820366_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Itype ot visit. tvrq:ompnance inspection V uperation xeview v atrucrure r,vaivanon V iecnmcai Assistance
Reason for Visit: t911ioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: / f County: Saiz IN
Farm Name: ,c- J cs" l &L S 5 Fq4 v�. Owner Email:
Owner Name: -,7 k Kr el.e o1 3 a. 5,5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Crjk t r &" -WiG � Title: Phone:
Onsite Representative: 1c Integrator:
Certified Operator: �� c 3 a. S$ Certification Number: C5
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: AL1
Discharges 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 [:3-9-o— ❑ NA ❑ NE
[—]Yes
Design Current
[f—NA
Design
Current
❑ No
Design Current
Swine
Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle, IPop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
jig jf 0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
©, P,o_ul
Ca aci
Ro
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges 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 [:3-9-o— ❑ NA ❑ NE
[—]Yes
❑No
[f—NA
❑ NE
❑ Yes
❑ No
[3•15A
❑ NE
❑ Yes ❑ No
[] Yes [r]"No
[]Yes Eallo
E] -9.A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - b Date of Ins ection: 2S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _.N ❑ 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): 3-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []'Na ❑ 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
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[5 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3" Bio
❑ 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
[3'lTTo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes
[3'1To
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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 Windows ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): )VO
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
[EjNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2 -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'1\fo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑filo
❑ 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. 0 Yes Q -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!jNo
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 2/4/2011 Continued

Facility Number: Date of Ins ection: 1
IT
[3<o
24. Did the facility fait to calibrate waste application equipment as required by the permit?
❑ Yes Q'igo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑<o
❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
[3'—No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
34. Does the facility require a follow-up visit by the same agency?
26. Did the facility fail provide documentation of an actively certified operator in charge?
[] Yes [E No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [:I.Nu
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ZrKo
❑ 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
[3<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3110
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3'—No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fNo
❑ 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).
C,1'fb — F-�_l-17
y `Y
4(L�- e
C -e -q Cl (° - 10 q -�? 51
Reviewer/]nspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: o- `t 33-333
Date:
21412015

Type of Visit: 40'Com ante Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: h
it U2-
Arrival Timed H
Departure Timer
County:
Farm Name:c7Z
e/oq_ S -e55
Owner Email:
Current{Design Current
Swine Capacity Pop.
Wet Poultry ` :
Capaeity
_ Pop Cattle _= Capacity Pop.
Owner Name: it Phone:
Mailing Address: '
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:qD
Back-up Operator:
Title:
Integrator:
Region: P(C�
Phone:
Certification Number: 2� 00/
Certification Number:
Location of Farm: Latitude: Longitude:
Dischar es and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes C o ❑ NA ❑ NE
❑ Yes 0 No [I !A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
�lA
Design Current
c. What is the estimated volume that reached waters of the State (gallons)?
Design
Current{Design Current
Swine Capacity Pop.
Wet Poultry ` :
Capaeity
_ Pop Cattle _= Capacity Pop.
Wean to Finish
Layer
❑ NE
'` Dai Cow
❑ Yes
_r:fNo
❑ NA
❑ NE
Wean to Feeder
I INon-Layer
eNo
L Dai Calf
Feeder to Finish
of the State other than from a discharge?
Dairy Heifer
Farrow to Wean
Design
*'u jDry Cow
Farrow to Feeder
D . P,oultr,
Ca aei
1?0 . - v Non -Dairy
Farrow to Finish
K. Beef Stocker
Gilts
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s�
O#her
Turkey Poults
m" � -M r
Oth
ter
Ohers..-
�r
Dischar es and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes C o ❑ NA ❑ NE
❑ Yes 0 No [I !A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
�lA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
_r:fNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

