820404_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

II .i � 0E7
0
Type of Visit: &Uom ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �;�,�
Arrival Time:
U]�M
Departure Time: County: PS Iv
Farm Name:
jzo ya
/
Owner Email:
Owner Name:
0. �-e�
9 f
Phone:
_
Mailing Address:
Physical Address:
Facility Contact: QI, J I C 9 mac„ te6, Title:
I(
Onsite Representative: Integrator: M S `.S
Certification Number: ' 17q & t
Phone:
Certified Operator: �J—e h Ate[
Back-up Operator:
Region: p2o
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
❑ Yes [J' ❑ NA ❑ NE
❑ Yes
DMin- urrent
U]�M
Design
Current
Design Current
�Swme; '.
6,0
k C pacify Pop.
Wet PoultrUSacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
—vo
D . P,oultr
Design
Ca aci
Current
P.o P.
Dai Heifer
Cow
Non -Dairy
_7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Turkeys
,Others a �" rTMt
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)?
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?
❑ Yes [J' ❑ NA ❑ NE
❑ Yes
❑ No
U]�M
❑ NE
❑ Yes
❑ No
01 -GA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No EE' A ❑ NE
❑ Yes ❑,N -o NA [DNE
E] Yes o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

LFaci@ty Number: 6 Date of Inspection:
. c
❑-hZ__ ❑ NA
❑ NE
WasteCollection& Treatment
❑ Yes
[Q-1155-0 NA
❑ NE
4.. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
E] Yes
�,��
L_ i'�O L� NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [+]'11.A- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
E] Yes
[Ej"No ❑ NA
Spillway?:
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesNNo
❑ NA
Designed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j'No ❑ NA
Observed Freeboard (in): 7i-7
the appropriate box.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� o [:] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
fJ lqo ❑ 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
Qom❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ET 1�❑ 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
[]I_Na---D NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!'71To­❑ 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): C 13 14 S16- 0
13. Soil Type(s): IV p r1t.4"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑-hZ__ ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Q-1155-0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ -Va—D NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ YesNom
❑ NA
E] NE
18. Is there a lack of properly operating waste application equipment?
E] Yes
[Ej"No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesNNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j'No ❑ NA
D NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Wo ❑ NA [] NE
Page 2 of 3 2/4/2015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9-?Co-�❑ NA ❑ NE
"n. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I__I z ❑ NA ❑ NE
the appropriate box(es) below.
0 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
Q"iVo ❑ 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 property dispose of dead animals with 24 hours and/or document
❑ Yes
�• o NA
❑ NE
and report mortality rates that were higher than normal?
❑ Yes
0-<o ❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3 -go— ❑ 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
QH<o ❑ 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
E34<� ❑ 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 Reviewerllnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0-<o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ld"wu ❑ NA
❑ NE
Reviewer/Inspector Signatur
Page 3 of 3
2/4/2015

i`vision of Water Resources
Facility Number ®- �(� OO Division of Soil and Water Conservation
®Other Agcy
Type of Visit:7Routine
liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ P1 Arrival Time: Departure Time: 4' County:
Farm Name:_,T,0 W ray Owner Email
Owner Name: a Phone:
Mailing Address:
Physical Address:
Facility Contact: r f�(S (�-, ,,4 C ° Title:
Onsite Representative: _ (r
Certified Operator: �j (�L� G ' �� �G
Back-up Operator:
Phone�
Integrator: t7--,5,
Region:
Certification Number: r 7 l o f
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
❑No
[J I�A
❑ NE
❑ Yes
❑ No
ONA
❑ NE
DesignCurrent
Design
Current
Desi n Current
g
Capacity °Pop.
"WetP,oultry
Capacity
Pop:
Cattle Capacio
Finish
rl,ee
La er
Dai Caw
o Feeder
Non -La er
Dai Calf
to Finish
p,p
=
:-
Dai Heifer
Farrow to Wean
Designs
Current
D Cow
Farrow to Feeder
D �P`ouIt "'
Ca aci
P_ -o .
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Other
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
❑No
[J I�A
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes ❑ No SIA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Ye`s No ❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: j,- t Date of Ins ection: ,S
❑ Yes
[]Go
❑ NA
Waste Collection & Treatment
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[T No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
O -N A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[] No
Identifier:
❑ NE
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3o-
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
®.ado'
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑i 'leo
❑ 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
❑'o
❑ 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 ONNo ❑ 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 Typc(s): j�� ! ft,(,6 SG C) 14 f-&,-
13, Soil Type(s): )v ftC'r,"'dy rj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Docs the receiving crop and/or land application site need improvement? ❑ Yes [o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3,4 [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]Go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[T No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑1�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
1:1 Yes ❑-ado
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - J Date of Inspection:716y- 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3'�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ F=ailure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewerllnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CJ'N'o
❑ NA
❑ NE
❑Yes
[�]No
C] NA
C] NE
❑ Yes [B No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes D<O ❑ NA ❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
[dNo
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
[:]Yes
fNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
C}ed qcG_
Phone: yiq—" ,3
Date: 5LS0(4171-7
21412 15

