capacity Pap.
ara�v
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
' _
Dairy Heifer
to Wean pp
Farrow to Feeder
D Cow
Non -Dairy_
P'Frairow
Design Current
D . RUM Ca aci Paop
Farrow to Finish
Beef Stocker
Beef Feeder
Beef Brood Cow
' Layers
Gilts
Non -Layers
Boars Pullets
Turke s
Other : Turkey Poults
ty
-'
Other Other
Discharees and Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c- What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z. No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
O Yes
[] No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
MNo
❑NA
❑NE
❑ Yes
5-No
❑ NA
❑ NE
Page ! of 3 21412015 Continued

FacitiNumber: _ 3,5`L Date of Inspection:
Waste Collection & Treatment ,-�,"'�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E c ❑ 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): V`7 —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Bl o ❑ 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 E] 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?
F''res
ts-
( eo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'�io
❑ 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
ffYes
Enos
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D lqo
❑ NA
❑ NE
maintenance or improvement?
I i. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
O
12. Crop Type(s): Y0! f? tJ
13. Soil Type(s): W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RITo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes a -go ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ETNo ❑ 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?
Required Records & Documents
❑Yes [ o ❑NA ❑NE
❑ Yes �o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
D Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E][- o
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists [—]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[a-lqo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�J No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�J�o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -3�5-
I Date of lus ectiae:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ia rvu ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes
[a'lVo
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
[ rNO
❑ NA
[3 NE
❑ Yes [alo ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
ETNo
❑ 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
[i]'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
F-l"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�] o
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 o
❑ NA
❑ NE
Reviewer/I nspector Name:
Reviewer/Inspector Signatur
Phone: LO:J 3—D4SU
Date: � _J110L JV,-
21412015
Page 3 of 3

4.
Type of Visit: 0"Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 1 9 ' Departure Time: / D County: Region: ',
Farm Name: 5aLla y7 ,- X fjL; // ��,�yt. Owner Email:
Owner Name: S C_ r as �� h � �� Q Phone:
Mailing Address:
Physical Address:
Facility Contact: �� C,�/ p�� Title: Phone:
Onsite Representative: Integrator:
Certified Operator: S.,« Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current', Design Current Design Current
Swine
Capacity
Popp .. __'et Poultry Capacity
x�
P,op Cattle = Capacity Pop.
Wean to Finish
La er y
DairyCow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
' OZJ
- Non -La er DairyCalf
DairyHeifer
u� Design Currentt D Cow
S:-_
Dy" F,oult _ Ca aei I?o Non -Dairy
Farrow to Finish
Gilts
Boars
_
Layers
Non -Lavers
Pullets
9 Beef Stocker
Beef Feeder
Beef Brood Cow
Turkeys
Turkey Poults
Other
Z_;m Other
r;
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 ol'the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ja No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Cj�[ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

f Facility Number: - Date of Inspection:
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3,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): _ 73
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
[allo
❑ 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
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JS�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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E!�Slo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®Slo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Ln, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windrow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��•'le `OvY-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PNo [:3 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes a 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 allo ❑ NA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 [g—No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: — / --1
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Callo
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[Z, No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[�? No
❑ NA
❑ NE
❑ Yes
JS�No
❑ NA
❑ NE
Comments (refer to question ft 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:
ReviewerlInspector Signatw
Phone:
Date: / —/ /,;P'
21412015
Page 3 of 3

r
1.11M.17
Type of Visit: OTompliance Inspection O Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / / Arrival Time: +' "p Departure Time: County:-yie Region:L�
Farm Name: d rl �? ri ; (a f 'V Owner Email: TT�^
Owner Name: S �• r a5 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: _Ste - Q // 0 —Title: �`7`� r� r-/' Phone:
Onsite Representative: 5e_' � — Integrator: /� ncc S '
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Carreat
Swine GapacityWet
Wean to Finish
Design Current
Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Design G_ urrent
D�, PoW ";` - Ca aci P,o
La ers
DairyCalf
JC
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
-
Qther
Other =MLLOther
Turke s
Turkey Poults
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [::]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - 33 b Date of Inspection: /—/;9L-1i.
IF
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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Jallo ❑ 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
S 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
[8 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
[DLYes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r/'r404� A9
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I S. Is there a lack of properly operating waste application equipment?
❑ Yes �]X , No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E. 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 ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 2 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 21412014 Continued

