820390_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

type or visit. mr uompuance inspecnon v uperanon tceview C.J structure e:vatuanon V 1ecnmcai assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z? Arrival Time: Departure Time: .'t County:
Farm Name: jhd, __7 I/`�S©^ �.,. Owner Email:
Owner Name: ,r0 P1 Phone:
Mailing Address:
Physical Address:
Facility Contact: pOcpc, A,41 « Title: Phone: � ~
Onsite Representative:
Certified Operator: 1�P6
Back-up Operator:
Location of Farm:
Latitude:
Integrator: _ 166�
Certification Number:
Certification Number:
Longitude:
Region:
Design Current Design Current
Design Current
Swine C►apacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish Layer
Wean to Feeder Non -La er
Feeder to Finish
Dai Cow
DairyCalf
Dai Heifer
Farrow to Wean Design Gurreut
Cow
Farrow to Feeder Poultr Ca sci P,o P.
Non -Dairy
Farrow to Finish ers
Gilts TNon"-Layers
Boars Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Other : TurkeyPoults
Other Other
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 CoNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
P NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facifi Number: _ Date of Inspection*.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [:]Yes ❑ No 1 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ( No ❑ NA ❑ NE
waste management or closure plan? T
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 T No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 ' d Dri ❑ Application Outside of Approved Area
12. Crop `I'ype(s): GaSW
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [$] No ❑ NA ❑ NE
❑ Yes JpNo ❑ NA ❑ NE
❑ Yes
G� No
❑ NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
❑ Yes
�n No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P N
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
to
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�j No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ER No
❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ Yes `r No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ONE
❑ Yes Ep No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes qNo
❑ Yes 1� No
❑ Yes [S�No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: ! Co—�-73 33ep
Date: Z Z
21412015

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 0 Denied Access
Date of Visit: 7 p Arrival Time: p i OD Departure Time: County: 9_"_P&r0 Region:
Farm Name: Owner Email:
Owner Name: A—Acni— 4" Phone:
Mailing Address:
Physical Address: r� f
Facility Contact: 1-,bc /` sir-.p� Title: Phone:
r '
Onsite Representative: tIntegrator: Jr*tfs-%q�
Certified Operator: A4o Certification Number: 16 6 G
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
DeS_ 211Current
Design
Current
Design Current
Swiae Capacity Pap.
Wet Poultry
Capacity
1'op.
Cattle Capacity op.
Wean to Finish
Layer
DaiCow
Wean to Feeder 11
iNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes CgNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
j' NA ❑ NE
T� NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑yes
®No
❑NA
❑NE
Page I of 3 21412015 Continued

Fa6li Ndmber: - 113ate of Inspection: 7 -1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No P NA ❑ NE
Struc e l 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? E] Yes W No El NA [3 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 L? 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 KI 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?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overlcad ❑ 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 JWiindow_ ❑ Evidenc f�Wind �41'
Application Outside of Approved Area
12. Crop Type(s): 4�iv ^'' +r' " "` � "� "f _ ' -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
C�yNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes `P No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [;§ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ep No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 3 21412011 Continued

F'acili Number: - Date of inspection: 7 !B y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O 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 fo No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes M No ❑ NA ❑ NE
Other Issues
29. 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 fo No ❑ NA ❑ NE
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes 10 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 5� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. any otber comments' .'
Use drawings of facility to better explain situations (use additional pages as necessary). _
Reviewer/Inspector Name: b -`tom]/�JVW­Lw�j"
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f% a
21412011

hype of visit: ® Compliance Inspection V Operation Review V Structure Evaluation V IectlntCal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0_Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: _L
JL')j0jDeparture Time: County: tJRegion:
Farm Name: rrym /? Owner Email:
Owner Name: h_ Ad<5 Phone:
Mailing Address:
Physical Address:
Facility Contact: UQ A�0_' J Title: Phone:
Onsite Representative: to Integrator:
Certified Operator:Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Design Current
CapacityPop�
. Wet Eoultry
Design
Capacity
Current
.Pop.
Design
Cattle Capacity
C►urrent
Pop.
to Finish
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No ETNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 2/4/20I5 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �PA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)��N
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 g) No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA FINE
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) qP
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 R 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): CO(I'r '1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R, No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E� No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [NNo ❑ NA FINE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�J 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 1� No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes h No
❑ NA
❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes jpNo
❑ 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
is (refer to teest,on l Explain any YES answers ;and/or any additional recommendations or any other comments.
iz
wines oftfacilitv3to better egnlam sttuations.(use additional oases as necessarv). �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/'D _.y33 r 7
Date: 446
21412015

