820381_INSPECTIONS_20171231

NORTH CAROLINA ..�
Deparbnent of Environmental Qual

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' L'7 Departure Time: ;`c7 t7 County: Sv 5 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �ty,? Tlfr� `f_ Title: Phone:
Onsite Representative: Integrator: r
Certified Operator: Certification Number: 9 Yr��lf_
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
tesignIUSurrent Design Current
acity Pop. Wet Poultry Capacity Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Finish
La er
Wean to Feeder
airy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
nt
D , ,1P;ou1 Ca aci P.o P.
airyHeifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [moo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ Noo [:]NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes [3-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 10 ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
v 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ErYes
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
[3-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Effes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
Ea<o
❑ 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
E]')\10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�]'3VVo
❑ 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): Z26L/r-S
13. Soil Type(s): lC1D
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [a-Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []'�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes []JNo ❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]No
0 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
EJ- o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 " '
❑ NA ❑ NE
Page 2 of 3
2/4/2015 Continued

Facili Number: I jDate of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ Yes
E3-No
[] NA
❑ NE
❑ Yes
❑~No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑Yes [2No ❑NA ❑NE
❑ Yes 13 1 o ❑ NA ❑ NE
❑ Yes [3'11�o ❑ NA ❑ NE
❑ Yes [ lv°
❑ Yes [3-No
[:]Yes L3"'o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: "_? -70
Date: /0 —`I . /�
21412015

Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Type of Visit: QMompliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Crl�o`utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,'pp Departure Time: County: e� Region: tx D
Farm Name: jfJydry�,.��rr�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: lj r!L Title: eq(UM e,-- Phone:
Integrator: ldr��rrvt- S�ypp�
Certification Number:
Latitude:
Certification Number:
Longitude:
AEI ilDign Curre�tpes
�!
Swine Capacity Pop. ';
gn Carnrent Design Cnrrent
Wet Pontt , Ca aci Pa Cattle Ca paPo
ry E "p t3': p p h' P-
La er Dai Cow
Wean to Finish
Wean to Feeder
Non -La er Dai Calf
��„iJ',L Dai Heifer
�0
Feeder to Finish
L O
D
Farrow to Wean
esign' Cur D Cow
D P,oul Fr.,ad :.k: P.,o Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Boars
�
Turkeys
Other ="�
Turkey Poults
Other
Other
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes g�J..No ❑ NA ❑ NE
[]Yes [:]No ❑NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes ❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes fiINo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes E�"o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg 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
[g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance 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):-m>a 1 Dv��S k-ret
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes ®,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Dg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes '� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. JE[ Yes ❑ No
❑ Waste Application ® Weekly Freeboard Waste Analysis M 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 N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E. No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes ONo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Fai lure 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? ❑ Yes Cg No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [,No
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
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 U&No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑c ,No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP? ❑ Yes ®No
33. Did the Reviewer/tnspector fail to discuss review/inspection with an on -site representative? ❑ Yes r No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�No
] #) Explain any YES answersland/onany m
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
v�J-35 Frlr— 6,-+ milli —AW0"" ' v2p / ? e;.j .v04--
trJi' a ✓ GrJ�s�r Ana Si S �o r 4-r3-e -C—v r �A, �— F //7"
.S6,3/ I�L►'ta_� y _!� NDLIJ &-1'- s a rL l+nQ 17'y a�dS� tf-[�
o r
Y
Gar
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: —/ y
Page 3 of 3 21412015

M
(Type of Visit: 10-Co�ce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: oufine Q Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time:117775 1 Departure Time: o County: Region: -0�'D
Farm Name: llfae4 Ah"rt /" zrep %_ Owner Email:
Owner Name: /JfZ? rs�'Zff S A/D rr_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: _'04y� Phone:
Onsite Representative: f�� �� integrator: (Svw fl �✓.� S
Certified Operator: �js�-•--� Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Design
Curren
nt
Swine
Capacity Pop.
Wet Poultry
Eapacity
Eattle Capacity Pop.
Wean to Finish
La er
DairyCow
Dairy Calf
Wean to Feeder on -Layer
zt0111D
Feeder to Finish
, 03
Dairy Heifer
Farrow to Wean
Design
C
Cow
Farrow to Feeder
D o Poult
Ga aci
Po .
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Beef Feeder
Gilts
Non -La ers
Beef Brood Cow
Boars
Pullets
Turke s
Other
Turke Poults
Other
I
10ther
Discharges and Stream Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes �. o
❑ Yes 23-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: Date of Inspection: — -16
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [25No ❑ 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
J, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
-No
❑ NA
❑ NE
waste management or closure plan?
'to
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
Ott
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
�es
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
PSNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V�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): 49c� V-e s.5 -off
13. Soil Type(s): �ii %r_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CS No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ 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
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[n No
❑ NA
0 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 ELNo ❑ 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 ELNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FZ[No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

•[Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�3 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C!�N0
❑ 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
Callo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
IS No
D. NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes :0 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 7D 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
fEl'No
D 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
`�] No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JE_No
❑ NA
❑ NE
CConunen§k(ref& to, question_,# Explain any; YES answers andlor-any addih�on, al-recuuendations or any other comments.
Use,drawntgs�of facilityto bet0f plainisituations;(use additional pages! as,necessa., r
_=
c9a /,Is 64'�
f'f J4 r el C. Lc —j 0..J
I — IVAir
{Sa✓jkAGR
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: / ^
21412015

f ype or visit: Yycompuance inspection tJ uperanon. Keview t> arrucrure Lvaluanon v 1 ecunrcai Assisrance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: / .`3O Departure Time: ' 3 c7 County: S Region: /7:9�0
Farm Name: �/�� H lk% Fa"rn. Owner Email:
Owner Name: /W /:5,4a .,Q S An,- Phone:
Mailing Address:
Physical Address:
Facility Contact: rz- Title: d,7�f7 I Phone: /
Onsite Representative:-- Integrator:
Certified Operator: f�+r� - -_ Certification Number: g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DesiCurren#Swine
fflapalritIII&
Cy Pop.
Wet l'©ultry ` Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_ & 03
Dairy Heifer
arrow to Wean
m Design
Cnr nt
Cow
Farrow to Feeder
33 H:..
D Pop~CLa` ti
� ni �a:�i:
.
Po
k
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other=
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [& No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑.No
❑ Yes [RNo
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
Page I of 3
21412014 Continued

. Facility Number: - Date of Ins ection: Zp—E/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ 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 [A No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [Z 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):
r
Y
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP? [—]Yes JK No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R] 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 RNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ 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 [0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®. No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �&No ❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3 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
5,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
RNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes E&No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes [!�No ❑ NA ❑ NE
Ve"ings
mments (refer toigaestton#t) Explain any YES answers;andJor any sdditioaal recornmendahous or;anyotliermmertts:�w
of faciUN to betfer explain situations (use additional pages as necessary). ' �' _. -, .,
Reviewer/Inspector Name:
Phone: /�1 �-3 a 0
.Reviewer/Inspector Signature:
Page 3 of 3
Date: /�'—?-�d�—�
21412014