jFacility Number: f,47- Date of Inspection:
ti4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EgNo
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 12 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
P No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ej 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
fB'-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
[5 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
D NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question ft Explain any. YES. answers. and/or any additional recommendations or kfiy other continents.
Use drawings d facility to better explain situatwas; (use additional pages as necessary)....
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IN
�a5 a/;'A ti
Phone: 3�
Date: /���E'
21412014

4`
Date of Visit: / % Arrival Time: /p: J c7 Departure Time: County -se
Farm Name: �a �aKn fj�; %� �,�� �! Owner Email:
Owner Name: S�� G �a� 'j __� c : Phone:
47
Mailing Address:
Physical Address:
Facility Contact: Title: OW17 r� Phone:
Onsite Representative: _-5'�� Integrator:
Certified Operator: ��*� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Design Current
Wet Pointry Capacity Pap.
Design Current
Cattle Capacity Pap.
Wean to Finish
er
DairyCow
Wean to Feeder
ELa
Non -La er
Design Current
D , P,o_ul Ca act P,o P.
DairyCalf
DairyHeifer
Feeder to Finish
arrow to Wean
Farrow to Feeder
Cow
Non-Dai
Beef Stocker
Beef Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
urkey Poults
Gilts
Boars
Beef Brood Cow
Othe
Other I IMFrOtfier
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 Ic:i- No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 54 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - (o Date of Inspection:
-' f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
8No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2!�.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
J8No
❑ 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
[Z-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
allo
[DNA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below, [:]Yes [RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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): /'/tea / v P/ e--rJ
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
O 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 [RNo
❑ 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

IFacility Number: - &'I Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a -No ❑ NA ❑ NE
<� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CE� No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [K No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 CAWNiP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes �R No ❑ NA ❑ NE
❑ Yes [&No [DNA ❑ NE
❑ Yes allo
[—]Yes RNo
❑ Yes L&NO
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to queston4) Egplain any YES answers and/or any adddEtional recommendations or ,any other comiieiits. _
necessaryUsedrawingsoffaciytobettereplain situations (use additional page;as ).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:3`33f�a
Date:J lJ _
21412014

_ 1
(Type of Visit: qt Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason far Visit: '0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 9;5�2County: F Region:
Farm Name�Vah�j LFd(m f �, Owner Email:
Owner Name: sdG &-i1 4 _�I L Phone:
Mailing Address:
Physical Address: MMWA Rd ' F 0M) tU71
FacilityContact: acfl CTitle: Phone:
Onsite Representative: S+Zh Integrator:
Certified Operator: Roba+ Si 01(0ol ! Certification Number: JQ3fa
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

S
[Facility Number: blA jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R] 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): q
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
0 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
12 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5a 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 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): CM&M I&M-66 His S 1 66210' 0 _V P -
13. Soil Type(s): l ars" _
14. Do the receiving crops differ from those designated in the CAVR P? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D] 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
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tZ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
12 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis
❑ Waste Transfers
❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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
214.12011 Continued