type of visa: V uompitance inspection V vperanon iceview V �trucrure Evaluation V t ecnntcai Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:® Departure Time: ,, County: Syqft.PSo/J
Farm Name: AnA0,1.4 Pa/Sbn 67Z)M V/7) Owner Email:
Owner Name: Dcd!� Or, Phone:
Mailing Address:
Physical Address:
Facility Contact: Dou2j fJ1 V_rnD.Title:
u
Onsite Representative: Aq
f_ ....
Certified Operator
Phone:
Region: %Q"4D
Integrator: tA µ4—
Certi6cationNumber:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r
` Design
Design Current All
Current
Design Current
Swine
Capacity Pop _:. WetPotltry _Capacity
Pop.
Co. Capacity Pop.
nto Finish
La er
Dai Cow
nto Feeder
X
Non -La er
Dai Calf
er to Finish
Dairy Heifer
Farrow to Wean
Cow
Design
Current
Farrow to Feeder
_ _
_D PouI
Hpaci
Pao
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
oars
Bod Cow
Beef Brood
MEN�
_ � _
.-y
Turkeys
' ,,. , _..:...
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes [—]No
�NA ❑NE
�NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No �TA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes P No TT❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes OD No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: M Q Date of Inspection: 1(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
� NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
I
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
Pg 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
t9
P No
❑ NA
ONE
(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
F�j No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[41 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evident f Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Coa54� Paev, �R SS sip+ - .5. Qll Pd
13. Soil Type(s): 1QrVI rt ^paF� �L?`o[d5,�i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes go No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes V9 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reciuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F0 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 P No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412014 Continued

F;ciHty Number: jDate of Inspection: t 120
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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?
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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes �D No ❑ NA ❑ NE
❑ Yes P No []NA ❑ NE
0 Yes VI No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Commry(refer to,queshon #)Ezplaui any YES answers -and/or any adslrtronal5recommeadations or any other comuiients.
Use drai ns of faciliitY to better eapI situations (use additional pales as necessary):Ls
q!�
Reviewer/Inspector Name: //a Phone:
Reviewer/Inspector Signature: �U�'� Date: 70
Page 3 of 3 21412014

Type of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 / Arrival Time: Departure Time: County:i✓ Region:
Farm Name:_Z�n& n'l f Ovl Al7 Owner Email:
Owner Name: 14 so� Phone:
Mailing Address:
Physical Address:
Facility Contact: / l Title: Phone:
Onsite Representative: Integrator:'
Certified Operator: ,a�01 Certification Number: / G OjW
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
sDesign Current DesignCu_rreat ..
Design C*urrent
Swine
@spec ty P,pp. Wet Poultry CaPacityPop Cattle
Capacity Pop.
Wean to Finish
er DairyCow
Wean to Feeder
BLa
Non -La er
Dairy Calf
Feeder to Finish
k,
�;rt ': Da. i Heifer
Farrow to Wean
DesiCtirrent
fia
Cow
Farrow to Feeder
D Paul ; a i
La ers
?0 Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
(7ther � ' '' Turke Poults
Other Other
Discharges and Stream Imnacts
I. Is any discharge observed from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
10 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
9No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ANo ❑ 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): cJlr
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 P 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Amilication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ['� No ❑ NA ❑ NE
maintenance or improvement? T
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 17KApplication Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [jfNo ❑ NA ❑ NE
❑ Yes tom+ No ❑ NA ❑ NE
❑ Yes U3 No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Z - g Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [$1 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Fj 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 lssues
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 No
❑ Yes LN No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes `P' No ❑ NA ❑ NE
❑ Yes b No ❑ NA ❑ NE
❑ Yes [V No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
lComments (refer to question # ): Explain any. YES answers and/or any additional recommendations or_any other'comtsmen` i�
UseArawinks of facility to better explain situations (use additional pages as necessary). _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: F « — 3o
Date: V,
i
21412011