k s L LL.JVM
Type of Visit: ®'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access �
Date of Visit: Arrival
'Time: Departure Time: County: Region: �1
Farm Name: a4 +�1 �[. ( Owner Email:
Owner Name: J g 0, Phone:
Mailing Address:
Physical Address:
Facility Contact: Cx1 ����'t(j�i��� Title:
Onsite Representative:
Certified Operator: 'TJ G r:.�Td
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: go
Certification Number:
Certification Number:
Longitude:
1770
Discharges and Stream Impacts
Design Current
- - Design pCurrent y
Design Current
Swine
Capacity Pop.
_y
Wet PoultryCapacity 'Popes
Cattle Capacity Pop.
Wean to Finish
❑ NE
Layer _
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish`
❑ No
�` �- -
Dai Heifer
Farrow to Wean
❑ Yes
Design Carrent
Cow
Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
-
D ;P,oult . Ca aci Poi'
Non Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
NA
-Layers
Beef Feeder
Boars
E35o
❑ NA
—.Non
Pullets
Beef Brood Cow
,s
Turkeys
❑ NA
Other
I.R.Turkey
Poults
Other
Iffi
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[n No
0 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ffNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
E35o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ffNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

FaciliNumber: - Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a_Nw— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[LK�o
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U2/No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
[jXNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0"No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
VNo
[] NA
❑ NE
waste management or closure plan?
the appropriate box.
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
[j3'�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ZNo
❑ 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
(: j o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
1 I _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 Drifftt� , ❑ Application Outside of Approved Area
12. Crop Type(s): bew,� ff c, o �
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[LK�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U2/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[jXNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[B/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
La'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes VNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall E] 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 dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: jDatc of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.Tdo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [;�K% [DNA ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []'l _o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []Ko ❑ 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?
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 [v]"No ❑ NA ❑ NE
❑ Yes [�(No ❑ NA ❑ NE
❑ Yes [;�<o ❑ NA ❑ NE
❑ Yes [?"�o
❑ Yes [rNo
[:]Yes [ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional panes as necessary).
t�ty 9-0(7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 3— ' 3 3
Date:
2/4/2011

Type of Visit: �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: g>goutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: F35 Departure Time: ,� County:lS Region:
Farm Name: r,4L+1 .c Owner Email:
Owner Name: -s-i Phone:
Mailing Address:
Physical Address:
Facility Contact: �k v t t &.11W to Title:
tt
Onsite Representative:
Phone:
Integrator: M
Certified Operator: � r
��� .� Certification Number: 17f F B r
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharms and Stream Impacts ���
1. Is any discharge observed from any part of the operation? ❑ Yes Og-i"o ] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No E]"NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No [3<A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 No
[:]Yes dNo
dNA
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Desrgn
Ca aci
P ,h
) fjob
Current -- __
Po WetPoul
P ..t= �3
Layer
Non -La er
5 - '"*`" ..
D ,Poul
Design
Ca aci
::.P h
I
Design
PAPM
Current :
Po P
lop
Design Current
Cattle Ca aci Po
P ty P -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
<'
Pullets
Beef Brood Cow
Turkeys
Turke I'oults
Other '�
Other
Discharms and Stream Impacts ���
1. Is any discharge observed from any part of the operation? ❑ Yes Og-i"o ] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No E]"NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No [3<A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 No
[:]Yes dNo
dNA
❑ NE
❑ NA
❑ NE
(DNA
❑ NE
Page I of 3 21412011 Continued