Facili Number: 113ate of Inspection: 3
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 CR 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 [X No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No aNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [5;[ 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
CR 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
ER No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[X 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
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other-co3mmefiti:
Use drawings of.facility: to better -explain situations (use additional pages as necessary):
-7, PIS e Mow ) ayaoi bal ks - n ail dl1 d a,,e f/7 -Prl 1
I`Qa II of a0la,
ay, aoj; . Carr braj' h+nr nofl- rer&AS , ?om o4ll C411 t ungss +0 sfe. if h e h er a co y
his s frves or a r the 0�d�r►e y 1-f tF YYar n a- d � p
+h e- h �a,•tvr�� d Ole- a I r�a�y,
a 5, Sr �d e e ° �o, -NYC a ©I3 , P iPd�,_ do r�� i ot y .
9 �
A
V$7 II*sf fam , FaM hot beq, d-efofulak Are 34)1/p Ij013.
Reca,o[S i/1 djh°fie exec ar noied a bore,
9
Nvt on cIT
MM- WB--K-03T3 :Four -4x' ivie +D e0 "dko'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�n hn e,14
Phone: 91 ,33- ' f
Date: SPPO S, @013
'V -
2/4/2011

t
Facility No. Farm Name rryye�////// ��_��_ IJtlQ�J 1yyf Date ! .
Permit ✓ COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Cvarb.. reA I,ntY
Calibration Date
1
2
3
4
5
6
7
8
Ring Size in
.2
Design Flow m
Zb
Actual Flow
a6
Design Diam" (ft)
Actual Diam.
5
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP �.�
Dead box or incinerator
Lime Applied 0 Q
Weekly Freeboard ✓
—
Mortality Records
Cu-I `-"Zn-I ✓
1 in Inspections
Check Lists
Needs S (S-1<25) ✓
120 min Insp.
Storm Water
Needs P -Al?
Weather Codes
Waste Date
- 60 Da
+ 60 Da
N (Ib11000 Gal)
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
1— Z)(
r
s
verity b'HUNt NU1V1b3 KS and attiliations
Date last WUP FROG )I1j>8 FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike (09-0
Stop Pump
Start Pump 615
[o,34dp,41-7
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac

r + V'J 61 KV
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: , S Departure Time: i PZ County: N XVjn %61 Region: _
Farm Name: Owner Email:
Owner Name: S / Phone:
Mailing Address:
Physical Address: .50 Sr vainah �LJ� R!' i Aor)
Facility Contact: srea Cal Title: Qwgfr Phone:
Onsite Representative: S�r9Ir`D Integrator:
Y Certified Operator: RoWAS,-Care U Certification Number: Eq_3 _
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes E�`No ❑ NA ❑ NE
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 ❑ No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C'No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
Page I of 3 21412011 Continued

r
Facility Number: jDate of Inspection: Zffiro
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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):_
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes 21 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
& No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
tRNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If'yes, check the appropriate box below.
❑ Yes
[5�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): f
13. Soil Type(s): VV946111
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
tR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q 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 ® No ❑ NA [:1 NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis [] Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No E;�NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number. <3 a -394
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 01 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 54-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 allo ❑ 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
El 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
ER 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
C' No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2 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
5 'No
❑ NA
❑ NE
Comments (refer to questions##): Explain any YES answers and/or any additional recommendations or any or c theomments
Use drawings of facility to.better explain situations (use additional pages.as necessary). ._ ... ,�
ha vf— so( I +et d&ie. b y end 0-6- y ea,
a �(, Rear Ca (f irate be�dre e Y �a�
,)s-Sl1jd�yaesavee1xey &7 LfilI -for
j aor�1.
IVurs0--1 is I_eased Oct � ���j' S�vPlsa) �� his har �., dams ev&v I +�mes since.
~ }S..5; iV down eCoharfe_ �a�n�s. Cur ativm 01rf ill 7 .
�YeII mad l?oL jM 3ca -6elds,
1�-yov c. a�jle_ Cr'org y\c)L) wall nle. a_ ne)v rvas� P10/)
Reviewer/Inspector Name: Sch n�e l er
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 110-�3— ( [(P
Date:
21412011