(Type of Visit: qP Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: n `� 4�! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ("Vj Title:
�1
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
integrator:,O��i/►
Certification Number:
Certification Number:
Longitude:
Design Current
Design Current
Design Curreut
Swine Capacity Pop.
3WetyPoultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
-
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . }i'.oultry Ca aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 PS No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[:)No
® NA
❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Struck— Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
�No ❑NA ❑NE
❑No NA ❑NE
Structure 6
❑ Yes
* No
❑ NA
❑ NE
❑ Yes
E)�No
❑ NA
D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes "� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes F0 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 M No
DNA
❑ 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?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment!
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes P9 No ❑ NA ❑ NE
❑ Yes PO No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
)IM No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ElWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Tr nsfers
❑ 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 rVi No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pe. ? ❑ Yes No
25, Is the facility out of compliance with permit conditions related to sludge'! If yes, check ❑ Yes %% No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'! ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
P
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 4 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 [4 No [DNA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #1): Explain any YES answer"nd/or any additional recommendations or any other comments.
Use drawings of facility^to_6etter explain situations (use addihonal:-pages;as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature: \
Page 3 of 3
Phone: 9� I /p' -j30(7
Date: f$ )T/
21412011

type or visit: tv t ompuance inspection V Vperatlon Kevtew U Ntructure Evacuation C.l t ecnmcat Assistance
Reason for Visit: a Routine O Complaint p Follow-up O Referral O Emergency O Other Q Denied Access
Date of visit: i c1r 11 I Arrival Time: Departure Time:jjj�= County: Region: FRO
Farm Name: Owner Email:
Owner Name: Phone:
;Nailing Address:
Physical Address:
v �
Facility Contact: ow n ol-I Title: Phone:
Onsite Representative: f Integrator: �`�--
P t �}p"lv _
Certified Operator: �1lt��tain ill ou odne) Certification Number:
Back-up Operator:
Location of Farm.
Certification Number:
Latitude: Longitude:
Design Current .
Design
Current
Design Current
Swine
Capacity Pop.
�4'i tF 6ultry
C•apaclty
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish`
1#'
A - i._i
3
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D"> 1?oult �'"`
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 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)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [—]No ❑ NA ❑ NI?
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes N No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faci(i y dumber: -3qoDate of [ns ection:
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): _ 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? CaYes ❑ No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes (S 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 [5j No
❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CR No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r' No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy 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): co�?&A21 Ba&, LAa r'uy 4 e Vayt ' SI'1 ah eIrmh Qye(1P-
13. Soil Type(s):' !�S 111 D IJ 1VQf is f D I Lin�T�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (N7No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5JNo ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
�j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
FUU�N,'NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit y \umber: -32Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes PK No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No G37NA ❑ 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 concem?
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 NNo ❑NA ❑NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
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
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or -any additional recommendations or'any�.6ther commi6fi
Use drawings of facility to better explain situations (use additional pages as necessary). r.
71 J�si4, layoo>1wal�r �e.9- Cope-, bot -{or has c- a 10--eof bare g , pl&tre,
c [id �S�d- I aif'[1 aj [ ►Yrej. ''eagiff, wr �a o� ,7
�a� of end v�` c1 C Cl e_ I
Sl udie s Vve fti&(f 1 &) Orb I a o/ �.
Na,- Cj, rAr d 0�e_ N'r''v/,mfDj1/-2U D w 0491-, 19o0ob � hole
sftvr 7
Ott -Qw� coo[ /ecovil.
Reviewer/Inspector Name: to,,
Reviewer/Inspector Signature: �-,
Page 3 of 3
Phone: gto- 3 -
Date: S
21412011

Facility No. S 1. 3 clO Farm Name .V Date f It lit
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert )
�.M1i1l�i1���
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
�WsW i7FTiWNA
Calibration Date
Design Fl.Actual
i-------
Flow —1
V,
• - • Width
1-------
Soil Test Date
(4 1*
Wettable Acres `�
RAIN GAUGE
pH Fields
WUP
Dead box or incinerator
Lime Needed
0—
Weekly Freeboard
Mortality Records ..�
Lime Applied
1 in Inspections
Cu-1 —L,/Zn I
120 min Insp.
Needs P
�_
Weather Codesid
ff
('rnn Yialrf
Trnncfar Ch=,mfc h
I n
� )
lr� �i l(AI
Waste Analysis Date
Lis
r
�19311
11
. ..
r��rrr�0nrm
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
18
o
S7
Iq0
Qr`SP
s
o
va`
r;
sc
r
Verify PHONE NUMBERS and affiliations
Date last WUP FRO lj 103 0(9 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Difce
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 lb/ac
App. Hardware