6—
Fac(lity Number: Date of Inspection- .. ,
Waste Collection & Treatment
4. Is(s torage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E] Yes e— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (;>A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26 Ar
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PRINo ❑ 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?
❑ NE
18. Is there a lack of properly operating waste application equipment?
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 ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETN' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
9. Does any part of the waste management system other than the waste structures require [] Yes ❑" o
❑ NA
❑ NE
maintenance or improvement?
the appropriate box.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [T No
❑ NA
❑ NE
maintenance or improvement?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EyNo
❑ 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 Driftt [:]Application Outside of Approved Area
ro� ��
12. Crop Type(s): CSW � 4'1 e ^ fir—Z4 J CC) rC.G-►I
13. Soil Type(s): W f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R lqo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑'l o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q'lffo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ER�qo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
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 [ eNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall E] Stocking p Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W 4
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 2/4/2015 Continued

Facility Number: r Date of Ins ection:Ti,,—
24. Qid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [B'No ❑ NA ❑ NE
25. 11 the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [T 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
[;J -N -o
❑ NA
❑ NE
❑ Yes
EJ -No
D NA
❑ NE
❑ Yes
[3'1io
❑ NA
❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes [2 -No ❑ NA ❑ NE
❑ Yes
['No
[DNA
❑ NE
❑ Yes
2y No
❑ NA
❑ NE
❑ Yes
KrNo
❑ NA
❑ NE
❑ Yes
ZNo
[DNA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ce.,( 494 105ul V— (f. L- 6-(5
5&4�,c Suver 3 -to -t-7 6 -- q,5 P r � ;L -Fm
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
' IW90
SN33-33ft
-3
Date:i 1
2/4 Ol5

6tYA.s -9
(Type of Visit: O Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: ('Routine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: t p Departure Time: { Q6 County: .j K
Farm Name: �1 ,(,(, t{�, f� ejq?-t3-t 0 aLrY Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Q41 t � �� t4itle: Phone:
Onsite Representative: Integrator: 1'1""e
Certified Operator: _ c� rf Certification Number: :Z ✓C o
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
Design Current
❑ NE
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
❑ Yes
Wean to Finish
[9 -KA
Layer
e. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
I jNon-Layer
❑ No
�A
Dairy Calf
2. Is there evidence of a past discharge from any part of the operation?
Feeder to Finish
�o
-
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Heifer
ENo
Farrow to Wean
❑ NE
of the State other than from a discharge?
Design
Current
Dry Cow
Farrow to Feeder
"ry1roultr.
Ca aei
Po
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
jBeef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[44ftr-❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3-It'A
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[9 -KA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ENo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 .1412014 Continued

4*4
Facifi Number: - Date of Inspection:
s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[jiNo-0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �
❑ 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?
D Yes
[]I.-Nob ❑ 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
[3-'N'o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes fg'f4o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [E'<o ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [J leo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ffNo ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] ' ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): &) q_ bap
'SCO
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ENo ❑ 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 2<0 ❑ 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 E2�<o ❑ NA ❑ NE
[:]Yes [:140 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [] io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [ s10 ❑ 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes YNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

CIA 121 1
Facili Number: - Date of inspection C174* LGJ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �io
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [T No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ga'N'o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes R No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
0 N 0 N
❑NA 0 N
❑NA 0 N
[]Yes Ea�o ❑ NA ❑ NE
❑ Yes I;i<o ❑ NA ❑ NE
❑ Yes [2-& ❑ NA ❑ NE
[—]Yes C2rNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes ZNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [2 -Ko
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[-]Yes Q No
❑ NA
❑ NE
Comments (refer to question ft Explain any YESanswervaad/or any additional recommendations or any other eomments
: y
sem'
Use drawings of facility to better explain s rtuatio ,
ns,(use additional pales as necessary).
Cot(-& v->7L*f a_"u
SCS 5V
Reviewer/Inspector Name:
61 QC I ) P j -0
Phone: `t X '%
Reviewer/Inspector Signature: l ]�f �1,(/l�(fJ3 Date:
Page 3 of 3
3