r
Facility No. -3% Farm Name ISQII&VX99��WYit
Date
Permit —S� COC `� OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded i . ►,
Observed ee
Slud e SjTkVatff
Sludge Depth ft
Liquid Trt. Zone ft
5-
Ratio Sludge to Treatment Volume if> 0.45
3
Date out of compliance/ POA?
Calibration Dat4-----'
Ring Size (in)
Soil Test Date aMoa p �� J�� V P-111 rop Yield Transfer Sheets nk,
pH Fields Wettable Acres RAIN GAUGE
Lime Needed ssfb� WUP Dead box or incinerator
Lime Applied Weekly Freeboard ✓' Mortality Records
Cu-I ✓Zn-I v 1 in Inspections t — Check Lists L�
Needs S (S-1<25) 120 min Insp. Storm Water
Neeas v
Waste Date
- 60 Day
+ 60 Day
N 1Ib11000 G
0
.�
IMVTTX?-�
..
[[..
Ito W J�m-
Verify PHONE NUMBES and affiliations
Date last WUP FRO qr(;) ZC00 FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Am Top Dike
4 &� Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

Type of Visit: OrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 1$Roudne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: � Qj County: Region:
Farm Name: Savannah 4' d s f y- i ) Owner Email:
Owner Name: _6J� f C_ Phone:
Mailing Address: .`
Physical Address:
i.
l
Facility Contact: _SY1 IT +Alt.' Title: Phone:
On site Representative: JCO(I integrator:
Certified Operator: 6b,P t s Cur rol l Certification Number: 1 q3 t.:)
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
0.
Feeder to Finish
■--
���... ■
--.
■ 1 -
--..
�A.
■ i ' - ' - 1 -
--MMMTE
IT.
�n
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 DW Q)
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 5 No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C3 No
[] NA
❑ NE
O Yes
KNo
[] NA
❑ NE
Page 1 of 3 21412011 Continued

,I Facili Number: Aga - S Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LS 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
153 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
CR No
❑ NA
❑ NE
S. 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 C517No ❑ 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©oim [s?_rfivdo_ Hav , Srwt i a, -a ik o v,,,N ped
13. Soil Type(s): If Y d Af lM IS 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W 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 'Ie=J 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 N 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
Z NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�JNo ❑ 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
10 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
tRNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
tR 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
C3 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 151 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ayes [:]No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond 0 Other: S #ie ap-od— ia.; U )
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C`No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CgNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
a I { Yvlle aqa Se UI"� 6at
KIT l 1
r
a5, SI v e 1,�.�e ex �v7 ace f D= n 'r4 n 'OH� 1_r yea-,
j
f 1 �f �t 1S rra 0' 0-�` re Ctw
rrR 1S CvIfe� D{eopvlafrq �� f' �fi�� �(p��C11 �C%
c�j n` KF 1 � Coharm Coy �c c�r��e�).
9
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U3 70D(Ae)
Date: !
412011 � fl

. Facility No. OCO35 Farm Name
Permit _�-z COC
Dore $ f �f Date $ f
OICi NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
I� a
Sludge Depth ft
311
Liquid Trt. Zone ft
5,
Ratio Sludge to Treatment Volume
51-1y4f tkAlft U Vh I Do//
Calibration Date
1 j 0
2
3
4
5
6
7
8
Design Flow
Actual Flow
a
a(o
Design Width
3
Actual Width
Soil Test Date T Wettable Acres RAIN GAUGE
pH Fields 1 WUP / Dead box or incinerator
Lime Needed �S?,06-qd Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-1 ✓Zn-I 120 min Insp.
Needs P �Q Weather Codes
Crop Yield Transfer Sheets nTWW. 6f (d))1(0 Qq l(P
Waste Analysis Date
�
rra■rjs
r#
PulllField
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
Ka 8
C
P/Dcf-
pro
a
to r
-
SG
lop
S4._ M
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware

ez. S z-os-z0/0
Type of Visit Qe!6m'_pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -2Z-!® Arrival Time: Departure Time: %/,ZS County: Region:
Farm Name: _ .5AV1t,n1MCZJ64l -� r � Owner Email:
Owner Name: so e �-� r'^�" _�� Phone:
Mailing Address:
Physical Address:
Facility Contact: C& &n4� ��hJi [!\ - Title: liiCk i �GPhone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number -
Back -up Certification Number:
Latitude: 0 0 0 6 Longitude: [�°=' 0
Design
Swine Capacity
Current
Population
Design Current
!!'e# Poultry CapaciOR,opulation
❑ Layer
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
2000
/
1110
Dry Poultry
- ❑
Laye
❑ Non -Layer's
El Pullets
❑ Turkeys
❑ Turkey Pouets
Other
❑ Dry Cow
❑ Non -Dairy
❑Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures: f
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
ETNNA
El NE
El Yes
El No
LI NA.
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

r R
Facility Number: —3,560 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNNo El NA ❑ NE
a. if yes, is waste level into the structural freeboard? [I Yes L7 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 4`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [I Yes
��/
LT 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
2hrNNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
C_l No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 91-v'-r d 4. � �`� ra n1 (D
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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�L'No
0"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UTNNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
BIN
❑ NA
❑ NE
Comments<(refer to question #}: Explain any YESAanswersiandlor. any recommendations or any other commentsji
Use drawings of faetiity to better explain situations (use'add� io al pages as necessary)
Reviewer/Inspector Name �� S . s Phone: 9%j9'
Reviewer/inspector Signature: Date: /—Z 2-- 2 0
12128104 Continued

Facility Number: NY --35(v 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp (] Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain
Weather Code
Inspection�PNM
22. Did the facility fail to install and maintain a rain gauge?
❑ YesZo
El NA
El NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
[I NA
[I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FNo
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETI o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LZ
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ N
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
LJ 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
,�
'
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
ZNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
12128104

/O -07- 2 DO 9
ivision of Water Quality
Facility Number �Z G� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (3-Co—m- pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: �,�/(J,¢y� Departure Time: �3� County: S6� - ro,v Region: /1=5e4o
Farm Name: 54? ✓ /1/Nq_ Owner Email:
Owner Name: Sa Ua AJJIIA�.. �!'y � l��.s Phone:
Mailing Address:
Physical Address: ��++ /
Facility Contact: C�t/►'7t7 S �5t4.vuJ� Title:+,. LGnc . Phone No:
Onsite Representative: _4 _ap-11 _ y ° Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Fe der to Finish
arrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = Longitude: = ° [--] 1 a u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E_7No ❑ NA ❑ NE
❑ Yes
❑ No
[ qA
❑ NE
❑ Yes
❑ No
[ "i�lA
❑ NE
D<A
❑ NE
❑ Yes
❑ No
❑ Yes
E]�No
❑ NA
❑ NE
❑ Yes
9'go—
❑ NA
❑ NE
12128104 Continued

r
Facility Number: '` _3561 Date of Inspection
Waste Collection & Treatment ,�,�
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [I Yes [3 oo ❑ NA El NE
❑ M
a. If yes, is waste level into the structural freeboard? Yes - o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
e
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ElYes EK ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_) ,.,�
6. Are there structures on -site which are not properly addressed and/or managed [I Yes L`_TNo ❑ 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
9
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 21< ❑ 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 El Yes Eh<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ -w— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Cyr. ��_ (�� J;H4�I �v`.✓ [ C/rS., -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
r o
❑ 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
LNo
❑ NA
❑ NE
Reviewer/Inspector Name fit' P.�� ;<° f Phone:
Reviewer/Inspector Signature: Date: /S Zoo 9
rage-, of 1 IZIZ61V4 K-ontrnuea

Facility Number: 8Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0<
❑ 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 El Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,�R,�<ON//o
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[a o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B-N* o
ElNA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
M No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[a o
❑ 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?
El Yes
�
D o
❑ 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
,7�/
ENo
❑ 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
ET�qo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D-K-
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