Type of Visit Z$Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: [WbqjW] Arriv�al Time: ;ad Departure Time: 1 S p County: SI'�' Region: I= O
Farm Name: &- aly _ Dodson Fab Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: �.�r n
Facility Contact: 0� s Title: _ Phone No: �7 t Q 7
Onsite Representative: DodsDodso, Integrator: 11' L7
Certified Operator: Kba4sa, _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = o =' =
Design Current
_
Design Current
Design Current
Swine Capacity
P i ulahon
Wet Poult rY
Ca acPopu
p ty$
Cattle
Ca aci Po ulatian
_ .,a
Ulation
❑ Wean to Finish
Dairy Cow
❑ Wean to Feeder
I
❑ Dairy Calf
Feeder to Finish
-
-,D
Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean ty ry
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
Other z
❑ Turkeys
❑ Turkey Points
.:
-�
❑ Other
❑ Other
Nurtibe of=Structures:
Dischmes & 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 JjjNo ❑ NA ❑ NE
❑Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [& No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Page I of 3 12128104 Continued

+ Facility Number: &Oa — Date of Inspection W
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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
MNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
5LNo
❑ 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
f'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
15�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
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C;No
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. aYes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding Wydraulic 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 ❑ A�ypplication Outside of Area
12. Crop type(s) A,v " t J r/j' al 6/ 1/1 6S
13. Soil type(s) (_WIW(j ! Ift'6611f r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tgNo
❑ 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
NfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ED No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CRNo
❑ NA
❑ NE
T3
Reviewer/Inspector Name ��}�¢ �j' i Phone: GjjQ) 433-33XA3333
Reviewer/Inspector Signature: Date: bEg. aQ Q (21 Q
Pa me 2 of 3 17178104 Continued

Facility Number. OpX —3qo Date of Inspection Jg
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box.
❑ WUP ❑Checklists El Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
El Yes
NNo
El NA
El NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33_ Does facility require a follow-up visit by same agency?
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
❑ No
51-NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No J�JNA ❑ NE
❑ Yes 'ONo ❑ NA ❑ NE
❑ Yes IgNo ❑ NA ❑ NE
[]Yes EjNo ❑ NA ❑ NE
[]Yes 5JNo ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
AdditionaloCpmments and/or Drawings:
39, ND drv;n `}-is `
I, Pulk i 4a OrR or alIowP4 `I-o have- abo,+ )300Q 'gat WIS arl��o x f
i was s PY s �a �v I✓ h�trs-
�- sera e �,�-, s -ex etk "j � ���
p1 r� cnhCutts
j 0 Caq�'�- r �d r� �bo �4a h rs UI 1 a-3 '(4- va
-fOr each S fra
-1 is '�a Gr�� war jai �h''U.S I/Mgl -
Ptd id not g � row �u� +0 Ot�o� h'�h
Layc>o,) basks u,cC-�i-eldv rv-a-e rnaf� ca$�c� brsno� a�cl �o`f-C.I'�Pc clojely
WeN k� sec d.s, 7 , ,
qdd I'ttp�a l F� 1� 1 r� ram- eo [ 'j i ffs �� p�1�s i a a-� alai sa�LJ. The parr, b,1 o�
i�Ad th r mar >~ S 9 ! e -file 1 S five o) the hvv p �. �'
Page 3 of 3 12128104

Facility No. Sa-370 Farm Name
Permit
�w V �JDate
OIC^ NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spill a
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Actual.
Design Wi.
��------;
Actual Width
- I _------;
Soil Test Date �f jf7�b 1 Wettable Acres RAIN GAUGE
pH Fields Q.� �U� WUP Dead box or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records
Lime Applied ✓� 1 in Inspections
Cu-I ✓Zn-I ✓ 120 min Insp.
Needs P IV �l'Q Weather Codes yvo
k CIO/
Crop Yield Transfer Sheets
UK.
Wi 0'
I
�:
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Arnt
3,qg 15,0
$
Dot-M
Robn
Ln In
/ F, b
go 10
/5
Verify PHONE NUMBERS and affiliations
Date last WUP FRO hj5*QV JON6 Date last WUP at farm fth-e
FRO or Farm Records-O—
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac
19
ar
z
App. Hardware

