820402_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

M
7
Type of Visit: Q Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (!TRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : �d Departure Timer County: Region: �D-
Farm Name:
_ �� r-��-.. [ ,� .. Owner Email:
Y
Owner Name: �j�,�r T'� v,-,-- Phone:
Mailing Address:
Physical Address:
Facility Contact: �)eriir' /y o cy-i` Title: ZL4
y
Onsite Representative: (�Cy��/��,.Y j�rinry llyz�lpCz� Integrator:
Phone:
Certified Operator: Certification Number:.✓1�3
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
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)?
❑ Yes [ETNo ❑ NA ❑ NE
❑ Yes ❑moo ❑ NA ❑ NE
❑Yes LJ o ❑NA ❑NE
d_ Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [A'IZo' ❑ NA ❑ NE
2. Is there evidence of past discharge from any part of the operation? [::]Yes L] -M ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes B' iso ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued
Design Carrent
Design
Current Design Current
Swine
Capacity P,opa 1
Wet Poultry
Capacity
Pop. , „I.
Cattle Capacity Pop.
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
D r
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
5~
`'"`''"
Design
Current
Dry Cow
Farrow to FeederPoul
. ,
Ca aci
Po
Non -Dai
Farrow to Finish
Lavers
Beef Stocker
Gilts
" "
4'� i
Non -Layers
Beef Feeder
Boars
ll
Pullets
Turke s
I lReef
Brood Cow
Dtherrt„ '"
E
Ei11111ti)11I�"".tl�
ff
T urkey Poults
Other
xn.,�.,:nm�..w.mxawuu�iuunmwuesu�yw?�uw:.•
...!NE
uI.
x'n.s+
e.'s'.;,„..,..:
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)?
❑ Yes [ETNo ❑ NA ❑ NE
❑ Yes ❑moo ❑ NA ❑ NE
❑Yes LJ o ❑NA ❑NE
d_ Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [A'IZo' ❑ NA ❑ NE
2. Is there evidence of past discharge from any part of the operation? [::]Yes L] -M ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes B' iso ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: jDate of Inspection:
r No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[�"No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
fe
Observed Freehoard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Ht-go_
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[] Yes
0-go-
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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?
0 Yes
ET-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a 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
lI No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): &_/-r ! Uj r1. / c.� t✓ S >�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
r No
❑ NA
❑ NE
❑ Yes
[]] No
❑ NA
❑ NE
❑ Yes
[�"No
❑ NA
❑ NE
[] Yes []No ❑ NA ❑ NE
❑ Yes [r] No ❑ NA ❑ NE
❑ Yes []'lqo ❑ 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 FrNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rainfall Inspections
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?
❑ Yes E�t`No
[] Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑N
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: / J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3"No ❑ NA ❑ NE
! 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-10 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E] ' -No
[j NA
❑ NE
❑ Yes
Q'lGo
❑ NA
❑ NE
❑ Yes
E]-Iqo
❑ NA
❑ NE
❑ Yes Ej-f o ❑ NA ONE
❑ Yes Q o ❑ NA ❑ NE
❑ Yes B -No ❑ NA ❑ NE
❑Yes ONo ❑NA ❑NE
❑ Yes ["No [] NA ❑ NE
❑ Yes 6 -No ❑ NA ❑ NE
lComments (refer to question #): Explain -any YES answers and/or any additional recommendations or any other comments.
Uiedraw'Inji'� :of fad tYto better eiplain sit atipus'(use additinnuilp ges'as necessary)•
�,rp2T{4�p�ra� /�� {-'✓r-��jF.�-�-��tvCx`nl�/. jet i�- f}� �v?-��
�¢1� ons lv r✓�-- �AG-�c i C'D�1 u« r
Fr,,, h{ 5 Ct +erg ,'j mJ f-Z7at
L /,cam• l?' � �n1._�i�v./d :� �{� l�� � � k-�--- p�-� /y1 raS!!!// � �'-' �"t-� i � '�- V "" .-•_vQ
J p � f �
�l t�t7 i uo �"� [� A'o [} moi"` � �C /�rg� Z �1 ` 5 . rr -: Y
_✓/JCIlrals
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2015