i ype of visit: kV sAmptiance inspection V operation Review u structure Evacuation V i ecttnicai Assistance
Reason for Visit: QX'o"utine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: U�D County:
Farm Name: , OtAt' S IbA LAA s� - Owner Email:
Owner Name: ll Phone:
Mailing Address:
Physical Address:
Facility Contact: _- _ G , 4-S 1 c4--gjty/ Title:
Onsite Representative: V
Certified Operator: 7 J3 �3" S
Back-up Operator:
Location of Farm:
Latitude:
'I—
Region:
Phone:
Integrator: PrIe �S�
Certification Number:
Certification Number:
Longitude:
Design .Current
[] No
Design
Current
Desiga Current
Swine Capacity, Pop.
Wet Poultry
Capacity
Pop.
@able Capacity Pop.
Finish
La er
DanyCow
Feeder
Non -La er
Dai Calf
Finish S
` .f. ""'
-
Da' Heifer
o Wean
Design
Current
Cow
o Feeder
D . P,oui
Ca _aci
P,o
Non -Dairy
o Finish
PBoars
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify 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 NA ❑ NE
❑ Yes
[] No
Ej.?i'A
❑ NE
❑ Yes
❑ No
[3 -NA
❑ NE
[—]Yes ❑ No E3<A ❑ NE
❑ Yes Ko ❑ NA ❑ NE
❑ Yes �jNo ❑ NA ❑ NE
Page 1 of 3 214/2014 Continued

F cifl Number:- Date of Ins ection: 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ nie--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
Observed Freeboard (in):��3
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R]LNQ
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
[-]Other:
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[�
❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
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
[ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
R -M
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
2/4/2014 Continued
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®-10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 Tqo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift // ❑ Application Outside of Approved Area
12. Crop Type(s): C4) 1-3 e"--4" S b Alk.,
13. Soil Type(s): ('-J� i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [J>o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes- 1=J leo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes io ❑ 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
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�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
[E'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22- Did the facility fail to install and maintain a rain gauge?
❑ Yes[]
fNo
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Facility Number: IDate of inspection:
24.. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No ❑ NA
❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ej No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[ZJ D "►- ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[0No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes QNe- ❑ NA ❑ NE
❑ Yes 2—Tgo ❑ NA ❑ NE
[—]Yes 55,Ke ❑ NA ❑ NE
❑ Yes Cgofro ❑ NA ❑ NE
❑ Yes [Z,M
[:]Yes [E�Xb
❑ Yes ENO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

ov 13
Type of Visit: Q,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0.90utine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Fes/ ' I-� I Departure Time: //) /� Coun4
R on:
Farm Name:� b 1 C /f—SS Owner Email:
Owner Name: lr Phone:
Mailing Address:
Physical Address:
Facility Contact: tr_� ILLYeV` 1W 4itle: Phone:
Onsite Representative: Integrator: 17 f CV -4 02
Certified Operator: Certification Number: J o
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
DesignCurrent
❑ Yes
Design Curren# .
- Design Current
Swine *' v ap ct P
Cty. On.
o
Wet Poul#ry
Ca act ty Pop
p
•
Cattle Capacity Pop.
r-..
❑ Yes
Wean to Finish
Layer
❑ NE
Dai Cow
Wean to Feeder
Non -La er
C]" AA
Dairy Calf
Feeder to Finish
-" T
Dai Heifer
Farrow to Wean
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
"Design
D Cow
Farrow to Feeder
M
D : Paul
�Crrent
�;Ca aciPa
Non -Dairy
Farrow to Finish
Layers
❑ NE
Beef Stocker
Gilts
Non -Layers
❑ NA
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Turkeys
Other.;.
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
2'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EjT.IA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
C]" AA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[J NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E-&
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
gl;o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/412011 Continued

Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E.Ne— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q.NA --0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
13. Soil Type(s): /LA&(L_
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in):
[Z;�
[] NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PiPiT-0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
acres determination?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
B -N s- ❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
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 -M --j_] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
e -M ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
❑.Pdo
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D -N0-0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D� �o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] T�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift }❑f Application Outside of Approved Area
12. Crop Type(s):�
`
13. Soil Type(s): /LA&(L_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E! io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z;�
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
OND
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[j -Ko
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑.Pdo
❑ 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes []["�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [73'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