(Type of Visit: Q'Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: [�utine O Complaint p Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: . 1 Arrival Time: Departure Time: County:)
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: a/1� Title: "n4ezljfr.�— Phone:
Onsite Representative: _^S`�rrc� Integrator: Cis%�as+ fif
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
1
Desigu Current
x - 11)esign Current
Design Curren#
Swine Capacity Pop.
Wet Po !try Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design. Current
Dry Cow
Farrow to Feeder
D • al?aul
Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
113eef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - 38` pate of Ins ection: $
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Co No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
C] Yes
E� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �l 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): iJIL---
13. Soil Type(s): '/;
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R 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 [g No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Eg No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No [] NA 0 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 EKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

-[Facility Number: - 3 rl Date of Ins ection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C&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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IN No
❑ NA [3NE
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
MhA
❑ 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
[Z No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ga No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond . ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ea No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any"other comments: = �t- _+
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name: 45�7�e Phone: — 338D
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit: �Zutijn
i ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /z _ Arrival Time: : Z> Departure Time: /,' 3e� County Region: EK-2
Farm Name: A/0 I-^
Owner Name: %i Z ef*-
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:���ir.O - Phone:
Onsite Representative: Integrator: h.
Certified Operator: /%7 r Certification Number: 'Ygl % }
Back-up Operator: 'rwG Certification Number: g%S 77 y'-L_
Location of Farm:
Latitude:
Longitude:
Swine
Design
Capacity
CurrentMMDesign
Pop. Wef Poultry
Capacity,
Current
Pop.
Design Current
Cattle _ Ca aci Po
:. ,. P ty P•
Wean to Finish
^
La er
Non -La er
_
D . P,bult _,CaOac
Layers
I
De"sign
I
Cnrrent
P.o
_
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
L,
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
113eef Stocker
Farrow to Finish
b
Lilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
t'
r
Turkey Poults-
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
[:]Yes ❑ No
[]Yes fg No
❑ Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

lFacility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z 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 JEJ 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 JK No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JKLNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
54 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
[DNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
-® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
10 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
E] 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
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: ZEZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4 No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 Co 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 GAWMP?
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 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ;Eg No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes
CA No
❑ Yes
� No
❑ Yes
fg No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer, to gq&ti6 #) Explain any YES answers and/or any additional recommendations or any other commen"ts. ,
Use drawms of facility. to,better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9-733' 33a fl
Date: %/—/��
21412011
Page 3 of 3

n ... r r-... i _ 1
rype or visit: Qg Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Timer
Departure Time:
County: Region:
Farm Name:_H a/shgjj
[jo(4-e Foim
Owner Email:
Owner Name:
_ _ 11
Rome—
Phone:
Mailing Address:
Physical Address:
FacilityContact: SamrAw Ynme, Title: Phone:
Onsite Representative: S7411tAi, HorreIntegrator: &n61j1q PA
Certified Operator:'Sand % Certification Number: TY77YQ
Back-up Operator: Horw&Ae Certification Number. q$771a
Location of Farm: Latitude: Longitude:
Design Current = Design Current's Design Current
�..
Swine Capacity' Pop Wet Poultry Capacity Popes_ Cattle Capacity Pop.
La er DairyCow
Nan -La er DairyCalf
r Dai Heifer
5DQu T VDesijnCurrent D Caw
D . Poulhy Po Non -Dairy
Layers Beef Stocker
Non -La ers r. Beef Feeder
Pullets Beef Brood Cow
Turkeys
Other "" TurkeyPoults
Other Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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 �j No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes
[-]No
[:]Yes
No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facili .Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3No ❑ 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
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CRNo ❑ 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): /-ilk �emaa Srnaf� �rQ�n
13. Soil Type(s): j!
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
ER 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
r'5;tNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [a 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
ERNA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ 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?
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:
❑ Yes
tS No
❑ NA
❑ NE
❑ Yes
❑ No
5�[ NA
❑ NE
❑ Yes 153 No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
[]Yes �No [DNA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
& No
❑ NA
❑ NE
Comments.(refer to question #): Explain any YES answers and/or any additional recomme-odations or.any other comments' �. ,'
Use.drawings of facility to better explain situations (use additional pages as necessary}: _ -
-7, &re-s� On la,� slo q�e dl% in. P[�e nvlcj �i rv;A ro#en ha .
w 6 9 y
ple�� 9 �� ca fi � � �d�f y,��
as. pl-eo, e hove s I edge s wyey daT e beeare (V e/nr, , p[6*e roj1A6re_
S�rvej �� 'D0 [ f
a� P�od�ce� har bem vj 1t1 ob�sD�efe 'E�< J W Iw Q wea7(h w a e �1"P.,( S leibe-
U3� coin h d� 1 R P �aa �" O� -RII 1� ryea*1-c `i Cr' �fS as��
rJl t° r Th4is "
p to ae beer r � slice (`� �aa- bee,,mf1WA4 0/1 Kew v -F i 17s f�af.
1s available, a5 aq7&o e ppa jhmef- lorticvli,
V�ty neck} `�7rm an� p Gi2�. r�C©r�l P1ct�o� ar n0� a f��� .
10&V1 n0ifj not �
0,0141'aAla, bed a+fs;c���'a� vis b�i� y, �� 3 s►c��� G�e,�<own in�
,9.
Reviewer/Inspector Name:
MIUMMI'd-72
Phone: Ql Q-4 33 33I10 f (J(6 )
Reviewer/Inspector Signature:
Page 3 of 3
Date: DPI_ 14 0 a o l?'
21412011

#I
i
Facility No. / _Farm Name S ( Date a a
Permit ✓' COC OIC_ NPDES (Rainbreaker PLAT
Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
d
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Slud a to',Treatment Volume ifs 0.45
Date out of corn liance/ POA?
Calibration Date
Design Diaiii.--------
Soil Test Date[���` Crop Yield Transfer Sheets
pH Fields t r,1 (w tf Wettable Acres RAIN GAUGE
Lime Needed !�WUP Dead box or incinerator
Lime Applied ! Weekly Freeboard ✓ Mortality Records
Cu-I ✓Zn-1 ✓ 1 in In Check Lists
Needs S (S-1<25) rn� w 0 min Insp. Storm Water
Needs P Codes
Waste Date
- 60 Day i
+ 60 Da
N (lb/1000 Gal) ` -7n W6 ,/,q I V)
.
..
I �
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
i Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