Type of Visit: &-Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: :3 O Departure Time: County: _V � Region: I C7
Farm Name:
Owner Name:�QI�C
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 41rrr-r- myor-e— Title: T
Onsite Representative:�r%'fPJ�J3*�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 WNo ❑ NA ❑ NE
❑ Yes
gnesign
'
-Current
n Current
❑ No
❑ NA
e , .
Cacity Pop.
g
hlEj . We Poultry Capacity
Pop. Cattle Capacity Pop..
IIfiIIdW X. F
;
;,E 11111111111 HI IIS;
v'
Wean to Finish
La er
Dai Cow
Wean to Feeder
1
Non -La cr
Dai Calf
Feeder to Finish
�_�
a"
Dai Heifer
AI Farrow to Wean
3 D
Iii i i
1' Design
Current U Cow
Farrow to Feeder
,
5,;,kll . Point
Ca ace
P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I I
jPullets
I 113eef Brood Cow
t �° i' iij
Turkeys
tither � �
Turkey Poults
Other
I
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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes Eq No
❑ Yes fa_No
[:INA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page ! of 3 2/4/2015 Continued

Facility Number: gr - D Date of Inspection:
—� —
KNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
8 No
❑ NA
❑ NE
r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FZj No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l 2 Structure 3 Structure
4 Structure 5
Structure 6
❑ NA
!Structure
Identifier: ,% i , , p k Grng A
the appropriate box_
Spillway?:
Designed Freeboard (in): 2 —2-7-
}-7Observed
ObservedFreeboard (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
[allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
g No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):r,,,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rYLNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
8 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
allo
❑ NA
❑ NE
the appropriate box_
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1 f yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 N ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Alg? = I Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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 RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MVNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes f4 No ❑ NA ❑ NE
❑ Yes Cj� No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes , WNo ❑ NA ❑ NE
❑ Yes
®. No
❑ NA
❑ NE
❑ Yes
[R No
DNA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers'audlor any additional recommendatibns or any other Comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ! r 7�—
Phone: J`'/ " v 3`c71:5-1
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

ivision of Water Resources
Facility Number ®- Division of Soil and Water Conservation
O Other Agency
Type of Visit:Compl�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GrAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:I U c� Departure Time: D County: ��.y�Ja� Region: C7
Farm Name: G r r�,� e e2!2 -zL_,-x Owner Email:
OwnerName: Phone:
Mailing Address:
Physical Address:
Facility Contact: (j/'z'rr /y%Da/`L _ Title:
Onsite Representative: r/ �/►79 Dl/`� '
Certified Operator:i rn /� �
Back-up Operator:
Location of Farm:
Latitude:
rc' . Phone:
Integrator:
Certification Number: /2F
Certification Number:
Longitude:
y Design Cur erty Design Current - Design Current
Swore ° act Capacity Popes *` � Wet P�oultr -. Ca Pop"`' Cattle Capacity Pop.
.�� . �. � Y p ty ,�
Wean to Finish,' La er k`' Dai Cow
Wean to Feeder D �.�- Non -Laver = Dairy Calf
Feeder to Finish = Dairy Heifer
Desi n Current Cow
Farrow to Wean C ti � � g D
Farrow to Feeder±„s,�, D �P.oitltr Ca act ;Po _ Non -Dairy
Farrow to Finish Layers Z4 Beef Stocker
Gilts Non -Lavers Beef Feeder
Boars Pullets -_ Beef Brood Cow
Turkeys m
Other IT Points.
Other
�I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes. notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes MNo ❑ NA ❑ NE
E] Yes
E] No
0 N
0 N
❑ Yes
❑ No
❑ NA
❑ NF
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [—]Yes ❑No [:]NA ❑ NF
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes RNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

lFacility Number: - D Date of Inspection:
❑ Yes
�No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
�No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
DS -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
❑ NE
Identifier: ,rte r
Spillway?:
Designed Freeboard (in): --
Observed Freeboard (in): X32--- -3 �2_-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P, 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
.[Q 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
Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pg 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
E] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes . [ELNo ❑ 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): ur' rr
13. Soil Type(s): a;
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [X No ❑ NA ❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LF1,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2_No
❑ NA
❑ NE
the appropriate box.
❑ W -IJP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes [No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sol] 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 JR No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number:- (j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [.No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
0 Yes
® No
0 NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
S No
❑ NA
❑ NE
Other Issues
❑ Yes
R No
❑ NA
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ZNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ Yes
& No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Yes
allo
❑ NA
❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
0 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
R 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
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone:
Date:
2/412015