rl
Type of Visit ® Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ` Arrival Time: Departure Time; I 1,PJ3 County: Region:
Farm Name:
//pJJ[pp� _ �� Owner Email:
Owner Name: i / Phone:
Mailing Address: I — N� / /FLU /[�sC�i-rj
Physical Address: /� ��
Facility Contact: /a 61n ���M Title: eCu J-0e _ Phone No:
Onsite Representative: Integrator:
Certified Operator: W1,114w, 94 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= , = Longitude: = 0 0 6 = 1i
Design Current Design Current Design
SRine Capacity Population �4'et Poultry Capacity Population C•arile—C8P2CjrVjll.PjkgzU1ffNtion
Current
❑ Wean to Finish
❑ Layer I
ILI Non -Layer I
I
Dairy Cow
❑ Wean to Feeder
I
Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
J
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non
❑ Layers
-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Gilts
PEjBoars
C)ther
❑ Other
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�,/
L✓J No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
!J NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
8NA
❑ 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
B<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Cl Yes
,Q,0No
a No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: — Qjy Date of Inspection
Waste Collection & "Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes R 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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2•�Vo
❑ 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
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[I Yes
�,�
F3 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
��,,//
L10 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) &,,� 6�L o
Pq:c3
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
�
B o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�lo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R"-No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA [I NE
18. Is there a lack of properly operating waste application equipment?
ElLYes
�2<o
o
❑ NA ❑ NE
Comments (refer: to quesiiONY: Explain any YES: answers and/or any recommendations or
, any other
Use drawings of facility Whetter sr
g ty titter explain situations (use additional pages as necessary)
J
..:. _.. :,. .... _..,,
Reviewer/Inspector flame Phone:
Reviewer/Inspector Sig Date:
12/2'$/04 ' Continued

Facility Number: Z2 —0 Date of Inspection 3 D
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RVo ❑ 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
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
BNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2<o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�
BIZ
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2<A
❑ 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
R1vo
❑ 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
eNo
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�/'
IfJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
4
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes .
ONow❑
NA
[INE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ifd'No ❑ NA
❑ NE
C",
� W v+f IL
! a S S �55 Gt
r-+�t. >
C"O-C�
�', ej-0
0C T1
12128104

b IMs 1113 Iloy v'vf
Type of Visit ILcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1,2t Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 4—� Arrival Time: Q, fs Departure Time: 10, tlAt 1 County: S� Region: PRO
Farm Name: ffi. todio TD M Owner Email:
Owner Name: �tSD� Phone:
Mailing Address: i 5$ sa W _ �D!r- bmp 0934�
Physical Address: �y
Facility Contact: _ Amkmr Opdso, ,_ Title• nlrn+ Phone No: 3 ro-%go
Onsite Representative: AAftOadSm Integrator: HAAr-&oLn3 /,—Rlkv1%1 45 mhf1
t 11 //
Certified Operator: VV11 � - Operator Certification Number ---AM 106W
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
Back-up Certification Number:
Latitude: = c =' = « Longitude: = 0 0 J ET
Design Current Design Current
Capacity Population Wet Poultry capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoutts
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
ru'
Number o€ Strad
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
ONE
El Yes
ONO
❑ Yes RNo []NA ❑ NE
❑ Yes RNo ❑ NA FINE
Page I of 3 12,128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Rio
❑ 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):
���ttq
Observed Freeboard (in):. To
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E'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
RNo
❑ 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?
MYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ 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
19 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D�No
❑ NA
❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J@ 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 El Application Outside of Area
12. Crop type(s) ('�JQi T72 1 RA'� .C& ( IDD� i RM�Q�i� f iyll�*'2 S665 -
13. Soil type(s) NQA S' $ ; RD B S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[ZNo
❑ 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
15JNo
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment? ❑ Yes
5�No
❑ NA
❑ NE
YE5 answers an
{�
x P IN I
Use dr gphttn soya endatziins orany other comments.
Comet$ ieof faces veto better exlatn situahans. use atldrho ala a es as necessary)
t3' , P , g
ri
Reviewer/Inspector Name Phone: JJQ t433 00 X3333
Reviewer/Inspector Signature: Date: N
Page 2 of 3 U 1 1228104 Continued