(1 l m , r, "T, .. . 1. - 1
V fl"(S V "1 16 ld(01�
- Division of Water Quality
Facility Number ®- 3� O Division of Soil and V4'ater Conservation
QQ Other Ag�n�c}'
F
peof Visit: 18 Compliance inspection Operation Review 0 Structure Evaluation Technical Assistance
ason for Visit: 6)Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Timc:IqRu Departure Time: County: S(jtt �Q� Region:
Farm Name: Ht{ hA - flOtn2. TQhn Owner Email:
Owner Name: QC_S �1QI Korn2. Phone:
Mailing Address: D535 L04 a 6&lAd
Physical Address:
Facility Contact: rn rtle Title: Phone:
Onsite Representative: Homeintegrator: a necE 9w j' f
Certified Operator: Sam UP ` Tlol�t2 Certification Number: g8_7740
Back-up Operator: Nary Ant4f, Certification Number: QBTfYa _
Location of Farm:
Latitude:
Longitude:
_ Design Current h&':� Design Cu1,te,nt
a
Swine Capacity Pop. Wet PoultryCapacity
Design Current
Ca...tlle Capacity Pop.
Dairy Cow
airy Calf
Wean to Finish
Layer
Wean to Feeder
I INon-Layer I
_
_ Der, 1Poalt ; Ca aei P,o ..
I Layers I
Feeder to Finish
Dairy Heifer
jDry Cow
Non -Dairy
Farrow to WeanDesgn
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other "
Other
Turkeys
-
TurkeV Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes PE� No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit -Number: sa, - 3TI I jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Jallo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No aNA ❑ NE
❑ Yes R No ❑ NA ❑ NE
[] Yes tQ No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes in No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW T? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes IK No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes RNo ❑ NA ❑ NE
Comments refer to question # Ex lain an YES answers and/or any add ittonalirecominendations or an other comAME
(. q 3 P. __ y y
Use drawings of facility to better explain situations {use additional pages as necessa_ryj�� � `_ �
Prod v ce, if i�) 4AP- fmreu CC s f,(&4� jx rymve- oA JeL pc; ) mot 1
Ce ohs io I'M ft6e rau Co �. s if- d o i. -Aa+ Yva /z5f yea- u
�Do k�l� 0 Thy J'ma �11 bin f 11Pd. ple4e CVO bar¢ A 0--
yv� �w On �ea^ rc�� QfG� �Cl'9007 . 9 � In of IeOrl �ay�act.
y g I'�J��P�
©nt or mare Am n J1) e bvfi-%Cy 1ooks pe#y90a.
a I `Thf- so; I oha s t%f Roc polo war 'e1he,- Mt ratc_ O(11;*d 6i e, PIMP— 9� 01 io_-6ra011.
a 4, Co d i bca-h°a� needed- bed Od o-� y ea-,
a I, A f ek�e use_ C,p(Ai rho ) h� 1 Q A M d �o� rveaAq- � 1.
No s fca it ryas d n e_ I ou 1 A ler, sl s'ib'a e rA'o
as. ao�o .sr�d e s:��e 6ho+� Jaya� o,q(p, Vv17( n� cleana* -r
rvo to/s affPr h a�fih� o r �p a /►
am*„� n .off, l ► e?; I C" [Ka i -a'
i1�da4e.nc pr+ce� copy �10 anto soy Gnd�s1 Y`l>?r`�� o� P�S1� C4�+.,� I'-;
rF nrinJ
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: V O� Q Q0
11412011

;fi'acili dumber: Date of Inspection: j11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FZLNo
❑ 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
IR No
❑ NA
❑ NE
(Le., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JZ 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR 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
Jallo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
15.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
L Yes
Dg No
U NA
LJ 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
[R'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [—]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
'5? Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis MSoil Analysis
0 Waste Transfers
RjWeather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J�g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JZ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility No. V$ 31 I Farm Name
Permit � OC
M h Date
OIC
NPDES (Rain breaker
c /+
as3S
�lad
PLAT Annual Cert }
-
Design freeboard
-------
observed - - freeboard
�.���-----
..- SurveyDate
e��nmtn��■���
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
Actual Flow ---
Design Width
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP �� Dead box or incinerator
Lime Needed-1% 1, Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I L,-Zn-I 120 min Insp.
Needs P �0—T100) Weather Codes
Crop Yield Transfer Sheets n/Q
off
0
PulUField
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
CS th.s�
3
- 14&_
o,
, 4
O
Verify PHONE NUMBERS and affiliations
Date last WUP FRO �f�� Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
App. Hardware,Ivp
60 ®rr'
D�f�
Start Pump * aolDsoo, PAS r
Conversion- Cu-I 3000= 108 Iblac; Z¢n--1 3000= 213 Iblac

Type. of Visit 1�3Compliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2=Arrival Time: Q'.�a7 Departure Time: Q`li1 County: s Region:
Al
Farm Name: I' &,!I hcd [lle Fomm Owner Email:
Owner Name: H&TAgi 40f /] -e— Phone:
Mailing Address:
Physical Address:
Facility Contact: /1ArrY ille— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
integrator: 7L— rr •3+S rn � ( Gu rl ,d r m Svo)
Operator Certification Number: 937-7yo f
Back-up Certification Number: 2$7 7 Y�
Location of Farm: Latitude: 0 o a I = Longitude: 0 ° [= 6 =
Design Current
Design
Current Design Current
Switte
Capacity Population
Wet Poultry Capacity
Popnlation Cattle Capacity Population
❑ Wean to Finish
❑ La er
Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
R Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
Non -Layers
Beef Feeder
❑ Boars
❑ Pullets
El Turkeys
❑ Beef Brood Cowl
Other
❑ Other
❑ Turkey Pou Its
❑ Other
Number of Structures:
Discharizes & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes RNo ❑ NA Cl 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
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�!VNo
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: —
Date of Inspection S i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
15[No
❑ NA
❑ NE
a. If yes, is waste Ievel into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: d 14L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
19Yes
❑ 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?
`RYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1)-2 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes �TNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�7No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C'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
C' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IgNo
❑ NA
❑ NE
NQ
{ other comments. -
.y
Comments (refer to question #) Explain anv YES answers and/or any recomFhendi tions or anv
tUse`d av�ings of facility to better explain situations: (use additional pages as necessary) ;
Reviewer/Inspector Name [ � S 1✓�E f e� = �y``.I Phone:CgLo �,3— 33OD& —3 4
Reviewer/Inspector Signature:
72128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ 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.
❑ W[TP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[5�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[!3rNA
❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
IRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No 9NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes t'No ❑ NA ❑ NE
❑ Yes t"No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes L No
❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
y oat C i dCf Ne_) A0+ o� 10 001 ' LA e . Pled t? co A1gw_ rn i 4�
Sid2^ v(ri b��f
wor �_ a, aid[ ba-e 3 pts &I ocrhw /a pg off( _e7' ! c�roi {' ve
on 104,0.
OfT_ s rno l l g on backsiye, To �e D �w ��
�I� has otz� comae C e
s �a ►olds . 9 a Week 10, ,
c r �yen-,
s f ld e s.,,,, e is � v�1 01 y � s l�d� , �-o�a x -trPa�rn�It vol �� rer�4'o .
sts t9
b e- Yv' ier.
I6o&L recwo S.
Page 3 of 3 12128104