11A 13 -
Type of Visit: 4a Comp ' ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: CrRoutine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: lL-J Arrival Time: .3 Departure Time: County:Region:
Farm Name: r rL� Y_ }t ) Owner Email:
Owner Name: �j f �f r �a �/�S �/ G Phone:
Mailing Address:
Physical Address:
Facility Contact: /1t ro17v-2-- Title: �_t_
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 9
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[]Yes. a No ❑ NA ❑ NE
❑ Yes
Design
Current _— a
Design
Current
Design Current
❑ NA
Ca aci
Po ,. WePoultry
Capacity-
Pop.
_Cattle Capacity Pop.
WeantoFinish
Layer`�,
Dairy Cow
Wean to
/v
'I
Ba Non La cr
Dai Calf
Feeder t Finish
Dairy Heifer
Farrow to Wean
7`r
3t _
Design
Current
Dry Cow
Farrow to FeederDr.P,oultr
,�
Capad
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
IPUIlets
Beef Brood Cow
" :' rTurkeys
Other
�TurkeyPoults
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. a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes CkNo
❑ Yes [Z No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/4/2014 Continued

FaciliNumber: - D Date of Inspection:
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Struc e 1 Structure 2 Structure 3 Structure 4
Identifier: I �aA ye3
_
Spillway?: _
Designed Freeboard (in): .�% ,12 �7
Observed Freeboard (in): 427 3 Ir"
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
❑ No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
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?
❑ NA
❑ NE
❑ Yes
❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes
❑No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 25,--y-/W t(/cam t.TSz-r'�/
13. Soil Type(s): (_ ;
c
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - D Date of inspection: /0— 9L--/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
0 N 0 N
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as 'necessary).
s; 11'-srf //-3 --'9D /S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

t ype or v isit: CJ t-ompuance inspection v ijperation mevtew V structure Evamanon V i ecnnicai Assistance
Reason for Visit: GrIto—utine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; Arrival Time: `3 Departure Time: ` 3� County: < W.e ,
Farm Name: �I r�i^- CSX Owner Email:
Owner Name: �jL�, ( v't-d` roeof-$ J/ C Phone:
Mailing Address;
Physical Address:
Facility Contact: t ; Fr. rc- Appel Title: �r
Onsite Representative:`
Certified Operator: Vers L jy� pDr�
Phone:
Region: f:"�n
Integrator: `j7u✓�� /j raul+'�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream lmnacts
I. is any discharge observed from any part of the operation?
[:]Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Design
Current
❑No
Design Curremt
Swine
Capacity Pap.
Wet Poultry
Capacity
Pvp.
❑ NE
Cattle Capacity Pop.
Wean to Finish
La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Dairy Cow
❑ No
.. Wean to Feeder
p
Non -Layer
❑ Yes
R No
Dairy Calf
❑ NE
Feeder to Finish
❑ Yes
WNo
❑ NA
❑ NE
Da Heifer
Farrow to Wean
g
Design
Current
Dry Cow
Farrow to Feeder
D 1?ouit ,
Ca aci
Pkv
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other ..
ti
Turke Poults
Other
Other
Discharges and Stream lmnacts
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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

Facility Number: qDI Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
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 5� 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 ❑ YesNo [:]NA E]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 [21 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 r-_1 No [DNA [D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0C�Mifdla / ®UI/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ZI No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[KNo
❑ 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 p Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q No
[:]NA E]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
RNo
❑ NA ❑ NE
Page 2 of 3
2/4/2014 Continued

Facilit
y Number: - Q Date of Inspection: — 1W
24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes [. No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? tf yes, check ❑ Yes ED 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [KNo ❑ 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:
0 Yes 2 No ❑ NA ❑ NE
Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes MNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes LANo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes allo
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional psees as necessary).
Reviewer/Inspector Name: ,� ��� _ Phone: 30o
Reviewed]rispector Signature: Date:
Page 3 of 3 2/4/2014

Type of Visit: (D -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:/�-7 13 Arrival Time: ; 9 Departure Time: County:
Farm Namerr�1- �tr�-� ru_ Owner Email:
Owner Name: FiA,t P,_5 L L G Phone:
Mailing Address:
Physical Address:
Facility Contact: f�Z.r /li�a��_ Title: _5�4-
Onsite Representative: �j![pp/y �T,`�lt.4y /yLaal`c�
Certified Operator: 4 a; - g r.� /%1600r—
le"_ . Phone:
Integrator: Af c_'"
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
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 [S No ❑ NA ❑ NE
[] Yes
[:]No
❑ NA
Design Current
Design Current
WRIP-5-21
t p.
1111
et PoWtry
tii,nrrent
Capacity P p'"
Cattle Capacity Pop.
Wean to Finish
❑ NE
Layer
Dairy Cow
Wean to Feeder
101f IDDOP
INon-Layer
I
Dairy Calf
Feeder to Finish„
Dairy Heifer
Farrow to Wean
3 f}
Design_ Current:
Dry Cow
Farrow to Feeder
D , P,oult .
Ca acity Po :`-
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
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: ❑ 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 [S No ❑ NA ❑ NE
[] Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
C] Yes
[] No
❑ NA
❑ NE
❑ Yes
ULNo
❑ NA
❑ NE
[:]Yes
Dg -No
❑ NA
❑ NE
Page I of 3 21412011 Continued