Facility Number: Qj —3Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropirate box_ ❑ WUP [:]Checklists []Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[$INA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
15kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C 5,-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C§CNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E&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
E.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
DS No
❑ NA
❑ NE
AddifonalaComments andlar Drawingsr;,,WZ
-1. Top of l a!yoa7 * s fi 11 h or lw7 j +bre s-edfs (I I t Sides, P -0 Mos seeltf i�
S�.y baj-dUdnol-yowd-..+oo(aojhf, 063e_add -brsofII tI'Me sped
4- mulch , TruUt aid o,,,b fde wQ I ha,-e— pre oaf co�,�.,
3q, please ca l i brakree. i by ,pid of ytoa- d(Lh ;�, zz awa )
a i. V1Nn l io do so j j 011a ys 'j i7 Per IN4 rp Saw -ftet - rns nth Mmz-,
Pail l� ov�.I�rd _ in +rNmis 4 rye_ � M l l d o More whe
ov&aI13 oat 100iC q -faun w hj od- records,
Page 3 of 3 12128104

Facility No. $a -3 V Farm Name Ppof
gh Date
Permit r/ COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert)
Po . T e Design Current
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date Perm Liquid ft
Sludge Depth ft
Cali6raflon Date
lesign FlowActual
��]�---_---
Flow
�' - Y
Soil Pest Date � r
pH Fields "r,Z,rt a Crop Yield V! 1 all dh 4h»
Lime Needed y Wettable Acres ✓
Lime Applied ~� 3.7 �; WUP
Cu %' Zn Weekly Freeboard
Needs P Rainfall >1"
1 in Inspections
✓
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
M -15 -T-d-- (—
>�r�
Pull/Field
Soil
Crop
RYE
PAN
Window
ow,%-44
12a--
0^-SP
Scob
50
3
-S
s
_n�..
y
Verify PHONE NUMBERS and affiliations
Date of last WUP FRO
1tNO a000 Top Dike 5 3% wl
Stop Pump ,
Start Pump :5
0
Date of last WUP at farm 1A App. Hardware Max Rate Max Amt
+6w,K j—On 6�'� I .�s . yp Pl**jA{
we�Irkf�+ko y all

Division of Water Quality bob
Facility Number a 0 Division of Soiland Water Conservation
-- 0 Other Agency
IZf s°l
Type of Visit 11 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emer ency 0 Other ❑ Denied Access
Date of Visit: 3 p1 Arrival Time: .3 � 5 Departure Time: County: Region:
Farm Name: `� � "L.\ t ')a � n ti COX CY1 1 1Y0 N_ jwner Email:
Owner Name:y1,Yl`t' ny"%U 'i� S�Vl Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representa
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
Gilts
Boars
Other
❑ Other
Title• 1 Phone No: _
�� I' t` Integrator'. 6 _
0n Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 A= Longitude: = 0 0 6 0 S,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turk-ev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
1
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No OrNA
❑ NE
❑ Yes
❑ No ,RNA
❑ NE
1�
❑ No Vf NA
❑ NE
❑ Yes
❑ Yes
ko JUNA
❑ NE
❑ Yes
❑ No )<NA
❑ NE
12128104 Continued

Facility Number: a — 0 Date of Inspection 1 is
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes �INo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [)3 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: a
Designed Freeboard (in): 1
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 arc not properly addressed and/or managed ❑ Yes fio ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes $ 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 06 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 06No ❑ 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) �)tg MukC�9� P �m CAP- UI S
13. Soil type(s) O r, no
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/MNo
❑ 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):
&J,r_ o Yt t Z S
,e . RIM so�'in
b a,n L a IC
� i� � Sa,�a r rn 0 rQ_a'4 p ,~
`Cb
NI use Q � 5� bL� �� g
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: `
Date: G
12128104

Facility Number: Z - p Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )� No ❑ NA ❑ NE
the appropirate box. ❑ W'UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes 10,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:]No
[ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�%No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
4 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? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VX No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-- S=� ti 1 S ales cl ue. to V2_1 Z, a 7� .
I so_�I_z 6o" 6��
12128104