facili Number: - Lfoq jDate of Inspection:
❑ Yes
11*1
n No
❑ NA
Waste Collection & Treatment
❑ Yes G/ No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5 -No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No D-1 A-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
[:]Yes No
❑ NA
❑ NE
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
Designed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in):�
❑ NA
❑ NE
[DNA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
64< ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E] -No— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ej'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
eb ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a_bie- ❑ 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): A -Csr AA -14 9" �V /6 ✓Bt' Z_f1
13_ Soil Type(s):
ft4v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
11*1
n No
❑ NA
❑ NE
❑ Yes G/ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Oj'�o
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�<o
❑ NA
❑ NE
acres determination?
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ZNa
❑ NA
❑ NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes G/ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Oj'�o
❑ NA
ONE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
[DNA
❑ NE
Page 2 of 3 2/4/2011 Continued

Eacili Number: 0 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (D -N5' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ff No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F41No ❑ 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:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [B"<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes OX6 ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNP? ❑ Yes 2<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes ;.No
<o ❑ NA F] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 333
Date: f t f
2/4/2014

I
Type of Visit: q>7outine
ante Inspection V Operation Review t,,,) Structure Lvaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ounty:
Farm Name: Roj, wl ('f, Owner Email:
Owner Name: L j LO C,/ Ge� Phone:
Mailing Address:
Physical Address:
Region
Facility Contact: 7—' (u4 Title: Phone:
Onsite Representative: Integrator: rl
Certified Operator: W V R.�Lxj I- i Certification Number: 17 t r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
SwineWD"
inish
sign ,Current �
apatty Pop.
Wet Poultry
La er
Design ,o Current
Capactri Pop
Design Current
Cattle Capacity Pop.
Da Cow
eeder
[DNA
Non -La er
❑ Yes
No
Da Calf
Finish
d" V
--
:. _
Da Heifer
Wean
rFarrow
kT
Desig4 �Cgrrent'
D Cow
Feeder
D , P,oWt ,
Ca aci P,,o .
Non -Dairy
Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke 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 pari of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NA ❑ NE
❑ Yes ❑ No g•NA ❑ NE
❑ Yes [] No [J -IgA ❑ NE
❑ Yes
0 No
[3<A
❑ NE
[:]Yes
["No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Faci i • Number: Date of Inspection:
!I -
" Waste Collection & Treatment rn�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes lo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EjNA- ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3<o
❑ NA
Designed Freeboard (in):
acres determination?
[]Other:
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-1�o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E4No-
❑ NA
❑ NE
waste management or closure plan?
❑ 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
Lg-l"o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a -I1
❑ 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
[a No._
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [ " ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5(2-0
13. Soil Type(s): /U a/\- 7T o ' a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�s 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
E3<o
❑ NA
❑ NE
acres determination?
[]Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-1�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�1 o
❑ 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
[3 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [—]Maps ❑Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E!rNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'[:]
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. 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?
Lilo ❑ NA ❑ NE
❑did'❑ NA ❑ NE
❑ Yes
EZj X'6
[:INA
❑ NE
[:]Yes
C.3t}o
❑ NA
❑ NE
❑ Yes
�
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes C3-< ❑ NA ❑ NE
[:]Yes [T No ❑ NA ❑ NE
❑ Yes Z6�" "'
❑ Yes 10
❑ Yes 12_<0
[:INA ❑ NE
❑ NA ❑ NE
❑ 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). _
1
Reviewer/Inspector Name:
N
Reviewer/Inspector Signature:
Page 3 of 3
Date: ,
l A41c: I �
2/4/2011