.[Facility Number: - kiQ24 Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 55
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
T 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
RLNo
❑ 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
ZI No
❑ NA
ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo ❑ 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):,YtttcJ� PJU er:5rr _ _
13. Soil Type(s): C'1:75
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 2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes CR No ❑ NA ❑ NE
[—]Yes [A No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E ,T o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

ID ;L—
Facility Number: - Date of Inspection: 11-7-1-3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
❑ Yes Ig No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes 2ZNo
❑ Yes La No
❑ Yes E.No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1�;
r�n,,y ✓�s.,f /t-�-tom �13a._/t7,3c�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of visit: Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for visit: Grifoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ®D Departure Time: County: v%- Region: fZV
AV
Farm Name: Cgrrt- fr yz 1 Owner Email:
Owner Name:Jrr- fa//XS Phone:
Mailing Address:
Physical Address:
Facility Contact: 6r2_-rr /o-1y0rr_ Title: ���� S, G� Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: ZR z q pp
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
y 4 p .,. __.,i'ry ':r z.,..li
,ftj�lggl
.
Design Current Des�gnCurrent Design Current
Swine Caaaty _Pop �,, _ Wet Pottltry Capacity Pop. Cattle Gapacity Pop.
Wean to Finish
Layer Dairy Cow
Wean to Feeder p t70 Non -La er I I I Dairy Calf
Feeder to Finish `. Dairy Heifer
Farrow to Wean 7n Design Current I Dry Cow
Farrow to Feeder Dry Poultry Ca aci RDP. Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other
Turkey Poults
Other 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
[—]Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes ❑ No
[:]Yes [)jNo
[:]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: 052E - I Date of Inspection:
❑ Yes
EQ No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[ No
❑ NA
❑ NE
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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: f_ 3
the appropriate box.
Spillway?:
Designed Freeboard (in): _27 27
Observed Freeboard (in): 1-33 !L
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
E� No
❑ NA
❑ NE
waste management or closure pian?
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
E] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® 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 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): a %j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA E] 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
EQ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RA No
❑ NA
E] 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 C1 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis []Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 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 2/4/2011 Continued

Facility Number: ga - a7— Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes MNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
E4 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessity).
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: 1,1;2
Page 3 of 3 2/412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (DRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Time: ; ;j Departure Time: Q County :-�i�r� Region:
Farm Name: ra,r�, �t3rr► Owner Email: '�'—
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
e2—rry-"- Affy'-_ Title: mz _!�a_el_l,
Integrator: (!/`
Certification Number: aqL�D
Onsite Representative: AZ--,er' 1WQr'-c, mug f)pr-,,
Certified Operator: i��i-1�,, L_
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ELNo
❑ Yes Callo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued
Y INV.:. ��6
'� I
� �
A� � ..Design�
Designs Current
Design Current
CapacityPop
Wet Poultry
Capac tv 'iPop -
Cattle- Capacity Pooil
Int
Wean to Finish
La er
Da Cow
Wean to Feeder
�' .t/
Non-La er
Dairy Calf
Feeder to Finish
=r' F:^`
DesignCiiirrent -
�i '11 P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean G
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
�� '_
Turkey Poults
Other
101 10ther
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ELNo
❑ Yes Callo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

Facility Number: - p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E;No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): _ AZ
Observed Freeboard (in): 32 3 Ct 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[gNo
❑ 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?
ER Yes
9fOo—
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes 5a 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 E]Application Outside of Approved Area
12, Crop Type(s): ,d _
13, Soil Type(s): of _
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yesk56LNo ❑ 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 Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ea No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K[ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:'
b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.Ao ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 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 [K No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
r-'9 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
®. No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
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
MI No
❑ NA
❑ NE
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinEs of facility to better exulain situations (use additional naees as necessarv).
a, rix "B�/r ar/'2'4L tbr- I- t+ b,, -k fid'
f�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �fQY,3 �3tDp
Date: Z&Zk
2/4/2011

