820406_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

i-�' oM,
Type of Visit: 0CCo Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit:1 F1 7F,11IMMIArrival Time: Departure Time: County: Regioni�
Farm Name: L.� -f L I Owner Email:
Owner Name: CoX14► f 2� f a d ►'(�s Phone:
Mailing Address:
Physical Address:
Facility Contact: �tt 1`5 (� UG Title: Phone:
Onsite Representative: t i Integrator: " !'7, �—
T�'
Certified Operator: 1 Certification Number: Lg 3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
[:]No
Design
Current
Desigm
Current
Swine °' Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish _IfEl p
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul
Ca aci
Po .
Non -Dairy
Farrow to Finish
I Layers
I
Beef Stocker
Gilts I
INon-Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
n =
Turkeys
Other'— __V
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 ❑ NA ❑ NE
❑ Yes
[:]No
Ea<A
❑ NE
❑ Yes
❑ No
�A
❑ NE
[:]Yes ❑No ETNA ❑ NE
[:]Yes 6 N ❑ NA ❑ NE
[:]Yes ] ❑ NA ❑ NE
Page I of 3 21412015 Continued

lFacility Number: JDate of Inspection:
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4E j o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eq-Na` ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
Spillway9:
17. Does the facility lack adequate acreage for land application?
❑ Yes
E5 1V°
Designed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in): =-
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El-No"❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
[3'No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Ell o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
J-Ko ❑ 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
LEI< ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3 No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:[,Ko ❑ 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): ef%y'(.,tA,G{,[L �� L
13. Soil Type(s): w-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4E j o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E5 1V°
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [:]Yes dNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [?f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑i "No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes 1[3' -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CR"Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑-�Ko' ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E]�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2"�o
❑ 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).
CaUt (Q- v5 A
s G446c-t rl / I- �3 -11 6 �(3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L Ai k)
Phone: �w J S 3 l
Date: rj
2/4/2015

type of vnit. m "nipuance fuapecuon v operation rcevfew v Z,*liu(allfe r.vaufatfon %,j teenmcal Assistance I
Reason for Visit: Q'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:" ` w-1� Departure Time: County:64-A
Region!/
Farm Name: 4-04 I Owner Email:
Owner Name: oh&e er- E"7f' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
%-ft5 464-w 1* Title:
Y
Lr
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
.,
Currenkx „ Design Current
Design Current
,�, WWNe—s-igir.I
S �n
apacEty Popp Wet Poultry Capacity Pop.
,!cattle Capacity Pop.
Wean to Finish
I 11-ayer I I
M.
Dairy Cow
Wean to FeederNon-Layer
❑ NA
Dairy Calf
Feeder to Finish
44;
Dai Heifer
Farrow to Wean'
P ' a Design Current
Dry Cow
Farrow to Feeder
�"�D P ultr Ca acr Po
Non -Dairy
03 Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- Turkeys
-
q 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, notifv DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge by 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 �o ❑ NA ❑ NE
❑ Yes ❑ No [a -RA ❑ NE
❑ Yes ❑ No [J NA ❑ NE
❑ Yes
[:]No
ff"NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
Page l of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q oo
❑ NA
❑ NE
1 a. If yes, is waste level into the structural freeboard?
❑ Yes
No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Y cs
LJ "' 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
[TNo
❑ 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
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EfrNo
❑ 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 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[]j"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): Cow
13. Soil Type(s): W+--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E2<0
❑ NA
❑ NE
15. Does the receiving crop and/or land. application site need improvement?
❑ Yes
Fv-KN- o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[I -No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!3
❑ 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 El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
DNA ❑ NE
❑ Weather Code
❑ S I udge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R31<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey F-1 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 g3<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes UrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2No ❑ 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
Cq'No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
g!r'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C2rNo
❑ 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).
3
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
C,c( quo-3o�-68sc
Phone: �S3'3 -33 3
Date: 34 't 2/4/2015