Facility No.$)--3!KI Farm Name Mg -doll 4e _ Date
Permit COC OIC NPDES (Rainbreaker
FB
Drops
0�I
PLAT Annual Cert)
.Lagoon
061W
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
i0 8 f
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
3, Lf
r�s:�ia>�irrn,.
Actual Flow
Design
Actual Width
Soil Test Date's-� Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
'Lime Needed 04 Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I Zn-I ✓ 120 min Insp.
Needs P Weather Codes
Cron Yield Transfer Sheats
Waste Analysis Date
I "I Offo=
FF
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
3.5-
1.0
0
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 7 Jq(o-�_ Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac
App. Hardware
-04SE�

s �ivision of Water Quality
11.-Facility Number 8 �3 $ O Division of soil and Water Conservation
Other Agency
Type of Visit (Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ,00A Departure Time: j j; County: !}�^ Region: 1 ��
Farm Name: Irc4011 142roe F6lM_I Owner Email:
Owner Name:. N(�t.Fholl 1
: or'n-q— _ Phone:
Mailing Address:
Physical Address: 11 R
Facility Contact: S A41f Tii` ol-e— Title: `Phone No:
Onsite Representative: u integrator: t�Yy llyylL lm S'
le
Certified Operator: Marsh —1 �l — Operator Certification Number:A _...a0038,
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: 0 0 =1 Q u Longitude: 0 o = , 0 6f
Desig1. n Current iffillps
Design Current
Swine Capacty .Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Dai Calf
❑ Wean to Feeder
❑ Feeder to Finish
&Farrow to Wean 500
❑ Farrow to Feeder
❑ Non -Layer
Dry Poultry
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
La
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
El Beef Brood Ca
Dumber of Structures:
❑ Turkeys
Other I Sim ❑ Turkey Poults
❑ Other ❑ Other
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
❑ 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
5'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IET No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —✓S1 Date of Inspections—
�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f*No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4 Structure i Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in); o?y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
tkNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ISNo
❑ 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
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�j 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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
TKNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CRNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) 31071O L" HAjV/0}fu4,el
13. Soil type(s) AA(v011-e-
f /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
6�-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WWo
❑ NA
❑ NE
Comments (refer to question #i): 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 _J'Qf V S C Phone: [phone]
Reviewer/Inspector Signature: Date: kJ6 slogi
1ZI2Condnued

Facility Number: a 38 Date of Inspection ]
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. "Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 1SWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections CSVeather 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 (PLA1) 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
U No
❑ NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
19Yes
❑ No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
' ?No
❑ NA
❑ NE
❑ Yes
li�No
❑ NA
❑ NE
❑ Yes
'El -No
❑ NA
❑ NE
❑ Yes PTNo ❑ NA ❑ NE
❑ Yes 'KNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
�. Abv-+a, rno ,�) Vvz& a�alrses, lvm�e G�a�ys� aooc - C�o�ays,
,9a b�`f -t otm h as v i -ee w sf[a eye:
5 fit DCCrPc� {,�vr, Q P
� �'
fer year o4d I s- VA I1*e�� � vse- svm 06- P+A//
ie"� c hl 1 P, a gym . bleat Lie n` 4 Io
� a I �e nd of c dC m &,
a Sod ;�(5 b�a> r� aD���11 r n�dJ-6 sbehie evA' a
s i fi b/ aflo-�
� � ���� ha�� die �r � a r � e� �9i.� �
&ht _ h iz► etr now aboNe 4r1n_,- !-e1dj )4 refods 10of-9aam ,
Sabo lJeff-or, DlC -p-a4l ,
12128104

• Facility No5�3_Farm Name Date
Permit �4,L COC ✓ OIC NPDES (Rainbreaker
Pop. Type- Design Current
PLAT Annual Cert)
....
0©©0©00
Design - - ....
-------i
*bserved freeboard (in)
-------I
Slu.. - Survey Date1��--_-_-_-_-_-_
Sludge..
_
Liquid Zone
------I
Actual'
i��-------
1esign Width
Actual Width
Soil Test Date[
pH Fields
1
Lime Needed
Fq* 1,
Lime Applied
F1
Cu r/�
Zn
Needs P
tw kQ i/ool�
Crop Yield
dine Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections p"Nj
Weather Codes
Transfer Sheets n a
RAIN GAUGE
�.
/r
• 111
�a
�'
�
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
S
D.
b
G
5b
042
0,7-1
rify PHONE NUMBERS and affiliations
`e I9st WUP FRO 71010- Date last WUP at farm App. H
ardware
or Farm Records Q1�
n # -�ry-fa-
-e
•np
t
Pp
j,

Division of Water Quality
Facility Number ga 3S Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit RFRoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Q Arrival Time: Departure Time: County: j Region: k7Q
Farm Name: MLiI S (1Otn P B((lh) Owner Email:
Owner Name: SQM iiQ 1 A // Phone: 5 aq-Qag 5ag-64�S.(h 1
Mailing Address:
Physical Address: `
Facility Contact: Isz"Ovi Tft'X/lP , Title:
Onsite Representative: Certified Operator:.Hgahalj
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
ly
Operator Certification Number: P
Back-up Certification Number:
Latitude: = o = 6 = is Longitude: = o = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts 4
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 DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai ry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Fa I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes allo ❑ NA ❑ NE
❑ Yes D 'No ❑ NA ❑ NE
Page l of 3
12128104 Continued

Facility Number:$ a — 3$�
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: �f�flrp ',—
❑ Yes Tia'No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 1 q
Observed Freeboard (in): vZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CRNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ERNo
❑ 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
ERNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JR No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
'RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CRNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below_ ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Bgrnmh 14 C I St coQ 13. Soil type(s) 5�-f— �t%�i'/+yYi 1S '_ 6o s b o Is
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CYNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
C&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0No
❑ NA
❑ NE
Reviewer/Inspector Name I aft S NE Phone:
Reviewer/Inspector Signature: Date: Qt,*4f i 9, D0Q$' ) J
Pevv 2 nr ; U 12/2RAM Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CkNo ❑ NA ❑ NE
the appropirate box. ❑ wUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CNA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
{$�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JRNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C@ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a 1, Pj%e., keee U0 y f e r e co tds,
I �. So 1 % needed- t�--h y�Pcr. Pl&�e a�jf l�n,e reco�.,,�,da`f �''
% A,,,
C_j ch&,p "jejfd1k 4 Marl io Pa[e#h
��2ebar�Jcrvp yields � 4n-%ram,
Mah6i� ) rewds -eorOy s-yearrt
Page 3 of 3 12128104