N
Type of Visit Q<bmpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Q-Kooutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other [:1 Denied Access
Date of Visit: Arrival Time: ! Departure Time: �flO County. Region:
Farm Name:►'s_r�. _�as;•,�..9/, x Owner Email:
Owner Name: _ cBL.ek Ki Jed` �ddryrs_ /% G Phone:
Mailing Address:
Physical Address:
Facility Contact: C9f�--s-r NOvtG_ Title: � Sn�d' Phone No:
Onsite Representative: 7;—" 7 _[ Lr' r' -r• - Integrator: z/,,
Certified Operator: - oo,^r-_ Operator Certification Number: Da
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 =' = Longitude: = o =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
Wean to Feeder M Ko o DO JLJNon-Layer
❑ Feeder to Finish
®,Farrow to Wean % 7
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La vers
❑ Non -Layers
❑ Pullets
❑ Turkeys
DTUTkey 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 r:
Cattle Capacity Papulation z
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
Number. of Structures: ® Jz
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 L9 No ❑ NA ❑ NE
El Yes
❑No
DNA
EINE
El Yes
El No
❑NA
0 N
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[KNo
❑ NA
❑ NE
[--]Yes
O No
[INA
❑NE
Page I of 3 12/28/04 Continued

Facility Number: V:6tLI Date of Inspection
O No
Waste Collection & Treatment
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes ®.No [-INA ❑ 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:
❑ NE
Spillway?:
® No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in): �7_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo [JNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LhNo ❑ 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 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0,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)rrnu��
13. Soil type(s) Gp Z
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
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
[K No
[:INA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #.): Explain any YES answers and/or any recommendations yr any other comments.
Use drawings of facility t© better explain situations. (use additioaai pages as necessary}:
a
1W
Reviewer/Inspector Name `•', . r ��,;;3 Phone:
Reviewer/Inspector Signature: Date: ZZ -- 7=
Page 2 of 3 12/28/04 Continued

Facility Number: — 'D Date of Inspection
1
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z) No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [:1 Maps El Other
21. Does record keeping need improvement`? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9jNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[F1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[S 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 reviewh nspecti on with an on-site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
91No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

8 -TiifS 1Z -2_Z -Z-,:267
Type of Visit,Coom-pliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
l7 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: !7`/7-Dq Arrival Time: /D: DOR,.. Departure Time: ��w County: SQ/K�Soi,! Region: F•CO
Farm Name: arete_N2 e2=21 C1X' Owner Email:
Owner Name: 6lo,c-k giver Faym i LC Phone:
Mailing Address:
Physical Address:
Facility Contact:
G r.ec r- Moo tr-p_.
Onsite Representative: 71 �"'"� Mao re✓
Certified Operator: Moo r ,_jaw,es 0''
Back-up Operator:
Title: 1444 • &<-C- • Phone No:
Integrator: 44- 8 -,julA1
Operator Certification Number: 22-400
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 1 ❑ u Longitude: ❑ o ❑ T ❑ u
Swine
a
Current
Population
w
Swine
Design
Capacity
Current
Population
Design Current
We# Poultry Capacity Population
Design Current
Cattle Capacity Population
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Yes
® Wean to Feeder
104100
400
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish I
3A
❑ NE
I
Dairy Heifer
® Farrow to Wean
34479
347
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
����
LANA
[:INE
2. Is there evidence of a past discharge from any part of the operation?
❑ Non -Dairy
❑ Farrow to Finish
El NA
❑ NE
❑ La ers
❑ Beef Stocker
,B
L�'fNo
❑ NA
❑ NE
on -Layers
❑Beef Feeder
rPGilts
:110 Boars
❑ Pullets
❑ Beef Brood Co
Continued
❑Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: 1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
EI<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
3A
❑ 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)
[I Yes
❑ No
����
LANA
[:INE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ngo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
,B
L�'fNo
❑ NA
❑ NE
other than from a discharge?
12/28104
Continued

L
Facility Number: $2— f/02 Date of Inspection
Waste Collection & 'treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L"J NNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
L No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: _Lag / Lpf 0 Z Ale/ /1"'I lrucr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �S 3tij�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UKo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental) thereat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El 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
B No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �tx oda. ��u�S V�—� 57ww li Gr -1-1J (O,5 .
13. Soil type(s) CAi tJ kc -
14,
a
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
Cl Yes
[ErNo ElNA [:1NE
[ No ❑ NA ❑ NE
L]'No ❑ NA ❑ NE
LJ No ❑ NA ❑ NE
L<o ❑ NA ❑ NE
Reviewer/inspector Name _i CM114 1S Phone: [phone]
Reviewer/Inspector Signature: ,ctelE, _e-� Date: 12—/7-2-06"/
12/28/04 Continued