9TM s 8/z9/06 W4-
-
i
Type of Visit C'Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S^/Z-Q$ Arrival Time: Departure'l'ime: �%.� S7q County: S' :fn457oa1 Region:
Farm Name: _ Su V OL /r1►Ju in i j l SAY Owner Email:
Owner Name: _'�'GL Va IVNGL 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: U Y k- Title: 1 e SOS Phone No:
Onsite Representative: integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = L = Longitude: = ° = I = u
Wean to Finish
I
tlLj Layer
Wean to Feeder
❑ Non-L;
Feeder to Finish
D , Pa
❑ La ers
Farrow to Wean 7-600
205-0
Farrow to Feeder
Farrow to Finish
Gilts
Boars
ElNon-L
❑ Pullets
Poults
Other j J 1 1❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance ratan -made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
ri
❑ Yes [Tio ❑ NA ❑ NE
❑ Yes
❑ No
[TNA
❑ NE
❑ Yes
❑ No
EII�A
❑ NE
[ i A
❑ NE
❑ Yes
❑ No
❑ Yes
EMo
❑ NA
❑ NE
❑ Yes
25-o
❑ NA
❑ NE
12128104 Continued

i •
Facility Number: Z
Date of Inspection FOE Z -O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ETNNo
❑ Yes L7 No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
ri
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El No ❑ NA Cl NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes t3No ❑ 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 E NNo ❑ NA ❑ NE
[
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes E3<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop lWindow [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � LA�%'L�
13.
Soil type(s) ijAj 0,_
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
�,/
EJ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�ErNo
L� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E? o
❑ NA
El NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
L7 No
❑ NA
❑ NE
IComments (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 I-,'-ft V Phone: y/�. �3.3 •333�
Reviewer/Inspector Signature: Date: ?— I Z- Z 4 0
12128104 Continued

4 •
g-iz�o 8
Facility Number: `' -3S1p Date of inspection S- Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes DNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�io
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues ,_,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes LS No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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
�,/
L7 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
El Yes
//
B o
❑ 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
[3"No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
B<o
❑ NA
❑ NE
Comments and/or Drawings:
12128104

,e„r)k_CaG 9-7-7-67 POL
® Division of Water Quality
Facility Number $z 35(p O Division of Soil and Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -Z%-D% Arrival Time: / ZS Departure Time: �0100,¢ County: SDI/
Farm Name: Z&,,Vle (_< k*vll Ar Owner Email:
Sava.+ Ka "- w,;q F-- _ s
Owner Name: �,�va,mWA lj�ii • s,LLG Phone-
Mailing Address:
Physical Address:
Facility Contact: 646i­& C ?4­Wi Title: L/��Y� Phone No:
Onsite Representative: (j Integrator, ceze.� . 14iY Al_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Region:��
Latitude: = o ❑ d ❑ Longitude: 0 o 0 , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
UU
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [ No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑Yes No El NA
El NE
❑ Yes [9 No ❑ NA
❑ NE
12128104 Continued

q-z7`0 7
Facility Number: %-Z — 3S(o Date of Inspection -z-T-d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [;fNo ❑ 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. ❑ WCTP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
7P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ice' No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
['No
++�
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[5dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

W Division of Water Quality
Fif6fiNNumbeir, — J 3S (0 O Division of Soil and Water Conservation t/
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: $; Departure Time: County: 51!V_S11 Region: FAD
Farm Name: _ _S DC %egSinld _ Owner Email:
Owner Name: �l l Phone:
Mailing Address:
Physical Address:
Facilih, Contact:
Onsite Representative:
Phone No: r
Integrator: �4l' Q 't'ayw'-5
Certified Operator: _ 1),6 c_v L 5 ��� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede:
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Back-up Certification Number:
Latitude: 0 Q F--T ❑ " Longitude: = o E� ' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
I❑ Non -Layer
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke y Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CON,.
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 hypass the waste managcntent 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 CR No ❑ NA ❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
(�No
❑ Yes
(PQ No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12128104 Continued

Facility Number: Z— S Date Inspection
of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
R No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
l►
Designed Freeboard (in): l 9
r�
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EdNo ❑ 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
[A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[:]Yes
[KNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) f3r ✓►,, a , 14a_L, e�:6d I-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name [ K i G ;h jK V Gt , ` _1. Phone: O
Reviewer/Inspector Signature: Date: 26d
11/Ldr/l14 uonanuea