FacHi Number: - Date of Inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge ievels
❑ 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?
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 file drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No ❑ NA ❑ NE
C3,N,o- ❑ NA ❑ NE
❑ Yes g -Ko- ❑ NA ❑ NE
[:]Yes ICSH" ❑ NA ❑ NE
[—]'Yes ❑��T ❑ NA ❑ NE
❑ Yes Qs Io ❑ NA ❑ NE
❑ Yes Cry- ❑ NA ❑ NE
❑ Yes [ids ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Eq-. ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ENo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�to ❑ NA ❑ NE
U S`0_ f f c Sty tnl better explain situations (use additional p ages as necessary). on ft Explain any YES answers and/or any additional mendattions or.. any other;co menfsy�
c -`moi 6 i��
S it�Q sa,,C7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V q(1 d.sz
P- 3-1
f 6A,6r�vj
���� •' '�

i
ivision of Water Quality -- _ �G „�/�
Facility Number � - ,ivy ®Devisiou of Soil and Water Conservation
O other Agency
Type of Visit: ompliance Inspection n Operation Review Q Structure Evaluation Q Technical Assistance
[lesson for Visit: tine 0 Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Departure Time: ;lam County: gz� Region:
Farm Name: �r �� g3 _ Owner Email:
OwnerName: r�.-� zass Phone:
Mailing Address:
Physical Address:
Facility Contact: � p.-� Title: Phone:
Phonem�e:
Onsite Representative: JG Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
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 (galions)?
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 ;EI -No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [-]No
[—]Yes ❑No
[:]Yes H_No
El Yes �.No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current
Design
Current,
Design Current
Swine
Capacity Pop.WetlPoultry
Capacity
Pop.
Castle, Capacity Pop.
Wean to Finish
La er
iry Cow
Wean to Feeder
Non -Layer
iry Calf
Feeder to Finish
M
Dairy Heifer
Farrow to Wean
,�, Design
Current
Dry Cow
Farrow to Feeder
-
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eefBroodCow
- _..
Turkeys
Other
Turke Poults
Other
FFOthcr
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 (galions)?
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 ;EI -No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [-]No
[—]Yes ❑No
[:]Yes H_No
El Yes �.No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili ]Number: -3&bl Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes RM E] NA F] 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 S No [:INA ❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? []Yes RNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�I.No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes JZ�No ❑ NA ❑ NE
❑ Yes ❑.No ❑ NA ❑ NE
❑ Yes [21 No ❑ NA ❑ NE
[:]Yes [allo ❑ NA ❑ NE
❑WUP [—]Checklists E] Design [] Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [8.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: $- - 111 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes I- No NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes allo 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 RNo NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes No NA NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? Yes No NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Ej 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
0 No
NA
[—] NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
[Q No
NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
0 NA
ONE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
C� No
0 NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f5z7/z pFp%z
214/2011

a
Type of Visit: e'Oompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0160'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I
n rriva1 Time: Departure Time: : D[7 County:�O_--
Farm Name: tL/� /L C'p,�t �a,f� Owner Email:
Owner Name: s Phone:
Mailing Address:
Physical Address:
Facility Contact: 1� le -".0 -It, 3Ccs S Title: gOuJPt t+/
Onsite Representative: _ 5��
Certified Operator: .festa__
Phone:
Integrator: Z!fln�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region: / ��
Design 'Current
Design
Current
11EI =11
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P,ou!
Ca aci
P,o .
Non -Dairy
11 Farrow to Finish
ILayers
Beef Stocker
Gilts Non -La ers
Beef Feeder
Boars
Pullets
01 113eef Brood Cow
_... _.:
Turkeys
Other
Turkev Poults
Other
Other
Discharges and Stream Impacts
_ 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 Eg No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [] No
❑ Yes []No
❑ Yes ® No
[:]yes No
❑ NA ❑ NE
C] NA ❑ NE
E] NA E] NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
1 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
oNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C@ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
0 NE
maintenance or improvement?
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo [DNA ❑ 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
/fDrift / ❑ Application Outside of Approved Area
12. Crop Type(s): S_-lrn JQ / vcrf,-,,-
13. Soil Type(s): iNg
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes al No [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ N£
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes IN 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 �R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CA No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - 3 jr jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes ® No
'I 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes [y No 0 NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
FRI Yes [:)No ❑ NA ❑ NE
[—]Yes ® No
[:]Yes ® No
[]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/201I