� L
Facility Number: 82 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP [__1 Checklists [3 Design ❑Maps El Other
❑ YesNo ❑ NA ❑ NE
❑ Yes B<o ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑ Weather Code
L310
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
[:INA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6 -No--
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
BNo
❑ NA
❑ NE
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L310
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D No
❑ NA
❑ NE
12!28/04

t
V/ rA.45 /— o 8 - 0,7 - 2�–
Type of Visit (D7'—Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit erlioutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: JZ-!b'O g Arrival Time: 2 ; Departure Time: ;/D County: Se r.f Region:
Farm Name: „ Cv«,, Fay .�-� _ Owner Email:
Owner Name: siar=g P_iy .v- h°'Y'•--S LL Phone:
Mailing Address:
Physical Address:
Facility Contact: ar-"-tr Moore— Title: � t-�^ SDee Phone No:
Onsite Representative: G f -a, -r I���y� Integrator: At
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=o ❑, = Longitude: =° =, ❑ u
~ Design @urrent rDNOign Current Design Current
Swine Capacity Population Wet�Poul�try� paw cit S d ulat,onW. �Catt�e s Capacity Population
❑ Wean to Finish ❑ La er 1 17., ❑ Dairy Cow
® Wean to Feeder L' � ❑Non Layer
❑ Dairy Calf
❑Feeder to Finish ❑Dai Heifer
Farrow to Wean x t ❑ D Cow
DryrPou.ltry'
El Farrow to Feeder " i"
El Layers Non -Dairy
El Farrow to finish ❑ Beef Stocker
❑ Gilts ❑ Non -Layers 1.
� ❑Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Co
L ❑ Turkeys
❑Turkey Poults 4
r
❑
r
Othe. Other Num. er:ofa5tructures: Z
:. f a� M
Discharges & Stream Impacts
�,�/�
1. Is any discharge observed from any part of the operation?
El Yes
L7 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
��
ETNA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
L?1CA
❑ 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
EKA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12/28/04
Continued

(Facility Number: jr? -4/6Z I Date of Inspection
ETNNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2$10
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[Ko
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: CZ S —L_ G S` Z_ G -furs l
maintenance/improvement?
Spillway?: /1i 0 /j 0 Jd6
ffNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Designed Freeboard (in):
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cropr Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
�} i
Observed Freeboard (in):
12. Crop type(s) 1► -r , c,�d c� G rc e_ 5:�••� l� �ta i nr S �D . S ,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�/
L7 No
❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
ffNo
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[ "No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
ETNNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes
IJ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes
B<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E3<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ffNo
❑ 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 Cropr Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1► -r , c,�d c� G rc e_ 5:�••� l� �ta i nr S �D . S ,
13. Soil type(s) a 9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ffNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [3No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes Q�No ❑ NA ❑ NE
Reviewer/Ins ectorName t�' `{ `6 ":�� �" /D 33,3330
P ,� Qt:J S_. >� i� e. Phone: S ��
Reviewer/Inspector Signature: Date: %Z -1;g� -zoo
Page 2 of 3 12128104 Continued

j
Facility Number: g2 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Er'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps [I Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. [_1 Yes ET No [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:1 NA
[__1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�ETio
LJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑'t<'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ET_No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-Ro
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9-1q'o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ -Ko
❑ 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
El 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
O 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?
El Yes
��--�
LJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E7 No
❑ NA
❑ NE
Comments and/or
12/28/04

R_Tt .5 V,J of/ost/zone
8 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: f 2 -IZ -07 Arrival 'Time: /z : �a Departure Time: Q% /D County: �d SQiIL_ Region:
Farm Name: C7, tr`ciA.t C__ Eay v x- _ Owner Email:
Owner Name: _CLC_ !Zi V e tr ra►-was LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: G+S-C_r-*- hkucr-,-L l Title: S?e Phone No:
Onsite Representative: G4`c�c�r_ MCOV c - / Integrator: i uv $r al,,J1v
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of farm: Latitude: ----] o E::]' = « Longitude: =0=4 =
gg
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
0400 I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
-11 Number of Structures: Z
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 frorn 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 M No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
[:]Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 402 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier: (rs
AL
Spillway?:
Reviewer/Inspector Namekltck4l2eV e S Phone: cj/0. e133 , 330 0
_
Reviewer/inspector Signature: Date: J Z— VZ, -2 Q6 7
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
q 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
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
M No
[:INA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Arca
12. Crop type(s) 13�►rw���a ipct5�►-�� 5,�.�1� Gr ti �r �O v ers<-cad
13. Soil type(s) CCt
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EA No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2f No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[A No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
PI No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
m No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
W
Reviewer/Inspector Namekltck4l2eV e S Phone: cj/0. e133 , 330 0
_
Reviewer/inspector Signature: Date: J Z— VZ, -2 Q6 7
12/28/04 Continued