Ii ype of visit: tmompuance inspection u Uperanon meveew V btrucrure r vaivatlon V i ecnnical Assistance I
Reason for Visit: 42rRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /' 0 County: SEVil
Farm Name: 9 4—rY Owner Email:
Owner Name: v K ist. �uV LC f Phone:
Mailing Address:
Physical Address: /�
Facility Contact: Cf &4t S •Cy—�1 itle:
Onsite Representative: / 1
Certified Operator: t(
Phone:
Region: FiII
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E3 v 2 -KA_ ❑ NE
❑ Yes ❑ No ED NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Design
Current
Design
c. What is the estimated volume that reached waters of the State (gallons)?
Desigu Current
Current
Swine Capacity Pop.
W..et Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Well
an to Finish
2. Is there evidence of a past discharge from any part of the operation?
La er
�No
❑ NA
❑ NE
Da Cow
Wean to Feeder
dNo
on -Layer
❑ NE
of the State other than from a discharge?
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to feeder
D . P,oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
e Poults
her
TO'
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?
❑ Yes E3 v 2 -KA_ ❑ NE
❑ Yes ❑ No ED NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2014 Continued

Facili Number: - Date of Inspection: 3
Waste Collection & Treatment
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 L fit' ❑ 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
[?fNo
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in): ef -7-
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ /�No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
5.
❑ Yes
E3'lqo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Re uired Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[(3 No
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fNo
❑ NA
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
eNo
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2r�4o
❑ 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
L�J`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes E1410 ❑ 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 ew 5�;-
13. Soil Type(s): lj i[,� �aWf�, i^
9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ /�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?[]
Yes
XNo
❑ NA
[D NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[30Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fNo
❑ 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 E2rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vr'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

4z�Facili Number:- Date of Inspection:
,24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E] ?Wo
O NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[:•Wo
❑ 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
allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E3 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[;� No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [2rNo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
[:]Yes eNo ❑ NA ❑ NE
r] Yes [ No
❑ Yes ETIVo
❑ Yes Elr<o
❑ NA ❑ 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(useadditional pages as necessary).
CIA r4 t co h ic oma[ ~ C l
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
I- " Phone: U3, 3 3
` Date: GWAJ
2/4/2 14
.-_,

it ype ox v [sit. L.0-a_ompnance Inspecuon v vperanoo tceview v atructure r,vamanon vi ecnmcat Assistance
Reason for Visit: (klioutine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time; County:
Farm Name: 0-1-411L Owner
O wnneer���E"'77Tmaail:"�""'
Owner Name: ccpyC--L 41 rA Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: C �- 5 Title: Phone:
Onsite Representative: V Integrator:
Certified Operator: Certification Number: ! i �iq 7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑No
[315A
Design
Current
Design Current
Seine Capacity Pop.
❑ NE
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Firas
I ILayer
DairyCow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ou1
Ca aei
l;o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
a 4
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?
❑ Yes Q�❑ NA ❑ NE
[:]Yes
❑No
[315A
❑ NE
❑ Yes
❑ No
[2 -NA
❑ 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
❑ Yes FNo
[:]Yes
[ZrNA ❑ NE
E] NA C:] NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection-
Waste
ns ection:Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Er11q_o_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0-151A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
[�No
❑ NA
❑ NE
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
❑ Yes
[! No
Observed Freeboard (in):�
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
©-ice
❑ 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
2No
❑ 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
DIG
❑ NA
❑ NE
8. Do any of the structures Iack adequate markers as required by the permit?
❑ Yes
[.I�lo
❑ 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
[TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes l.a "o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15_ Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
[*NNo
❑ NA
❑ NE
❑ Yes
[! No
❑ NA
❑ NE
[—]Yes / No ❑ NA ❑ NE
[—]Yes [rNo ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
❑ Yes RIM ❑ NA ❑ NE
❑w -UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes E!fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T::fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA E] NE
Page 2 of 3 2/4/2014 Continued

FacilityNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes l� l o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-lvo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I_ -Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[jl
❑ 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
[31No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
To
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [215 -o -
.Q5 -o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [;Mo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3'1`Io ❑ 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),
c,r,,A6 1�4( EP--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 413-333
Date: !"
2/4/2011