Facility Number: —,�s(d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EffNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (A 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
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[W No
❑ NA
❑ NE
29,
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
(�j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[5a 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
�, a44
.
Addit�ona! Comments' -and/or Drawings: r x r ,:; °t
12128104

�' � Division of Water Quality � 7
Facility Number 902 sion of Soil and Water Conservation
Q tJther Agency
Type of Visit B Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3I S Io Arrival Time: Departure Time: County: czr­..z Region:
Farm Name: 5 av a•144wlca�, 1► �` rc�{ ,�_ Owner Email:
Owner Name: 'n I C st-^ r a Phone:
Mailing Address:
Physical Address: �4 a r��h _t-► �l �cQ 1 e�`�h1T i�.�.-3.� V
Facility Contact:
Title:
Onsite Representative: -,. - i_-k-%s c 1Sn,r wr�t�C
Certified Operator: 2S+e-V%.I S1_.___C 4LV- 4- t
Back-up Operator:
Location of Farm:
Phone No:
Integrator: C0Vx-> 11 � _
Operator Certification Number: J. 63 / _II21
Back-up Certification Number:
Latitude: [= o =1 Longitude: = 0 01 = «
Swine
Design �` -urrent`. Design` Current j. Destgo� Current
Aet Poult Capacity. Population Cattle '`
Capacity Population y Cap i_ty Population
❑ Layer
El Dairy Cow
`' ❑ Non -La et
j ElDai Calf
N` El Dairy Heifer
z Dry Panitry"
r
❑ D Cow
ElNon-Dairy
❑ Layers
El Beef Stocket
❑ Non -Layers
;t ❑ Beef Feeder
❑Pullets
El Beef Brood Cow
- LEI Turkeys
i�
Other
" ❑ TurkeyPoults
❑ Other
' ❑Other
u
Number of Structures:
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
® Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑Gilts
❑ Boars
Discharges &Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
h. 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'? (I f yes, notify DWQ)
?. 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 lei No ❑ NA ❑ NE
❑ Yes
1
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
2/28/04 Continued

Facility Number: — d"
Date of Inspection 318 QS�
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 ? Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 A
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 [VI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes % No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes W 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 W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Croptype(s) ��� )a.:X
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []d No ❑ NA ❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes IN No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name M
Reviewer/Inspector Signature:
❑ Yes ® No ❑ NA ❑ NE
Phone: `j/° Wi I�'I
Date: 3 / so /D S
12128104 Continued

-emuFacility Number: a —35 Date of Inspection C
Required Records & Documents
19. Did the facility fail to have 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 ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record [seeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
54 Waste Application ® Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [2120 Minute Inspections [M Monthly and I" 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
® No
❑ NA
❑ NE
24- Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[2 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
21 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
[P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
© No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N 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
[�5 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
A`dditionalkCo ments and/or DrawingQs" * =
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12128104

' V
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Noffication 0 Other ❑ Denied Access
Facility Number
hate of Visit. �"� Time: 4 SI S—
.sZ SG
Not Operational Below Threshold
Permitted ©'Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ ��_ Le—92 J, t7� S.y County: s a
Owner Name: S 41.4.— Phone No: 91.2 - i 3
Mailing Address: -2.9 �7
Facility Contact: y, j ,Qai w,'i �r Title: Phone No:
Onsite Representative: Integrator: ,C960r ze Fsi."s
Certified Operator: 56 rra%I _ Operator Certification Number: r13I ?
Location of Farm:
LI-S"wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� Longitude �0 �• �~
;a = -Design
S w Tz- Ca alit
❑ Wean to Feeder
barrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
abet o>I Lagoons
"Haldiig Panels! 5o1id.Traps _
current - ; Dr
oulation" "'Poulin Can
Current Gurrt
Population Cati1E :_ Cg dtv' _ po Iilal
Dairy
❑ Non -Dairy
Total.,esign:.Capacit� ,
rail S_ W
uid Waste
DiDi cchay & Stream Impacts
1- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed_ was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated floe in gal/min?
d_ Does discharge bypass a lagoon system? (if ves, notify DWQ)
2, Is there evidence of 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?
Waste Collection $ Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 'XNo
❑ Yes RNo
❑ Yes VNo
❑ Yes 0No
❑ Yes 9No
❑ Yes F No
❑ Yes / - �"No
Structure 6
Continued