Type of Visit: CCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: 5 Arrival Time: �_ Departure Time: OI County: Region:lw
Farm Name: �y Owner Email:
Owner Name: ����" Rt,L, nL Phone:
Mailing Address:
Physical Address:
Facility Contact: U 0.t2S ._ 1 J (4Q4?IC Title:
Onsite Representative: IVNE
Certified Operator: oL
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: _URI1}1�IpCelN
Certification Number: j 190 )
Certification Number:
Longitude:
I} g
esi n Current
Desi n
g
C urrenf`
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish p `
Dairy Heifer
ow to Wean
Design
Current
D Cow
ow to Feeder
D ,Poult ,
Ca aei
Po
Non -Dairy
to Finish
La ers
Beef Stocker
s
Non -La ers
Beef Feeder
!Farrow
rs
Pullets
Beef Brood Cow
Turke s
er
Turke Poults
er I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ES1 o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No � A ❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ) ❑ Yes ❑ No [114A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eg"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EdNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r �
Facili Number: - LAO jDate of Inspection: 5 a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No G2,KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
CS?$Vo
Identifier:
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
[PNo
❑ NA
Designed Freeboard (in):�
the appropriate box.
Observed Freeboard (in): LO
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Er&o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
21. Does record keeping need improvement? If yes, check the appropriate box below.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes [9,fVo ❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
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 FQ &o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [1. No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[�lo
❑ NA
9. Does any part of the waste management system other than the waste structures require
[] Yes ®'EVo ❑ NA
❑ NE
maintenance or improvement?
C1A
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [ErNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [g"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): }cgrm [�' Q,�( lj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9-14o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ llgo ❑ 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 �o ❑ NA ❑ NE
❑ Yes [2% ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CS?$Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[PNo
❑ 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
[D"No
D NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[�lo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
C1A
❑ NE
Page 2 of 3 214/2011 Continued

• 4
Facility Number: -L40 Date of Inspection: I f
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes E!rNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [-]Yes eg�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
M4 ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[O"No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
j[a'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
E2'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
[244o
❑ 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
[20No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 -3G& -t.951
Date:
2/4/2011

3(nw5 — '7//Y///
Type of Visit: (Com ante Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:Owner mail:
Owner Name: �C
Mailing Address:
Physical Address:
Phone:
Facility Contact: 0--klt`l -S Title: `EC ('�- _ Phone:
Onsite Representative: �G Integrator: M—Z._
Certified Operator: _ I C4-, Certification Number: 179,01
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
gDesi n Current
� Desi n Current'- A Design
Swine CapacrtyPop. WetaPdulfry CapaciC*attle Capacity Pop.
Wean to Finish La er y Dai CoJeri
Wean to Feeder
on -Layer Dai Cal
Feeder to Finish Dai Hei
Farrow to Wean_ Design" Current''=' Cow
Farrow to Feeder ,'Dryt Poal Ca ci 'I?o fir, Non -Dairy
Farrow to Finish Layers Beef Stoc
Gilts " Non -Layers Beef Feed
Boars Pullets Beef Bro
Turkeys -
Other, Turkey Poults
Other ISF,6ther
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
❑ Yes
is
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:)No
ETNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
[a A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑No
B<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
g3<o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[❑
NA
❑ NE
of the State other than from a discharge`?
Page I of 3 2/4/2011 Continued

Facility plumber: jDate 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: -A
Spillway?:
Designed Freeboard (in): le
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
Structure,5
2<0 ❑ NA ❑ NE
❑ No E]"NA ❑ NE
Structure 6
❑ Yes Ljj4o' ❑ NA ❑ NE
6. Are there structures on-site which are not property addressed and/or managed through a ❑ Yes 02�<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 64o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [LKo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LQ -<o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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?
Lj Yes
LLno
❑ Yes
[DN''"
❑ Yes
Ild'"'o
❑ Yes Ea'<o
❑ Yes 10
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes BIo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [R<o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2"N' o
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[jg, A ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Dumber: - Date of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�'<o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
txd' o
❑ 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
EJ!No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
Other Issues
28. -Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[13 o
❑ 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
Q,Mr
❑ 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
[R<o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
D<o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L0,Ko' ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes © c ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 6,KO'D 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). 7
N1114-lovk- '�S- U, ezn7�,,4
Reviewer/Inspector Name:
Page 3 of 3
Phone: 1'v lJ
Date: 7/6
4/2011