r ype of visit: %v t-ompn/puance inspection V uperatron xeview v structure r:vaivatton V recnntcal Assistance
Reason for Visit: 9.1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7 %j Departure Time: County* 9L. ���� �
Farm Name: rjrt Owner Email:
Owner Name: ,/� , a Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: r Phone:
Onsite Representative: gam_ Integrator:
Certified Operator: cam— Certification Number:�j
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
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 [Z No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[:]Yes ❑ No
(—]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/417011 Continued
Current{Design
Current
Design Current
Ca a
p
oultry
Cacity
Pop.
Cattle Capacity Pop.
I!W!o.no Finish
La er
Dai Cow
o Feeder
Non -La er
Dai Calf
Feeder to Finish C>
-
Dai Heifer
Farrow to Wean
'° Design
Current
Cow
Farrow to Feeder
D , P,oultry
=-_Ca acity
P.o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Beef Brood Cow
-
3•
=
Turkeys
Other`
"
T urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [Z No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[:]Yes ❑ No
(—]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/417011 Continued

Facility Number: - (o Date of Inspection: /
Waste Collection & Treatment
A 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [R No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes ® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑/ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _Z"AJ,
i
13. Soil Type(s): 1W A- j AJQ 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Callo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U. 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 B No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [$-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® 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 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 2/4/2011 Continued

IFacWty Number: - 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 ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 EZ No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes ®„ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: S'rz-Vt__ r-nv--t.y� Phone: )O—yj3-33,D0
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

Type of Visit QrCommppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: +� 17� Departure Time: County: Region:
Farm Name: Pe-1ZeD r\, 134 515 Owner Email:
Owner Name:ALL; jrV'11_ V zn,-&✓yYL Phone:
Mailing Address:
Physical Address: J
Facility Contact: Ve I tee'-- 3Q�,; Title: L9W4 w/— Phone No:
Onsite Representative: Integrator:
Certified Operator: 1"w''t`� Operator Certification Number:���
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = u =I ="
Longitude: 0 ° =1, =
Design Current
Design Current
Design Current
Swine Capacity PupuIn n
Wet Poultry C•ap�aei�ty Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
a. Was the conveyance man-made?
❑ Wean to Feeder
on -Layer
❑ NA
❑ Dairy Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
S -Feeder to Finish O
-
❑ Dairy Heifer
❑ Farrow to Wean
=Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
Farrow to Finish
El La ers
❑ Beef Stocker
ElEl
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ NE
❑ Turkeys
❑ Yes
Other
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
Number of Structures:
Discharges & 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?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U].No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

M Facility Number: Date of Inspection - ✓�!
�! Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /19
Observed Freeboard (in): 62b
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes O.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 &,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 10No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �TNO ❑ 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 jof Area
12. Crop type(s) l[]1✓t ! L�yhHa�- /✓ya ! Qy` x';�t7 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? []Yes nNo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes V3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes A No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes R9 No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes 56 No ❑ NA ❑ NE
Comments (refer to question
#) Explain any YES answers and/or any reconiinendations or any other comments.,....,,
7Use drawings of facility to .betfer explain situations. (use additional. pages as necessary):
_
Reviewer/Inspector Name - Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: $' — Date of Inspection
` Re. uired Records & Documents
19. Did the facility fail to have 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 RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ffNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
18 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ji�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C&No
❑ NA
❑ NE
29. Did the facility fail to properly 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
23 -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
F0 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
9No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
At" w �.
dditional Comments�eaillrir�Drawings:
r
]2/1&/04

I
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l7 D Arrival Time:; Y � Departure Time: '� County: Region:
Farm Name:�LAMA
e .�xds Owner Email:
Owner Name: _Tth h A o-- L s s Phone:
Mailing Address:
Physical Address:
Facility Contact: T) rf 9f C- O -- J Title: D'OJ /--r- -I— Phone No:
Onsite Representative: c • —e Integrator:'�s
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=o
=t
0 Longitude: =0=6
o=6 = is
Design Current
Swine Capacity Population
Design Curren
Wet Poultry Capacity Population
. n Current
-es
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Daia Calf
Feeder to Finish
❑ No
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ NE
❑ Turkeys
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ER No
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
;&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ER No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: —3
Date of Inspection 1_O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ON -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?:
denti fter:
Spillway?:
Designed Freeboard (in): /9"
Observed Freeboard (in): to
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(2 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
W No
❑ NA ❑ NE
through a waste management or closure plan'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
To
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
allo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
G�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
UNNo
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES•answers and/or any recommendations or "any other comments. ` ..
Use drawiu sof facili hto better explain _additional a s as necessary)
7
IV w`ip4-1-7
Reviewer/Inspector Name I� „' wa Phone:
Reviewer/Inspector Signature: Date:

IV Facility Number: - Date of Inspection
Re uired 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 ®-No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
E4No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes
E,No
❑ NA
❑ NE
12/28/04

iMion of Water Anality
====cilimber MEMO on of Soil and Water Conservation
er Agency
Type of Visit qorcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : D D Departure Time: ; fl County: Region: FX0
Farm Name: ^- LZS4
/ Owner Email:
Owner Name: � kPL!Py h _ c1. /e&�L ir fa 4, Phone:
Mailing Address:
Physical Address:
Facility Contact:- �e I n.L .9ct.1 Title: Phone No:
Onsite Representative: fes, -.t— Integrator: T T_
Certified Operator: jrlgo [ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
='
= Longitude: = ° = I = N
'1[ a4
Destgn {{ urrent
Design Current
Design Current
Swine
CapaciPopulat'on
Wet Poultry Capacity Popullatton
Cattle Capacity Population
Finish
❑ La er
❑Non -La er
"`
❑Dai Cow
❑Dai Calf
❑Dai Heifer
❑ No
to Feeder
❑ NE
r to Finish a
❑ Yes
w to Wean
❑ NA
Dry Poultry
dNon-Dairyw
D Cow
❑Beef Stocker
w to Feeder
PEOFFto
to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Beef Feeder
❑ Beef Brood Co Number of Structures:
s
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
Discharges & Stream Impacts
❑ La ers
❑ Non -Layers
❑ Pullets
Turkeys
❑ Turke Poults
❑ Other
1. Is any discharge observed from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
SNo
❑ NA
EINE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number• g
•� 3� � ©ate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M -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): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes ERNo [INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13.
Soil type(s) _1,U& I I jJp4
�pt �. J -r1 {� rM ��- D'''►- � � a-
-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q?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
[0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[K No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments s fel o eteshon # Ea lain an YE$Yanswers an&orNai/ Ra me�it�datlons ar anV other comments.
f .. ..�
Use drawings of facrhty to better�eiplam�sttuafious (use addrttonal,pages;asneeessary}:
�pt �. J -r1 {� rM ��- D'''►- � � a-
Reviewer/Inspector Fame Phone: 9/0 — J/. Q7_X_T b D
Reviewer/Inspector Signature: Date: 7-
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
9Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
[]Yes
[KNo
[INA
❑ NE
❑ Yes
(RNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
El Yes 59No El NA El NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128104

t
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation 4 y �i)— 0,7
O Other Agency /
Type of Visit &<6`mpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: ! tfia Arrival Time: r✓ D DepartureTime: 'f (7 County: Region:
Farm Name: Q Owner Email:
Owner Name: ie - D At_ _1g,5 -. Phone' L1
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -54'� _ _ _ Integrator:
Certified Operator: tri. -.-L,— _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=0 =, =„ Longitude: =° ❑I I=] N
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Laxer
Dry Poultry
Nan -L,
Pullets
Uiurkey Poults
❑ Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design 'Current
Capacity Population
❑ Dairy Cow I _
❑ 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 CKNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
12 1 o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: -s3j,� Date of Inspection
4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
%A�!/�r-S<Cdl _1 ;Fi"
Spillway?:
Designed Freeboard (in):
13. Soil type(s) Ala _
Observed Freeboard (in):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 51
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
&No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
(R No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? '® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[9No ❑ NA ❑ NE
maintenance or improvement?
f.No
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
❑ NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CKNo ❑ 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) GaAr _/_ � _ Wil -/, ri?!Y
%A�!/�r-S<Cdl _1 ;Fi"
Jye_e.
13. Soil type(s) Ala _
T
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 51
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
(Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f.No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
52No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 51
12/28/04 Continued