Facility Number: $2 — p Date of Inspection i2'I z- 07
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes O No [INA ❑ NE
the appropirate box. ❑ WIJp ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(8 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U1 No
❑ NA
❑ NE
Otherissues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division ai' Water Quality
Facility Number $Z �[p Zion at Soil snd Water Conservation
1§011DliM
er Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit. Arrival Time: ��0 Departure Time: ��s County: sa%KnSa•u Region:
Farm Name: _ r`eCje - t -ars..,.,.. � Owner Email:
Owner Name: r1 Mooirr rf!14 Z-LCPhone:
Mailing Address:
Physical Address:
Facility Contact: MAa&r-Z Title: Phone No::�
Onsite Representative: Gr{ �Y lReorc- r --f M AdAW c_ Integrator: /,6rA1Ji✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=A
=At Longitude: = ° = A =
11
Design Current
Swine C►apacity Population
Wet Poultry
Design Current
Capacity Popud lat�ion
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
I
I I
❑ Dairy Cow
❑ Wean to Feeder
IEJ Non -Layer
❑ Yes
❑ Dai Calf
❑ Feeder to Finish
EINE
�*1
❑ Dai Heifer
Farrow to Wean Z& 2
Dry Poultry
��;
❑ D Cow
❑ Farrow to Feeder
❑ La ers
`,r .,``,
❑ Non -Dairy
❑ Farrow to Finish
❑ Yes
�zNo
❑ Beef Stocker
El Gilts
❑Non -La
❑ Yes
El Beef Feeder
❑ Boars
Pullets
El Pullets
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Brood Cow
PNo
❑ Turkeys
❑ NE
w
Other"
❑ Other J110
❑Turkey Points
Other
I
Humber ofStructures:
Page I of 3
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[%No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
V9No
❑ NA
EINE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
[PNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
�zNo
❑ NA
E]NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: KZ — L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PU No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2,
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
KT
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o No ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [)I 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 19 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rL �kw i C --- �i <// t�9 Y�ii✓ (/p. S, J
13. Soil type(s) CAP,
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 VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [N No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ Yes (ZNo
[:1 NA ❑NE
El NA El NE
Comments (refer to question #): Explain any YES answers.andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name ~ ` _ - - - i Phone: 3-330
Reviewer/Inspector Signature: �,e-.p�L� Date:
Page 2 of 3 — 12/28/04 Continued

Facility Number: $Z — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes OfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EYNo ❑ NA ❑ NE
the appropriate box.
❑ WUP [j Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P0 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
PM No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 N
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
pNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P�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
ONo
❑ 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
PvNo
❑ 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
PYNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
QgNo
❑ NA
❑ NE
Additional,'Comments and/or Drawings:.
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

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: Arrival Time: g. Departure Time: ,o ,w County: .5&ts=AS v-.
Farm Name:rev+-ttiaYti.. Owner Email:
Owner Name: 1614cltU P ✓_'_��tri../ s 4 4 e Phone: qr cJ - 3 3 Z - fi 2-17-
Mailing Address: t2 o l R r r` e l �S Al e a
Physical Address: -
Facility Contact: (11t,046- A 02 L ir,Title: Phone No:
Onsite Representative: i c ev_ - �lNNi��e or e- ��i %w lvl n p `- c _ Integrator: �
Certified Operator: Operator Certification dumber: a 3 4- c d
Region: + /fit)
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 9&uc 2 3 p k.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Sack -up Certification Number:
Latitude: [ o [=]' ❑ Longitude: ❑ ° [�' = "
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cove
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[2�No
[_1 NA
ElNE
El Yes
L�No
❑ NA
❑ NE
12128/04 Continued

Facility Number: gZ —4,4 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i 'Z -
Spillway?:
Designed Freeboard (in): 0 _ 2 r
Observed Freeboard (in): Q-17 .32
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure pian?
❑ Yes E9,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes [9/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [D'No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
G�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
gNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No
❑ 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) _Re r to u o(a ,. Sk_ �� R r ..w C(_7' rQ z -.41
13.
Soil type(s) d'tR_
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
[TNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
I.J' No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
LTJ No
❑ NA ❑ NE
Comments (refer to question #); Explain any.YES answers and/or any -recommendations or any other comments.
.Use drawings of fa to better explain situations. (Use additional ece
pages as nssary):
Reviewer/Inspector Name %,�y; Lj' 4-i Phone: fi u - 4/ - /,i'V
Reviewer/Inspector Signature: Date: '�-A d J
12/28/04 Continued