tBJWS 2 -0el-2010
Division of Water Quality
Faciiit_y N_umMer SZ � �f p l Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ergoutme 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:-O/J-0
�/O Arrival Time: �/:3 SAy.. Departure Time: �Z %SS County:
Farm Name: . i onJa-Owner Email:
Owner Name: Z -a 'M Ro r1 G. _ Phone:
Mailing Address:
Region: -IfIZO
Physical Address:
Facility Contact: Cky+t�.s "���"t'� Title: ` ' sP'e_ - '_ _ Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ED o =1 I = u Longitude: = ° =1 l = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E'No ❑ NA EINE
❑ Yes ❑ No L?►vA EINE
❑ Yes
❑ No [9 -KA EINE
❑ No 31NA [:INE
❑ Yes
Design CarrentENon-Layer
Desiga Current
Design Current
No ❑ NA ❑ NE
Swine Capacity Populationultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑Dai Caw
❑ Dairy Calf
❑ Wean to Feeder
ELaEer
1
eeder to Finish 000
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Numof 5truetures: /�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E'No ❑ NA EINE
❑ Yes ❑ No L?►vA EINE
❑ Yes
❑ No [9 -KA EINE
❑ No 31NA [:INE
❑ Yes
Yes
ElEg
No ❑ NA ❑ NE
❑ Yes
No ❑ NA ❑ NE
12/28/04 Continued

Facility Number:
SZ
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:
Spillway?:
Designed Freeboard (in):
r/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ��L7NNo
El Yes L7 No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes LI No ❑ NA ❑ NE
❑ Yes L1 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B tvo ❑ 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 ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 2<o ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
EINo ❑ NA
❑ NE
qV
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date: Z — O/ — _20/0
❑ 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.
�j // r
Crop type(s) �se_u"_ i

i
Facility Number: 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 El Checklists El Design El Maps ❑Other
❑ Yes
NNo
El NA
El NE
❑ Yes
,E
B No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L7No
❑ NA
❑ NE
[I Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
�❑
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
lT No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 -go
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
301�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EK
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[E Ngo
[:INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
B o
❑ 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
L11vo
❑ 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
[:1L�],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
B-55-
❑ NA
❑ NE
Additeonal CommeIts- andlo'r Drawings ! �"W '
1z
12/28/04

i3_L�4S /0 -OS 0 4
G-6 vision of Water Quality
Facility Number 84- O Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(?`I�outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other Cl Denied Access
Date of Visit: Arrival Time: /0:30 Departure Time: /1.�26q,., County: '``f�"� Region:
Farm Name: :TdI iSI�'-rG� � � q Owner Email:
Owner Name: 7Z364 nj Ro Y C, r Phone:
Mailing Address:
tzrI70
Physical Address:
Facilitv Contact: �L[✓Ti ii. w, kl Title: %P 1, S1 -C Phone No:
Onsite Representative: C-crr fn's Integrator: lac, L►� i ���2 ''�" s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=o = =,d Longitude: =0=6 [= ,d
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Weeder to Finish I /000 1105-0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Lavers
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Design `Current' r
Capacity Population.:.]
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 No ❑ NA ❑ NE
❑ Yes
❑ No
[3<A
❑ NE
❑ Yes
❑ No
0-5A
❑ NE
E NA
❑ NE
❑ Yes
❑ No
❑ Yes
EhZo
❑ NA
❑ NE
❑ Yes
Digo
❑ NA
❑ NE
12128/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0' Flo ❑ 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 El Yes D o ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes E o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑'N'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/lWindow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &C—etiret dw g t=Ps•cu C. 6;L17 �F.,aCE'J.
13. Soil type(s) �p met C
r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
E o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Facility Number: igz -`' Date of Inspection
El NA
1:1 NE
17. Does the facility lack adequate acreage for land application'? El Yes
El -No
Waste Collection & Treatment
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
,L--slNNo
l_ <a
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
,�,�
Lr No
❑ NA
❑ NE
a. If yes, is waste levet into the structural freeboard?
❑ Yes
ETNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3*-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,�,�
l_7 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
�o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0' Flo ❑ 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 El Yes D o ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes E o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑'N'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/lWindow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &C—etiret dw g t=Ps•cu C. 6;L17 �F.,aCE'J.
13. Soil type(s) �p met C
r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
E o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
1:1 NE
17. Does the facility lack adequate acreage for land application'? El Yes
El -No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
,L--slNNo
l_ <a
❑ NA
❑ NE
a
Reviewer/Inspector Name • Phone:
,'4,G �� .
Reviewer/Inspector Signature: z Date: %-1,6 0 y
Page 2 of 3 12/28104 Continued