f� Facility Number: —3t,4 Date of Inspection LC'L 7�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 01No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J0 No ❑ NA EINE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
.Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes X No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EKNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�gNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Outer Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
(9No
❑ 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
J2 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
[KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Comments and/or
12/28/04

i
i -inion of WateC Quality
Facility Number ® Q Division of Soil and Water Conservation
- Q Other Agency
Type of Visit 6
Compliance Inspection
Q Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
Gr1fo—utine Q Complaint
0 Follow up Q Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: (, Arrival Time: % ; Departure Time: County: Region:
Farm Name: L Owner Email:
Owner Name: C `- .2 c L c or- 45 Phone:
Mailing Address:
Physical Address:
Facility Contact: zeus Title:
Onsite Representative: -L�*-
Certified Operator: -
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' =] " Longitude: = ° 0' Q u
=%sign Current
Swine Capacity PapulationWet
❑ Wean to Finish
Poultry
La er
Design Current
GapacityP�opulatioa
Cattle
❑ Dai Cow
Design Current
Capacity Population
ElWean to Feeder
LIE Non -La er
Dai Calf
ElEl
a. Was the conveyance man-made?
❑ Yes
EN No
Feeder to Finish p /s
x
:
El Dairy Heifer
CKNo
❑ Farrow to Wean
Dry Poultrykrry*+
c. What is the estimated volume that reached waters of the State (gallons)?
D Cow
❑ Farrow to Feeder
El Non -Dai
RNo
❑ Farrow to Finish
❑ Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
& No
El Gilts
Non -La ern
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Feeder
D?LNo
[I Boars
❑ s
Pullet
other than from a discharge?
❑ Beef Brood Cowl
=
❑ Turkeys-
Page I of 3
12/28/04
Continued
_ _
❑ Other
❑ Turkey Poults
❑ OtherNurribe
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;, No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
EN No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (I f yes, notify DWQ)
❑ Yes
CKNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
RNo
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
& No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D?LNo
❑ NA
EINE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:X,,2--,3L Number:—,3L(, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes LgNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): 41K
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [A No ❑ NA EINE
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? C.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 5.No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CKNo ❑ 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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) G(% / N o.4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
29 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES --answers and/or any recommendations orany. other comments
Use drawings of facility to better explain situations: (use additional pages as necessary):
Reviewer/Inspector Name .] Phone: g/p -y33 333.E
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection — d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ,0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 99 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Dd No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
54 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
]R NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LgNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
m No
[jNA
ElNE
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
M No
El 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
[VNo
[_1NA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
,w
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Date cif Visit: s �7'a Y Timc:
I Facility• Number a !o
.�,�� Kot O erational Below Threshold
L10 permitted ,Certified ❑ Conditionally Certified O Registered Date Last Operated or Above Threshold:
Farm -Name: Q4.SS County:
Owner -Name: _T 4in sQn 0elep.� _ duss Phone No.
Mailing Address: 1020 _LilPcf Al f G. eel rr .4ur e 6 R C/ ' C 3 2 9
Facilitv Contact: Title: Phone No: -1/0 - a5 -
/�
Onsite Representative: M e- le o A 8 � -t Integrator: f/'P.S
Certified Operator: _ 464-k0'j J Ba -JS Operator Certification Nurn ber:
Location of Farm:
3Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current
Swine rnunrity Pnnniafinn
❑ Wean to Feeder
Q'ieder to Finish I I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow- to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acitw Po ulation Cattle Ca acW Population
❑ Laver I I JEE11 Dairy I
❑ Non -Laver I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I / I I❑ Subsurface Drains Present -JE] Lagoon Area J❑ Sprity Field A�
Holding Ponds / Solid Traps ;- ❑ No Liquid Waste Management System 7_
Discharges S Stream impacts
1 _ Is any discharge observed from any part of the operation?
❑yes No
Discharge originated at: ❑ Lat=_oon ❑ Sorav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach %klater of the State? (if yes. notify DWQ) [] yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? 40/7
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [' No
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3 a
05/03/01 Continreed