. , Q� 7 1 L 3
Facility No. Unn� " a� Time In Time Out ate
Farm Name lliYljlf�_O1n 11;� S� ►i� ry,, �(�,� # Integrator fn d
Owner n a Site Rep
Operator OG� S No.
Back-up No.
COC
�2
Circle: G ner or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wea — sh
Farrow — Finish
—
Gifts 1 Boars
Farrow — Wean
Others
FREEBOARD: Desigry
Sludge'Survey ��/ q�,
Crop Yield 1
Rain Gauge
t'31—
Soil Test Wettable Acres
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Daily Rainfall V
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
'Z Z .`1
Observed
Calibration/GPM d 4 1
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
t [I 1
M
Pull/Field Soil Crop Pan Window
ti
�r
ok
Q h �r1 ►�
C

IType of Visit I&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: F Q(p� Arrival Time:�Departure'rime: Countjj_W_y\ � RegiouF
Farm Name: bvl Owner Email:
A�AOwner Name: Phone:
Mailing Address: W
Physical Address: //�� l
Facility Contact: __n i ] t t'lolnU Title: _ LLmgz Phone No:
Onsite Representative: Integrator: t t ti
Certified Operator: 1'►`Tt 1� �4r1 Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: I--] o = = Longitude: = ° ❑ ' ❑
vK1 S'dR V4,9— z) - % sou �, % tic. ft 133$
Design Current Design Current Design Current
Swine. Capacity Population Wet Poultry Capacity Population Cattle 'Capacity Population
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
Farrow to Wean
1
sa-j
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarlZes & 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 DWQ)
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
i
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes toNo ❑ NA ❑ NE
❑ Yes
tZ NoMA
L mNA
❑ NE
❑ Yes
❑ No
I'NA
❑ NE
❑ Yes
❑ No
1XNA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
12129104 Continued

acility Number: a —
Date of Inspection 0�
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:/
Identifier: ri
Spillway?: N ZA
Designed Freeboard (in): -19 ►1
Observed Freeboard (in): `3R'r.
Structure 2 Structure 3 Structure 4
[--]Yes '5(No ❑ NA ❑ NE
❑ Yes )No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes "N 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 10 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
`Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ` 4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes _1P No
❑ 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) � rnlJSh. — 'Aa1.\ i PQ�,_ "'&n ' Gta L, -01W aj ,
13. Soil type(s) t k l AMi D I UICL140 A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes VN•'o
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes �vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 'M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 14 No
❑ NA
❑ NE
Comments (refer to question ff): 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):
O t'sc. 1 o.and rn u 1 ch rrw��
Reviewer/Inspector Name 1CA9_AS-T
54fL60t: AS -lam; l
So { Sf o,n c� 5e eot A
ri� . c-4 J
be &n4_: CICIJ
Phone:`\ 10 �k3 3366
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number: a — 0 Date of Inspection Ob
Required Records & Documents ! j
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 'PS No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
%No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'KNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
1ANA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
WNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IXLNo
❑ 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?
El Yes
,,��qq
[*No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:]Yes
'CkNo
❑ 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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VANo
❑ 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
aIo
❑ NA
❑ NE
C�1(ov-'er skod j_ 1 wj-e. `i'ec-kni coA SP-e.60A : S4 oreVatt e. �>la�*qod'Jo�-i->,
m�.n a
bz i rt A ', Co.,LtA Q 1i UO r orY. S p f
C',"d I ff
12128104

pivtston of Water Quality
FactFhty`;Number g� 3c Q'Dtvtsion of Soil and Water Conset-%'ation 17
- --I ,aotlfwAgency Via...
t NLt .J'�'C. �xr�� i .... � .. - . ._ :.. i.'.dF+� � -G� ,i — c•—:�:— .-ir
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - •off Arrival Time: ;Oa Departure Time: County: s� Wit_ Region: f/?0
Farm Name: _14-014o'r __ Fa�� TQ/ry jt /7 Owner Email:
Owner Name: /9nAtV AoolePhone: 9_/o - S6 1- 6JR3
Mailing Address:SNc- "Y93e-2
Physical Address:
Facility Contact:
Title:
Onsite Representative: _I1rnloh�. �eA'sa�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: /GG q9
Back-up Certification Number:
Latitude: =o =' =" Longitude: =o=' 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑'Freeder to Finish So
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Lave[
Dry Poultry
❑ Lavers
❑ Nan -Lavers
❑ Pullets
❑ Turke s
❑ 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'?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters ofthe 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 EMo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
D'%
❑ NA
❑ NE
12128104 Continued