Facility No.- � Farm Name �JUI) �AC Date
Permit COC OIC,,-,' NPDES (Rainbreaker PLAT Annual Cert }
Design Current FB Drops
Freeboard
Design
Sludge Survey bate Perm Liquid (ft)
OP-41
�M
RL. jV&_ Sludge Depth (ft)
M��
W7f�M
_ ... . - -
, f..
Design
Actual Flow
Spray Flow
Design Width
NAM ITAIFIR611
Soil Test Date W 01
pH Fields
Lime Need d
Cu Zn
Needs P T
Crop Yield - *Q�Md-ob lr'''
Wettable Acres
WUP
Rain Gauge
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
N&�
Waste Analysis Date
man?
MKOJ
in"
.0 ..
Puli field Soil Crop Pan Window
S(a Qj-
-C
k-USwI'm ifkovi 1I 1 airy., ToYro -,P*bhaAr - Da btu. l"Voy
Av CO

' =acifityumber � Division of Water Quality �`' I 1J
O Division of Soil and Water Conservation 1 jol
0 Other Agency I dd
Type of Visit _Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QRoutine 0 Complaint 0 Follow up O Referral 0 Emergency 0 other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: n Region:
FarmName: L� Dili ice. Q Owner Email:
Owner Name: I t 1Q.��6�1��` _ 4'� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1-TIMTitle: Phone No:
Onsite Representative: Integrator:
Certified Operator: _ Y yaf,- _ Operator Certification Number: CRII ! 46
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Latitude: = = ` [�" Longitude: = o = `
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non-L
Pullets
Poults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [i]I
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 Wo ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
❑ Yes
❑ No
IN NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
12128104 Continued

Facility1Vumber: — ` Date of Inspection t i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Q 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 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?
F
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ED 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 Chop Window El Evidence of Wind Drift ElApplication Outside of Area
12.
Crop type(s)
! M O0, " ,
_
13.
Soil type(s) Q
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�0 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[a No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
I&
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 9 STl0 (AN—rD Phone: fo
Reviewer/Inspector Signature: Date: upv
12128104 Continued

Facility Number: ,-I- — Date of Inspection 1 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ""Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )�jNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IkNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes '�&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[XNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
to
Wo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1iNo
❑ 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
0 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
E)SNo
❑ 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
y No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
qNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
-- �J1US� P- CA:) eL� CLA vre.►2�
Q,-rs-
N yr-IrbVI-t MO-4 5
'/" d S 6 n
12128104

Facility No. �� '�{ Time In Time Out Date
Farm Name, Q�_ <Z Ack*4 _ Integrator
Owner Site Rep
Operator No. 77
Back-up 0 No.
COC ✓ Circle: 7 Gen�r I or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean -- Finish
Farrow — Finish
Feed — Finish i
Gilts / Boars
arrow -
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Ga6ge
Soil Test ✓ Wettable Acres
Weekly Freeboard ✓" Daily Rainfall _
Spray/Freeboard Drop
Weather Codes ✓ 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Observed
Calibration/GPM 1
Waste Transfers �r
Rain Breaker
PLAT
1-in Inspections
l
r�
Date Nitrogen (N)
a 2 . ,
Pull/Field Soil Crop Pan Window

On I
Division of Water Quality ,
Facility Number ` O Division of Soil and Water Conservation Vl
Q Other Agency
Type of Visi ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint '>Ofollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ( Arrival Time: f-I Departure Time: County. Region: F1o1
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ID n = , = „ Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
El Other
Discharp_es & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ELI
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? (11-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 '�Z5o ❑ NA ❑ NE
❑ Yes
❑ No
C kqA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ No NA
❑ NE
❑ Yes
❑ Yes
o
ElNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

' _Y*a� ,��. 3..: "E ;�• �'✓": .`f�." �,�**+«..: a': �itrae:=�7j.s �' �. .. ., °'- .�,. s;; . -, ��... s a.. �.� _�. Y,...
'!'� '. ! 9 . . 1 7 - - I I - . `V --, - �
Division of Water Quality T U
facility Number ` O Division of Soil and Water ConservationCA
Q Other Agency
Type of Visit�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint '�Rpfollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (p 0-1 Arrival Time: CA) Departure Time: County: njQ5M Region:
Farm Name: SLnf Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: E-- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: 0 0
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: = o
M
- t
Design Current Design Current Design- Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
f
a er
L Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: El
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[:]Yes '�Ko ❑ NA ❑ NE
e
❑ Yes
❑ No OVA
❑ NE
❑ Yes
t
ElNo NA
40 NE
❑ No '� NA
❑ NE
❑ Yes
❑ Yes
7,�o ❑ NA
❑ NE
❑ Yes
'EkNo ❑ NA
❑ NE
12128104 Continued

mbu"[Ul'j�
Facility Number: 2—W Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M 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 opo ❑-NA LINE
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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA �NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �'NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �fNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �~
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ No ❑ NA aNE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name_Cbvj Aj Phone: 0
Reviewer/Inspector Signature: `tZ Date: - )Lc u
12128104 Continued

Faf ili ,£ umber: 2— %
Date of Inspection l ED1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�%No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El -Yes
No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
*o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
/&No
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA -NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
. ❑ 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)
k
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?
El Yes
El No
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
[]NA JRNE
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
IComments (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 Aj Phone: j ci
Reviewer/inspector Signature: i.�, Date: (4 Kl 2j_,,?r_V7
12128104 uonnnuea

]Facility Number: — g Date of Inspection a
Repaired_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑yes ❑ No ❑ NA [ENE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes [--]No ❑ NA �JNE
❑ 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 ❑ No ❑ NA �NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA P NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA EJ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA WE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA PdNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA UNE
Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElYes Jd No b NA �3 NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ,PNE
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 0.No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA �NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA NE
AdditioAsl Comments and/or Drawing s ::,� `'
r �
ral[�,, c� ~Y� Cv►St,lr�, FV-apr ire M,,,J U ��
a
veBl�c� C-209;w sue, ( 0.VX.ta
FY o �A 0-4 e.x red C1_1 re d rn-. � C- c l- S U
eVV\-6kV'_[c.e.yyVj'V '
Page 3 of 3 12128104

Facility Number: Date of Inspection a a1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [ENE
the appropriate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA 15NE
❑ 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 ❑ No ❑ NA �X, NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA 91 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA �5 NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA PONE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA *E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,[� No ❑ NA jq'NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA 9PNE
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 OtNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA [�iNE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA 10 NE
Additlianal:Comments and/or Drawings:
�atlQx, c�� � �'►nS r� I?yEipt YcMU✓'
tY"- W �d0� �� WOE �� uC 6C CjC
G& �_j - sue- U_d ; ,-, C'nUU fa
C' Ck S
Page 3 of 3 12128104