_.40 4
Facility Number: —34&
Date of Inspection
5. Are there any immediate threats to the integrity 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 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
8. Does any part 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?
Waste AnDlication
El Yes r'vf No
VV
❑ Yes EX No
VOYes ❑ No
❑ Yes No
❑ Yes M No
10.
Are there any buffers that need maintenance/improvement?
9 Yes
❑ No
11.
Is there evidence of over application? ElExcessive Ponding ElPAN ❑ Hydraulic Overload
❑ Yes
IZ] No
12_
W. cG ic/
Crop type t 6A�1,-dz:t) I , ko&j Crary ro+ .-Viekj .QC_ N c�
cm.
--
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
X^41.
`F Ik1
(��
e7 Lk ^.�+ �'O etp 1 O i`�d{C sT W4atG
e [G� � 4 1
b) Does the facility need a wettable acre detetrnination?
❑ Yes
M No
c) This facility is pended for a wettable acre determination?
❑ Yes
ru No
15.
Does the receiving crop need improvement?
❑ Yes
FNA No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[K] No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ElYes LN No
25. Were any additional problems noted which cause noncompliance of the Certified A1ArMP? ❑ Yes M No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refevty question #): ' Exphun any YES_answers zmWor any re-6omtatendations or -any other- cowmenUz-
Use lrawings of facility to flatter exQlain situations: (use additiouat pages as neeessary) •;
_
s'
Field C'ory ❑Final Notes71
7- V/I.ic. G'f L �7OLL-�C 4[�S Gi1C�S-c ��pCJ S �rU 1«4i
�O W4, rA Q.3.7 L'i
rCea-%y fi�C 1:;1r Ghok- []tiGGc C��/6u�.o� eraAck
cm.
"E a
i �-ova ��Vcys;br�
l� [�- r:d
i�
n�
.� 1��Cp1.-f
41. 'Nc (Ga� Q �1 CJ- l � (�
� q 3 � f '�' �- b.. l r� LA V, L� t C 7� M c, %
X^41.
`F Ik1
(��
e7 Lk ^.�+ �'O etp 1 O i`�d{C sT W4atG
e [G� � 4 1
__pp7�l
Mt.at� •�iJ i`_'. OU t`GM�. L.a \�"`..\\ h4 CJ -r L,.. -Ir fQW-+�1G .
r
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: S= / 7-11
05103101
Continued

FaciliryNumber L� 3(0
- (0
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Ll Date: 9 G
Time: '4
General Information:
Farm Name: Me- e- Cc+ t l + w 34046 --County:-- 55 `'�
Owner Name: Phone No: S33 — 3 `f S0
On Site Representative: JtJ_�_� �..��.,.� ------integrator:— X-J�7-e-
Mailing Address:_Ws lool bIOL4s� -
Lmor N c 2.$3 $ 11
1 2
Physical Address/Location:
Latitude: 1 I Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine
❑ Sow
0 Nursery
❑ Fetder
OtherType of Livestock Number of Animals: Z
Number of Lagoons: (inc ude in the Drawings and Observations the freeboard of each lagoon)
No. of Animals
Type of Poultry No. of Animals
❑ Layer
0 Non -Layer
Type of Cattle No. of Animals
0 Dairy
O Beef
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for 'spraying?:
Does the cover crop need improvement?:
( list the crops which nee improvement)
Crop type: Acreage:
Setback Criteria
Is a dwelling located withi i 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste Iand applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17,1996
,r
Yes ❑
No i3J
Yes ❑
Noia-`
Yes ❑
No 0--'
Yes ❑
No
Yes ❑ No rri'
Yes ❑ No=
Yes ❑ No �.
Yes ❑ ,No ?( -,
Yes ❑ Nom .
Yes ❑ No

Maintenance
Does the facility maintenance need improvement? Yes d No Gr
Is there evidence of past discharge from any part of the operation? Yes ❑ No
Does record keeping need improvement? Yes ❑ No gro"
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No7
Explain any Yes answers:
Signature: Date:
cc: Facility Assessment Unit Use Attachments if Needed
Drawines or Observations:
:72j!�"?'.� -._ _..� "�` ,:tea' ..�....•r ti.�.,.;a...�s -,Y �` __.
AOI -- January 17,19%