Facility Number: ga — 3 �
Date of Inspection 3 ',
5. Are there anv immediate threats to the integ-rity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 eras answered ves. and the situation poses an
immediate public health or environmental threat; notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
,Vaste .Application
10. Are there any buffers that need maintenancelimprovemenl?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type—r1'8A_ _ Al(.7Y �".Q ca ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA\k MP)?
14_ a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wcnable acre determination?
c) This facility is pended for a wettable acre determination?
15_ Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
RRe _uired Records S Documents
17. Pail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. rail to notify regional DWQ of-menzencv situations as required by General Permit?
(ie.- discharge, freeboard problems. over application)
23. Did Reviewer/Inspector fail to discuss revieu;'irspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PIN
❑ Yes [KNo
❑ Yes No
❑ Yes N No
❑ Yes %No
❑ Yes ;K'No
❑ Yes ;gNo
❑ Yes PICo
❑ Yes ❑ o
❑ Yes Q- o
❑ Yes O'No
❑ Yes 93Go
❑ Yes 9-Ido
❑ Yes 2 o
❑ Yes ❑-o
❑ Yes EgNo
❑ Yes ©'No
❑ Yes EiNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
U-No
JIT No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Cammeuts;(refer io'q»estzon: Ezpl:atiy YE5`saswers and/or,�eity ree�tuatradsteons ar $uv_ aie_r,camttiaats.k
ZZ
Use drawings of faciltty to heifer explain sttnahotts. (use addttmnal pages as necenary) ld
e Copy ❑Final Notes
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RevtewerllnspectorNgme
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Nwnber:IL-_W P
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
Time:
General Information:
Farm Name: Fir m15 County: s c .
Owner Name: Cog v_�� �� � o 1,�Phone No: 5 9a 33„7
On Site Representative: CF)do Integrator:_
Mailing Address:_ P _y
OC �2333-S- -
Physical Address/Location: AC9 s
Latitude:_/ 13 I_�� Longitude: -7 9 /_3 ! /. / 9
Operation Description: (based on design characteristics)
Type ofSwine No. of Animals Type of Posdiry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer O Dairy
❑ Nursery O Non -Layer U Beef
❑ Feeder
OtherTjpe of Livesrock_ •� s - Number of Animals: -�`F9 C }
i -- — - _
Number ar Lagoons: t kmcivae in me Urawsngs and vdservatuons me tmeDoara or each lagoon)
Facility Ins
Lagoon
Is lagoon(s) freeboard less than 1f foot + 25 year 24 hour storm storage?:
Yes 0
Now'
Is seepage observed from the Iagoon?:
Yes ❑
Nog'
Is erosion observed?:
Yes U
No?,
Is any discharge observed?
Yes ©
No�a
0 Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes a
Nox
Does the cover crop need improvement?:
Yes ❑
NoX
( list the crops which need improvement)
Crop type:_ Acreage:
�a
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑
Nqg�d
Is a well located within 100 feet of waste application?
Yes ❑
No
Is 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 Blue Line Stream? Yes ❑ No
A0I -- January 17,1996

Maintenance
Does the facility maintenance need improvement? Yes ❑ NqRV
Is there evidence of past discharge from any part of the operation? Yes U No�
Does record keeping need improvement? Yes ❑ NoJ:i
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 0 No WI
Explain any Yes answers:
cc Facility Assessment Unit
Drawlng5 or Obsery Lions•
Date: -�
Use Attachments if keded
AOI -- January 17,19% Z