Type of Visit % Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z Arrival Time: �0 0. Departure Time: 4; County: . Region
Farm Name:Y� t�l�� O i1P .�"C�S f I(Iti- _ Owner Email:
Owner Name Yl S 1 �A a i i% Phone: _
ti
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:' fy)c--
Certified Operator:
Back-up Operator: —f-2w \ �AD t VW,
l IV- zoJa-s- __ Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number: SQ
Location of Farm: Latitude: [� o [� , [::] is Longitude: = o =' ❑ u
t
Design Currents ri�F' "Design
C►►urrent"'
Design Current
Swine
�;
Capacity Pop- ahon �'�'Qt�Pon] "Capacity
Population Cade
Capacity Population
❑ Layer ❑ DairyCow
❑ Non -Layer
❑ DairyCalf
s�k „• ..,
'(g �x. ❑ Di Heifer
s x c
s a"
,, r,
UryPoultry
s_ j
❑ D Cow
-
❑ Non-Dai
❑ Layers
❑ Beef Stocker
M.
❑ Non -Layers
-9 ❑ Beef Feeder
❑ Pullets
14.
-
❑Beef Brood Cowl
I
. ❑ Turkeys
Other
❑ Other'
�_ ❑ TurkeyPoults
❑
Structures:
Other
_ �--Numtiernof
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PLIGilts Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes N�No ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes
❑ No ,ANA
❑ NE
❑ No >A
❑ NE
❑ Yes
❑ Yes
PbNo ❑ NA
❑ NE
❑ Yes
t9'No ❑ NA
❑ NE
12128104 Conlinued

Fdcility 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
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No IPNA ❑NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo
❑ NA LINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �!PNo
❑ 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? )Yeas ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �LNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �N.
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metais (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s).X-i 1
(�,
13. Soil type(s) ()11 V i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Mio
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
)gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)C No
❑ NA
❑ NE
r
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):.
_ ? ka-se- 6k Su -de +o use. -k kc- cxLe ee o -�-
„o. L,` �! +JJ_Q'Sj_'Q OwYA-i
v g I i C f Coo C1Qt S 6e'�as 4?— --z� (o0
5 Rk-6-x
PleaSe C,ov lCJ_ Mane Qd :J `t �doCn
PA Ck1cviaon-5
Reviewer/Inspector Name —ISMKIC — - T .. ` `'.
--]Phone.- Q in '-f 3 33v0
Reviewer/Inspector Signature:
Date: UC.
Page 2 of 3 12178104 Continued

Facility Number: 1 Date of Inspection Z
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 'tgNo ❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes KNo ❑ NA
❑ NE
the appropriate box. ❑ 1AW ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 14 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 WNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No Q NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Wo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes KNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes EA No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes OR 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 V No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes Wo ❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes gNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
c6Yes &o ❑ NA
❑ NE
Additional Comments and/or Drawings:f
--
N Qore_cof- d o eC_C.K Yal, rj evtn`� . C N OT 10 L
t
` 6- Wes-0J
W : 11 vex " s 1 LL & Y- 90 A has 6-CrIt It& Lx :� h 5_61e. i7t
SA A ry,0A of , aA CQ�`�C� C �.Q , SCLrn �I c Tlux r L,
,)
D
CL.V V V,It A Qn 51 t_Xi w o r So ; ; P, (vu "'l
So c
4o kee� Coe o� IL �or
rev,e,.3 .
C cos I ON on %cickc S'• �z Q- 6XVIL , eycL1rr'
Vu . 4 V, z_z" ac-+- A c l a � . 76vi --a a v ese-ed
1V e-8
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w4l,, nc3o " _-
a, r cr a-r-k x ; n ,; R-n [ [ 5 •
Page 3 of 3
12128104

Facility No. Y Time Inq�_ Time Out Date
Farm Name
Owner -- G
Operator Y1e_
Back-up
Integrator lav- �a VIL VG
Si
te to Rep
No.
�-
COC Circle. Gen or NPDES
Design
Current
Desi n
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Fee
Gilts 1 Boars
rrow —Wean
Others
FREEBOARD: Desi
Sludge Survey
Crop Yield
Rain Gauge p'fe, '
Soil Test PLAT
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker
Wettable Acres
u i'04
�A�
R �Pv
etej
Weekly Freeboard Daily Rainfall 1-in Inspections
SpraylFreeboard Drop�i ' \4 ��� SW (D4 I j
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
1.3
Date Nitrogen (N)
2.1
I,,l1
2-1 Z,(q _�_

n
ion of Water Quality
Lca
— ��iiity Number Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit O Routine Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: `O 7 Arrival Time: Departure Time: ; County: Region:
Farm Name:Owner Email:
Owner Name: orn as Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: s�'y"� Integrator:
Certified Operator: J�'�+e— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = 1 = « Longitude: ❑ ° = g = 1i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean O O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Lay T I EE]
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ TurkeyPoints
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
�1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection r3"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):7-�-,�
�r-
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ER No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? KYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes CgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA �
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JS No ❑ NA WNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
® NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
Comments {refer to question .#) VExplain any YES answers and/or any recommendations or any other comnients� "
Use drawings of facility to better-exglain situations. (use additional pages as oecess iy
f��in • •. ND vtd[Jas fVa-toe Dvr/"
Reviewer/Inspector NameTc✓ �. �Phone:
Reviewer/Inspector Signature: Date: 0
Page 2 of 3 - / 12128104 Continued

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
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 [I Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [K 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?
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?
Comments and/or Drawings:
❑ Yes
❑ No
❑ NA
JONE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
[9NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
JK NE
El Yes
El No
El NA
DaNE
❑ Yes
❑ No
❑ NA
UNE
❑ Yes
❑ No
❑ NA
aNE
❑ Yes
IM No
❑ NA
i#055�
❑ Yes ® No ❑ NA (��
❑ Yes
k9 No
❑ NA
❑ NE
YM Yes
❑ No
❑ NA
❑ NE
7V t- a `� Av��rcrJvS � Q i ���f,P •` 6� s.r.
�/BK If:�GTa /11,411 .Su;S Z, 7 �/C✓� c� '
J. U) U, P �— — d) I W,
d- i o o >� L o a.� /y!� ��rr is S x- i ; 7 r7 ere-01, rr���r�r< I pt .
Page 3 of 3 12128104

Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �~ Arrival Time: r Departure Time: County: ti Region:
1M Farm Name: AY 5 !!it 1))� d Yh t Tw✓mot Owner Email:
Owner Name: MA r5 G 1 GL„_e V h e- Phone: 9/d ,. 4h',� .I-_,,,,f a P/ -
Mailing Address: �� �� �"_+• ���[-�at,� Lam . �✓� d� k-'Y4I
Physical Address: //�
Facility Contact: _1�QySL4:/ersz e Title:
Onsite Representative:
Certified Operator: 144"Sko _! allirH .ef
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: ,4w 2 00 3 2—
Back-up Certification Number:
Latitude: = o ❑ f Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry .. Capacity Population
❑ Layer
❑ Non -La_ er
❑
Wean to Finish
❑
Wean to Feeder
El
Finish
Farrow to Wean
U
,-p 0
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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 DWQ)
Design Current I
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non-Dai
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
�J
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 EjK0 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
ElNE
ElYes
94.
❑ NA
❑ NE
❑ Yes
UJX.
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
��,,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
[DY o
❑ 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?:
11
Designed Freeboard (in): aseol
Observed Freeboard (in): .2 Y /0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[TNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J2<o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ['No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes Q'l�o ❑ NA ❑ NE
maintenance/improvement? �`-
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ' rL _._
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
[3No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E N
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,No
l.+J'No
❑ NA
❑ NE
Reviewer/Inspector Name MTII Phone: q/D_-i�P�
Reviewer/Inspector Signature: Date: -Z+<
12/28/04 Continued

' 1
Facility Number: Date of Inspection
Re uired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Uf4o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 046 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rl�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Uk�4o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E?<A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
93lo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Elo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ulo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�fo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E?Ne
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[✓rNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(�
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El[E Yes
,!YNo
No
❑ NA
❑ NE
12128104

(Type of Visit • Compliance inspection O Operation Review Q Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: %a � Timer-' O�
- Q Not rational C Bellow Threshold
M Permitted ja Certified 0 Conditionally Certified Q Registered Date Last Operated or Above Threshold: �—
l�
Farm Name: .._— IsIN9t AK e- �aCounty: . St �. � .
1 . �r,�r[f ,' rr �-M - 'T."
.................._.r...
Owner Name: _ g�_. ti rv� Phone No:
Mailing Address: __.. _�G� �� �� _ _ _ _ 42g9.r�a. + .� L
Facility Contact: Title: Phone No:
Onsite Representative: M&CS&U-__---lfQr-n.C, Integrator.
Certified OperaWr: — A CC74W L . _ "O r 0-4F, — Operator Certification Number -
Location _.
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • u �u Longitude •
Disc6 es 8 StreamImpa
I. Is any discharge observed from any part of the operation? ❑ Yes J,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUrnin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Struc=e 4 Structure 5
Identifier: ---L-- - Z —__
Freeboard (inches): (p ko 04&t —
12/12l03 � -V
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
&No
❑ Yes
M No
❑ Yes
F1 No
Structure 6
Continued

Facility Number: — 1 Date of Inspection
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes R N
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes JA No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Iff No
8. Does any part of the waste management system other than waste structures require maintenanoUmprovement? ❑ Yes J@ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes IM No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerimprovement? ❑ Yes Jj No
I 1. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes RNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type SGr' LVjVL . 3rvta t 4r'0LI A-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ERNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes Eallo
15_ Does the receiving crop need improvement? ❑ Yes ®,No
16. Is there a lack of adequate waste application equipment? ❑ Yes FLNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes $dNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes KNo
Air Quality representative immediately_
:Goats (trj�� y avers gory° _ +aura* atr�oa�
�:k i eld Copy Final Notes
WEIAZW
Ab
Reviewer��r Name s �l s
�.�;�.. � � si.a�:� �.�.
Reviewer/Empector Signature: Date:
713i77m2

Facility Number: —$1 ! Date of Inspection
imwred Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes KNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes $LNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No
❑ Waste Appiicatio�❑ Freeboard❑ Waste Analys4.10 Soil Samplinp-."
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes C&No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes H No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes M No
27. Did Reviewer/inspector fail to discuss review/mspection with on -site representative? ❑ Yes JKNo
28. Does facility require a follow-up visit by same agency? ❑ Yes E& No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes %LNo
NPDES Permitted FacRides
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes %No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [:]No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
MUM

State of North Carolina
Department of Environment
and Natural Resources
Fayetteville Regional Office
Michael F. Easley, Governor
William G. Ross, Secretary
Division of Soil & Water Conservation
June 26, 2001
Mr. Marshall Home
2595 Lamb Road
Garland, North Carolina 28441
SUBJECT: Operation Review Notice of Referral for
Marshall Horne Farm,
Facility Number 82-381
Sampson County
Dear Mr. Home,
JK
FAA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
JUN 2 8 2001
DWO
On June 15, 2001, an operation review was conducted of Marshall Home Farm, facility
number 82-381, in Sampson County. This review, undertaken in accordance with G.S. 143-
215.10D, is one of two routine site visits scheduled for all subject animal operations in 2001.
Staff from the Division of Water Quality will conduct a separate compliance inspection.
During the operation review, the following items were noted:
Pull #4 small grain - 2.6 acres - up to 50 lbs./acre of nitrogen is allowed. 79 lbs./acre of
nitrogen was applied causing an over application of 29 lbs./acre.
• Pull #5 small grain - 2.0 acres - up to 50 lbs./acre of nitrogen is allowed. 80 lbs./acre of
nitrogen was applied causing an over application of 30 lbs./acre.
It was for these reasons that your operation was referred to the Division of Water Quality for
further investigation and possible enforcement action. G.S. 143-215.10E requires staff from
the Division of Soil and Water Conservation to notify the Division of Water Quality and the
owner/operator of these observed violations.
225 Green Street, Suite 714 / Systel Bid. Fayetteville, North Carolina 28301-5043 Telephone [phone]
FAX [phone] An Equal Opportunity Affirmative Action Employer

Mr. Marshall Horne
June 26, 2001
Page 2
A copy of the operation review report is enclosed for your information. Site findings and
recommended corrective actions as discussed are noted in the comment sections.
Please remember that in order for your facility to remain in compliance with environmental
regulations, animal waste cannot be discharged into the waters of the State, and the animal
waste collection, treatment, storage and disposal systems must be properly maintained and
operated under the responsible charge of a certified operator.
On behalf of the Division of Soil and Water Conservation, I appreciate your cooperation with
this. operation review. Please do not hesitate to contact me at 910-486-1541 if you have any
questions, concerns or need additional information.
Sincerely,
Trent Allen
Environmental Engineer
cc: Paul Rawls, Division of Water Quality
Wilson Spencer, Sampson Soil & Water Conservation District
Alfred Smith, Ernest Smith Farms
Carroll Pierce, Division of Soil & Water Conservation
225 Green Street, Suite 7141 Systef Bid. Fayetteville, North Carolina 28301-5043 Telephone [phone]
FAX [phone] An Equal Opportunity Affirmative Action Employer