J i
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LSNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other ,,��,,``__
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LSNo ❑ NA ❑ NE
❑ Waste Application ❑ Week+y+ board ❑ W, is ❑ Sys ❑ Waste Transfers ❑ Apnnal C'ertificlu PC
atiesn
❑ Fi4 ❑ SW&ittg ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" stain Inspections ❑ Edi;
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
Ev NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EjVNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eg-No
[__1NA
[_1NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:3Yes
[9 Vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Eg1Vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of deadanimals within 24 hours and/or document
[] Yes
EKNo
❑ 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
[gNo
❑ 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
[2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
D No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
Q/No
❑ NA
❑ NE
AdditionalComments Dr'awin&-_, ,
1agd/o'
A
.2 /kv� 3wi ( ��la+�Tc�f.GS:'•, [ CLldW eler s 10— 110PIVD 1WJ C,,Y/,-,61- t e
Dy U,GC aoor, cl
12/28/04

jType of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation "
Reason for Visit O Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: `t�i� Time: : 3 O o ie ! 5 y 5-p'"
p'"
O Not Operational O Below Threshold
Permitted ['Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: .. 6a�f___&lea..-•................................M .. _ ._ ____ .. County:
' F LLC Phone No: 9 d- s3 y7aq
Owner Name: 11AC1%_.....!� ��t[1......!5'e� .__.�.._ . _� .� .......... .......� - -. . ...... ......... ...... ------.... .._.
wiling Address:-•�p;-d; .-Q�?X-( H rre _ IV L .7 y�!
Facilitv Contact: ...t"Cr.........rr............ ---- Title:.._ .. __.._. - ..... Phone No:
Onsite Representative:..G�te`C_. Q�trL .,�7:�++ _ ff��----� W... Integrator: --- y1 1 tQk✓t�-----�--- „ „._
Certified Operator: _ ..... T�4t �; 5............ .Q.lt f . ... .................. ............ ---- Operator Certification Number: ...........
Location of Farm: - �&,t weft
[Swine 0 Poultry ❑ Cattle ❑ Horse Latitude �• �4 46 Longitude • 6 44
. "Design Curr
Swine
Wean to Feeder
Feeder to Finish
arrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Ciirr+�t: `
ultry_ C aci Po W[ation.
Layer
Other
Total Design
Tota
Capacity
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [Tgo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0-11o'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes [
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 [}�Ko—
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E3 -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes GM
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [3No
Structure; I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier- I ?
Freeboard (inches): -a(,
12112103 Continued

I
Facility Number: q,2 —4,0.2
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 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?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AURlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes EKC—,
❑ Yes 12'Ko-
❑ Yes [ iO
❑ Yes Q-NQo
❑ Yes �
❑ Yes E o_ ­
11.
_
I1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes E4 -Ko'
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type erm v
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes El -Wo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes O.PK
❑ Yes 9 -No
❑ Yes ❑ Xo
❑ Yes 91�o
❑ Yes UNO
❑ Yes ❑ No
❑ Yes ETIG
❑ Yes BNo
❑ Yes [moo
;Counts refer to 'toil: Ex iaw an - _
{ _ Vx ip y YFS artLswe�s andJor ar�y�ecummendatrons ory ot}ieroomietents. µ
_ _ _
Use drawings o! fniiity to better expla>n sttaat<oas. {use addtt,oaal pages as necessary) x . [Meld Copy ❑ Final Notes
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ReviewerAkspector Name-
_I/IGr
Reviewer/Inspector Signature: Zn4/3 Date:
-?
12112103 Continued

Facility Number: a -hoz Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/, chess, j,sigtt,_wap!r,—etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑li ❑�- ❑ tt is ❑Soil Sampling
-0,79, 0- V7 y- o.q-�', 0. 7 f- G ? I , I , P'. St1
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes GINK—
❑ Yes Q Niu
❑ Yes ❑ No
❑ Yes [9#u
❑ Yes 9 -Ko
[:]Yes [}#o
❑ Yes [moo
❑ Yes LKo
❑ Yes 91q-6--
es ❑ No
❑ Yes ❑ No
❑ Yes [. WK
❑ Yes goo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ Ncr —
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 1steeldng-Fejt ❑ Crap Yield Form ❑-Reinf H ❑
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
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12112103