Facility Number: 62 — WV Date of Inspection
Required Records & Documents ,--�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [__1B Yes <o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'leo ❑ 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
E lKo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B'go
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ko
❑ NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,[_
L7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[-io
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
``
B o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®-<o'
❑ 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?
❑ YesNo
❑ 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
Ell� Yes
r
4o
❑ 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
D o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
A"�d`dit oo aI�C �me�tartd/or Drawings:
rt
12/28104

11
81045
y -DS -fig
leo
Type of Visit aTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I &Q-/ 9' Arrival Time: % : 4e i.. Departure Time: /: SyS" County: s�`-_ Region; F2�
Farm Name: D LOL IJ Owner Email:
Owner Name: J oltN k> Gt Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu'' S �`j�'`"1j C- K- Title: Tum • Sn� Phone No:
Onsite Representative: CU rel S Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [::] 0 =' =] Longitude: = ° =' = "
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes B<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
_
DesignCurrent' ". w
Design Current ur
W Design Crent
Swine
Capacity Population WetPh�_`
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish/
S
�Oe30 D 7 -
- � � - .' El Dairy Heifer
"
❑ Farrow to Wean
x
DryEPoultry�=
❑ Ury Cow
�°j�;
❑ Farrow to Feeder
,
❑ Non -Dairy
ElLa❑
Farrow to Finish
Layers
�
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
A �..
[] Turke s
;,.
Other
❑ 'Turke Poalts
other than from a discharge'?
❑Other
_
❑ Other
iVumber of Structures:
Page 1 of 3
12/28/04
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes B<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
21 A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
B<A
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
Bl o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D o
[:INA
❑ NF
other than from a discharge'?
Page 1 of 3
12/28/04
Continued

r
Facility Number: 72 - Wp t I Date of Inspection
❑ Yes
B Ngo
El NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
El Yes
L-iN��o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LfNo
❑ 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:
BINZ
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _T"
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EKo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
[71 Yes
,-,�
D 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?
ElYes
L` /No
El NA C1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
-"f
252-
❑ 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
El Yes
��
EK
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L"_fNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
D -K
❑ 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)(� tarw� 6 �w s l� Grp; tir �D. S, FeScq <_
13. Soil type(s) Alo A , A -c-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B Ngo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
L-iN��o
El NA
F1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2<o
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
BINZ
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name R P e -v [ S Phone: 9/0,'I3,3, 3330
Reviewer/Inspector Signature: er w�, Date: 8 ` % 9 - Zo .08—
S
12128/04 Continued

facility Number: g2, —W$oil Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �[3No El NA [:1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes L7 No ❑ NA ❑ NE
the appropirate box. ❑ Wu, ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V 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?
[I Yes
,21No
L�fNo
[:1NA
E:1NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
[:1 NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,B<o
L� 'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[jNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
��,,�
El<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D o
❑ 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
2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,�
L� 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
BN o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
13 o
❑ NA
❑ NE
Page 3 of 3 12/28/04