O:Division of Water.Quality
Division of Soil -and Water Conservation
O Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 82 381 Date of Visit: 6-15-2001 Time: 9:00 Printed on: 6/26/2001
Q Not O erational O Below Threshold
© Permitted ® Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .......................
Farm Name: MA rShall. brialrXara............................ County: $.ampD . IAI........................................... kRQ ............
OwnerName: 5jarfibWL ............................... H.Q.rile ....................................... ................ Phone No: 5Z9-928.t....................................................................
Mailing Address: 2595.1( annb-Lid.................................................................................... faaxAaAlsL.fYC........................................................... 2.84-4.1 ..............
Facility Contact: MIESbi [ AOritc............................................ Title: ........... Phone No: ...................................................
Onsite Representative: Marshall.HQ�r�x........................................................................ Integrator: Hurphy1a jy.Far.....................................
Certified Operator: Mu.SbAh...................... .... awak............................................... Operator Certification Number:Z90.32 .............................
Location of Farm:
Dn the north side of SR 1135 approx..5 mile east of its intersection with Hwy 701, south of Clinton, NC.
r
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' 48 00 u Longitude 78 • 2Z 12 u
Design Current
Swine Canscity Panulatinn
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
500
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity 500
Total SSLW 216,500
Number of Lagoons 1 JE1 Subsurface Drains Present ❑ Lagoon Area ❑ spray Field Area
Holding Ponds / Solid Traps I JE] No Liquid Waste Management System
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
n/a
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure 6
Identifier : ...................................
Freeboard (inches): 20
05103101
Condnued

Facility Number: 82--381 Date of Inspection 6-15-2001 Printed on: 6/26/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ® Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ®No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®No
11. Is there evidence of over application? ❑ Excessive Ponding ® PAN ❑ Hydraulic Overload ® Yes ❑ No
12. Crop type
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
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
IN No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
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?
(ie/ 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?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any!other comments.
pi 1Use drawings of fa ,. ❑ PY
g cility to better explain situations (use additional pages as necessary) Field Co ❑ Final Notes
r
7- Make sure to cut and maintain the lagoon walls.
I I - Pull #3 on small grain 2.6 acres - 50 lbs. allowed - applied 53.16 lbs. = 3.16 lbs./acre over.
Pull #4 on small grain 2.6 acres- 50 lbs. allowed - applied 79 lbs. = 29 lbs./acre over.
Pull #5 on small grain 2.0 acres - 50 lbs. allowed - applied 80 lbs. = 30 lbs./acre over.
Over application greater than 10% has to be referred to DWQ.
T
wer/Inspector Name Trent Allen
E
wer/Inspector Signature: Date:
........ ....
0.5103101 Continued

Facility Number: 82-381 Date of Inspection 6-15-.2001
Printed on: 6/26/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
119- Start keeping the irrigation records on the Irr-2 forms. Mr. Horne is keeping them in a note book.
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
March pumping to the bermuda season for 2 00 1. Waste samples are only good for 60 days before and after the sample date.
the lime called for in the soil sample results. Mr. Home said he applied 1 ton of lime.
J
O5103101

,€ate 0 Division of Soil and Water Conservation [3Qther Agency -
-A Division of Water Quality=`
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
r �ru�r
Facility Number
Date of Inspection Z�-9
Z
Time of Inspection : a 24 hr. (hh:mm)
Registered Certified 0 Applied for Permit [3 Permit ed 0 Not Operational Date Last Operated:
Farm Name: `5�'��rJ+tCounty:..:.....................
................
.........
Owner Name:.....!! tArsAaal.................. ... e'............... ....... ............... Phone No:
Facility Contact: ..ie
din.. T 1e: �- �eSSee Phone No:...... .......................................... .
.......... . ........................
f
Mailing Address:..... .., �r`7,.Z`�....LG wifa....i................. I .......... I.......... ....L 0.r..�.. !1fJ!...r...... �� Z .T. .l.....
11
Onsite Representative:....3D.An, ......... 1111J.� � Integrator: .................FF ...............
Certified Operator..--...: S' � `-�`..........I...................................... Operator Certification Number:.........................................
Location of Farm:
0........ ,�l�r.......�i.e......'.........:l....I..L.�1.e....��sf...�tF.�:..s....�..._ ............................... i
............................................
Latitude a 0A 0" Longitude 0• 01 ="
Design Curreht [)esign "Current _ =
Designer ""C ffrent
r
S�t+ine ` �Capactty,nPopulatiion;; .Poultry` K ;Capacity, Population' Cattle .. Capacity Population
w.... , _ -
�El Wean to Feeder
❑Layer ❑ Dairy
ElFeeder to Finish
ElNon-Layer ❑Non -Dairy
Farrow to Wean
O0
❑ Farrow to Feeder
Other TF
`
❑ Farrow to Finish
a r
F t Total DesigifQipaciEy,z
S p4
❑ Gilts
[Itat Boars
e
. , x L W "
�
-c4 i�.
3
'.
ber of::Lagoons ! Haidutg Ponds ❑Subsurface Drains Present ❑ L agoon Area
i Area x
❑ Spray Field A
r
5§�g`:f _ F 31 � .f`'.x e.-- ..... - ...... . . ......
{ 3G�i�j .en,. 'fir:y.
❑ No Liquid Waste Management System�m
Ev
_
General
I. Are there any buffers that need maintenancelimprovement?
❑ Yes
*o
2. Is any discharge observed from any part of the operation?
❑ Yes
(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in OaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
A No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons holding ponds) require
❑ Yes
[ No
y
maintenance/improvement?
/
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible chae?
rg
❑ Yes]
No
7/25/97

Facility Number: z —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4
)(Yes to
❑ Yes P1No
Structure 5 Structure 6
Identifier:
Freeboard (ft):...................-.... .f ........... ..............
............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runof7ering waters of the Stage, notify DWQ)
15. Crop type Et'>tlrk 9.....................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does�ecord keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations.or dertcieitcies.wer'enoted-during this,visit. You:rviU receive.no' ftirther
::�correspondeitceaboufthis:visif.�:�:.::���-:��:-:::.,-. .� �.•.:-:.:-.�.•.� �:-::�::-:�:.�
GrAi IS la g��� S�c�e r�lel� r,ra.'►rr �/14
O,r,oj �� C�.�
❑ Yes P4No
❑ Yes PLNo
❑ Yes %No
❑ Yes ❑ No
❑ Yes ONO
-------------------------------
❑ Yes 5(No
❑ Yes $ No
❑ Yes (&No
❑ Yes �No
❑ Yes KNo
❑ Yes ONO
❑ Yes IgNo
❑ Yes ;qNo
❑ Yes 9�No
❑ Yes ❑ No
7/25/97
A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: z