Facility Number: — 3 tjp Date of Inspection 3 »r
Waste Collection & Treatment Bo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes L7 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?: It o
Designed Freeboard (in): .
Observed Freeboard (in): 3 %Z,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [TNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
tallo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
B No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[ o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
/or-
12. Crop type(s) r eg,S
13. Soil type(s) 6-v a.. !a ..
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
[allo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
❑ No
❑ NA B NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA C�lE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2 No
❑ NA ❑ NE
��fB✓.i.rtc� 'l'.g.'a Fr.4sarW lered �y/{� fir. 4 ,,Ij,, .
Reviewer/Inspector Name M,,.R' fra�fl� — Phone: y o• - / y / 7I0
Reviewer/Inspector Signature: (j Date:
l.VI... /i MG fL

Facility Number: —,390 Date of Inspection 3 OS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [TNo ❑ 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 appropirate box. ❑ ' ❑ Ch,, k- - is ❑ gaef�n ❑ US ❑ gates`
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LKNo
❑ NA
❑ NE
❑ WaSLU APFlit-stion ❑ «'@@I45' 9Feeb rd ❑ Wt�is ❑ &oil Art s ❑ was
L ,-rans fern
❑
n
❑ Rainfall ❑ ❑ Crop Yield ❑ l2 ❑ .
❑
3s,_..il
G. &
r
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
❑ No
❑ NA
aNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[FIVE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[;3-NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RVE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [moo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
G 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
21�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�'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
9-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additiodfil,Cotnments and/ortDrawings: 4 __
P�00%v P/GwS G4Ogge_ • rSGuG �a eet+ .4, l`."1 . Please .".11''e
��►,s 'X.-je Cefe.e ).ov S�rf �o�,,,p.'„9 " CoajloL( -IA;c y_.ar 14ler5e
re." a "J, & ke W"S le S u,. yd /-s . Plo"s �o 01.4/ So.•,r a�iu�'!,�,�a /a..
Ad u-as /d P /an
12128104

Type of Visit Q 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 3 v Date of Visit: i D Time:
NNot Operational O Below Threshold
[Permitted MCertified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ---------
Farm Name. �r,o.+ �a�Sovt County:.,, ,aov► _ _ _ ...................
Owner Name: hpd. :P�d SOK Phone No: -„_ f 0 _ 5'6c 3
Mailing address: 'JS /�ioM ! aM11L' A IQoSCiaoro�
Facility Contact:
_Title:.. _M"n!yGl'.._.....----
...� .. Phone No:
Onsite Representative:...[nyct' ..Nl�"^'" Integrator:..._.ucwl....S...�;r�............ _.................
Certified Operator:._•-- An A " ...,. ,�°dsav+ Operator Certification Number:...!�pL 9
Location of Farm:
M�Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �•
�' �"
DOiin Current — -Design Curireent Dcsrgn Cgireiit
Swine Ca o :..-Po alatton _'PoWtry . Ca ci Population
:Po'ulation
Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish tf cep' ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean:=' _
Farrow to Feeder Other -
El Farrow to Finish r TOW Des1 i Cap4oty -
-
Gilts
-
Boars Total SSLW
Number I f;Lagoons
401122
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes [?"No
Discharge originated au ❑ 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)
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ET&o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes eo
Waste Collection & Treatment ,_/
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes LI No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................. -............... ....... ......_....---....-•-• ... ...........................
Freeboard (inches): 3
,12/I2/03 Continued

Facility Number: ga - 390
Date of Inspection S=
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes [R No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ["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 3'� o
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,(, T"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes LI No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [RNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 014o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop types
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 19140
14. a) Does the facility lack adequate acreage for land application? ❑ Yes QrNo
b) Does the facility need a wettable acre determination? ❑ Yes OKNo
c) This facility is pended for a wettable acre determination? ❑ Yes Q'flo
15. Does the receiving crop need improvement? ❑ Yes 0'*No
16. Is there a lack of adequate waste application equipment? ❑ Yes LEI No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [R"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 G3"No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 93/No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 53"No
Air Quality representative immediately.

Facility Number: ga _ $ qo IDate of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ERKo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.) ❑ Yes GWo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis Soil Samplin on y4 uIkl
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes QfNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[jrNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
EVNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EB No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[!(No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
6?rNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ffNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 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 F Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103