r
® Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
I
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up O IReferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ID— 03 - D Arrival Time: Departure Time: County: YSc ' tK S V Region: `"
Farm Name: Owner Email -
Owner Name: �30tlws ]Z0,21 "I Phone:
Mailing Address:
Physical Address:
Facility Contact: CUr'k-t STitle: ANI/, Y . Phone No:
Onsite Representative: Cuk s Ba V- Lj c K Integrator: Co "Ve iGa't'tiLS
Certified Operator:
Back-up Operator:
Operator Certification Number:
❑
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =' ❑,t Longitude: ❑ ° =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 000 lOQ7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ other
Layer
❑ 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 CurrentFa:
Cattle Capacity P.,optilation
❑
Dairy Cow
❑
Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [A No ❑ NA EINE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[;4 No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

i
Facility Number:
Waste Collection & Treatment
Date of Inspection Jb-63 -o7
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32-
5.
Z5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 50 No ❑ NA ❑ NE
(ic/ 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 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 Ey No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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) r irw�u i f (a'rsra c _ 5 G!{ e- ea '&3 C_ S�rr4 U G✓aiF/ COS
13. Soil type(s) /lila &A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes INo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�3No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
[2 No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ke-kt j .kms{/ Phone: [phone]
Reviewer/Inspector Signature: R z� _ Date: /D -103 -zed 7
11/18104 Continued

1W- h.
Facility Number: EZ — fL Date of Inspection 1a-03-07
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes m No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps [:1 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes y No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[x] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [A No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
® No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
12 No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit ® Compliance Inspection (_) Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 2.SS Departure'rime- County: Region:.IF�'
Farm Name: _ =9 �-. At R13 �,4 o, t �1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ^ Title:
Onsite Representative: (26tf+L-, ,n►—
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:_ Cnin.C, r�.o
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =, Longitude: =0=,
°=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑
Layer
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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 Coy
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 [9 No ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
EINE
[]NA
❑NE
❑ Yes
(N No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

JI a
Facility Number: Date of Inspection
Croptype(s) B64, -P L46_k+._ 6 rot e_ i; L;J`4/"4/
AL -Cc -744 z
Waste Collection & Treatment
13.
Soil type(s)
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ NA
❑ NE
16.
Spillway?:
14 No
❑ NA
❑ NE
Designed Freeboard (in):
Does the facility lack adequate acreage for land application?
❑ Yes
�ff No
Observed Freeboard (in):
❑ NE
18.
Is there a lack of properly operating waste application equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc-)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
9 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?
El Yes
[w No
❑ NA ❑ NE
8- Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M 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
[:1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A] No
❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? if yes, check the appropriate box below-
❑ Yes
11 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.
Croptype(s) B64, -P L46_k+._ 6 rot e_ i; L;J`4/"4/
AL -Cc -744 z
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'; ❑ Yes
14 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�ff No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to,questio64): Explain any YES.answers and/or any recommendations or any other comments.
Use drawings of facility to,better explain situations. (use additional pages.as necessary}:` " ,
Reviewer/Inspector Name ` � � !� Phone: LO V870- /..0
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: �Z --1�lc Date of Inspection
Required Records &- Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 00 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 li� 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
*1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
It No
❑ NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
09 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
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
®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
El No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
81 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

FfHty Number 01y
0 Division of Water Quality.
0 Division of Soil and Water Coriservation
0 Other Ageney .4
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ®—d; Arrival Time. O S Departure Time: County: Region: F-7I�0
Farm Name: y+ Knc, a I k�J _ Owner Email:
Owner Name: t } , � _n g o y � i Phone:
-tailing Address: ��� �S /'t7f. �F:� Ck Aa A.,, Al
Physical Address:
Facility Contact:
Title:
Onsite Representative:(_ ur�r.S_ i /.was -La , cam
Certified Operator: 77o L, 1-1 t
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Ch L_a r " L
Operator Certification Number: 11,710f
Back-up Certification Number:
Latitude: =0 =, = Longitude: = ° =I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish D 60
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
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 ElOther
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
Number of Structures:
d. Does discharge bypass the .waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes © No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
121/2$/04 Continued

Facility Ttumber: —14014
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
Identifier:
Spillway?:
Designed Freeboard (in): /Z 02
Observed Freeboard (in): 029"
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Q No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 09 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 5 P�.
13. Soil type(s) N c,r Cat k, Ma%r u n —
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 W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%[] Yes [A No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.,;•
Use drawings offacility to better explain situations. (use additional,pages as necessary)
Reviewer/inspector Name 1',
Reviewer/Inspector Signature:
40ik
Phone: 1/g4 —
Date: .2 %•Z3/ate
12/28/04 Continued

Fcility Ikumber: g,2—�j/A�/ Date of Inspection -7-3 0�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ® Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
7 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector tail to discuss review/inspection with an on-site representative?
❑ Yes
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V3 No
❑ NA
❑ NE
A Comments and/or Drawings:
jddiilonal
n + , `
c- S C, r C �G7 r cel �L CC Y� `i vlG} fes' - Y' (64 rG V" G ry�7
ge-V_ loe-G� IlbrztcOr, S S��g� s�rVet
CSC. li l
y ''S u Pc Ar oQa4
12/28/04

[Type of Visit OrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit G&outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a Date of Visit: Time: �s
=Not Operational Q Below Threshold
MPermitted ErCertified D Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: ....... .. . . ........ County:.........
Owner Name: . ............................ _ l�°a .. .. ..........._ - - .._.. Phone No:
395 M+. .
Mailing Address: ..._... _ ��/tiart 14C�13,?l
Facility Contact. J��^- R� 't .... ---Title: �w'Q----- Phone No:
Onsite Representative: -.s ....._............................. Integrator: ....... et1!!!!"r{-_.... ................
_.
Certified Operator:........ _Sohn�`" c4 Operator Certification Number:.------_-___
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • S «
Discbarses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
El Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes []'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [TNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [;�No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Freeboard (inches):
12112103 Continue I

Facility, Number: $a -- Date of Inspection 10 0
r `cam, 1
Z
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
dNo
seepage, etc.)
Reviewer/Inspector Name „t _ -
ReviewerAa spector Signature: Date:
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
❑ Yes
[+FfNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
[?(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Rf No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[�No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefunprovement?
❑ Yes
YNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[R(No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type er a a� [SGwC 1Pos+, /<,J 41-1 14 Vvre Sr.Wd
13. Do the receiving crops differ with those designated in the Certified Animal to Management Plan (CAWMP)?
❑ Yes
dNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ff No
b) Does the facility need a wettable acre determination?
❑ Yes
9No
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
❑ Yes
UNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
bio
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
Rf4o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
O No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Q'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
BNo
Air Quality representative immediately.
ers �antcV _ �:
Comaten#s (refer to gneshoh #} E�cplatn aity$YFS,4W ar stay recd ons arty o ts.�� � t
or thcr�comimen
;Use drawuzgs of fac�ty to better explatn stfiations. {ose addxxhanal pages as necessary) [yleld Copy ❑ Final Notes
a _
r `cam, 1
Z
Reviewer/Inspector Name „t _ -
ReviewerAa spector Signature: Date:
12/12103 117 Continued

Facility Number: g% — l-oL� I Date of Inspection
Required Records & Documents
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/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
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?
INTPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. 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?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Oa/No
❑ Yes B*'No
❑ Yes [?No
❑ Yes [R&
❑ Yes [,To
❑ Yes [-No
❑ Yes Eg-No
❑ Yes 2No
❑ Yes 2Vo
❑ Yes 2 -No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit_ You will receive no further correspondence about this visit.
dditidi al Can' in- ents"and/or.Drawig gs
x' I n�y ks G? 6--g'q t � '.&S aj`'�r d .�crt ^er po j.
C�NiFf ►^1. fJ VMoK. �%� /Y �j.A..I� I � (�'Y7�t'( S ��Y
,12112103