I W's,
hype of Visit:E'Com fiance Inspection V Operation Review U Structure Evaluation (> "I'echnical Assistance
Reason for Visit: Qoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �{ j �j[ Arrival Timer Departure Time: County:
Farm Name: c[(/�lS L Owner Email:
Owner Name: r) G dP t t, Fra {yK r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
• 'PI a-
t
Certified Operator: C r
Back-up Operator:
Location of Farm:
s W_ CGfC Title: f .et ► Phone:
Latitude:
Region:
Integrator: P -t z2Ay _
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
Design C uen
ff NA
ent
Design Current
❑ No
[]'lq"A
Swine Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
airyHeifer
Farrow to Wean_
Design Current
D Cow
Farrow to Feeder
D . X"oul
RPMPo .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
e -e
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
ff NA
❑ NE
❑ Yes
❑ No
[]'lq"A
❑ NE
❑ Yes ❑ No
[:]Yes ❑'No
[:]Yes �No
dNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

f
Facili Number: - Date of Ins ection-
�-"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!�Mo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ED.l+itf ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [D. -No ❑ NA ❑ NE.
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Epflo ❑ 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 E3 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q/o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L ❑ 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): D 6V'vk & A S10
13. Soil Type(s): (Z iq jjj'C>ktj &
❑ Yes
[-15-o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ fro those designated in the CAWMP?
❑ Yes4o
❑ NA ❑ NE
C -]NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2/
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ Yes
❑ NA
❑ NE
acres determination?
❑ 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?
17. Does the facility lack adequate acreage for land application?
❑ YesNo
❑ NA ❑ NE
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[-15-o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LD.W
❑ 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;k o
❑ 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
U]-ITo-
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Io ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

,.
Facili Number: - Date of Inspection; r'
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3 -N`6`
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
Q No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E�-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
I �T o
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[?344-0
❑ 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
M -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
Q5>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
�10
❑ NA ❑ NE
❑ Application Field '❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
[DNo
❑ 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
2 lvo
❑ 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).
45 (3
C4_vb C�k�a�
Reviewer/Inspector Name: ��� _ Phone:
Reviewer/Inspector Signature: Date: l�
Page 3 of 3 2/4/2011

Type of Visit: �omppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: C'Koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; o a Departure Time: t7 County: Region: ,I O
Farm Name: �„C�jj�� �/!T� %%G� Owner Email:
Owner Name: �a)r1 cZ I`i t✓Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ! i�GF' y��jy��� Phone:
Onsite Representative: Integrator:
Certified Operator: _ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current7„
, ADesign Cu>reut
Design Current
Swine Capacity Pop.
Wet Poultry i itapac ty P,op,
Cattle Capacity Pop.
�
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish fl Ax�
Farrow to Wean
» °'„^D ignCnrrent
Dai Heifer
Dry Cow
Farrow to FeederD
. Pw_ul=i:Ca aciSPo
Layers
Non -Dairy
I I 113eef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
❑ No
Pullets
Beef Brood Cow
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Turke s
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
T ey Poults
❑ NA
❑ NE
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
-�
RA
❑ NA
E] NE
Waste Collection & Treatment
❑ Yes
rNo
❑ NA
❑ NE
4. Is storage capacity (structural plus stone 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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
QkNo
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): L2:
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L�[No
❑ NA
Observed Freeboard (in): qaa_
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
[M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[�_71 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste 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 CgNo ❑ 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): i&2ffw(�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RA
❑ NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
QkNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L�[No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 8 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JU9 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - f- Date of Inspection: I' 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes SID No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [MNo ❑ NA ❑ NE
❑ Yes 1Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
2�_No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional uaees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ¢/0-33 —33 or-'
Date: r_,�o�/
2/4/2011

Facility Numlier 5?�� -
Tv of Visit: UCompliance Inspection C� Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: D'Itoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 102 Arrival Time: / q Departure Time: aQ County: e�An
Farm Name: IA �AMIL F_ �Q(Z G LLLC' Owner Email:
Owner Name: CO �\p► 9MP c't rARMs Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: !agP..M%.
Certified Operator: Comm'—,
Back-up Operator:
Location of Farm:
Latitude:
Region: tIQC�
Phone:
Integrator:�� E
Certification Number: 93 4
Certification Number:
Longitude:
Y Design Current
•Po
~' , •
Des' n,
Current
;
Design Current
Swine '� Ca aci
• p ty p.
Vet Poult ,� Ca aci
ry p ty
Po p.
& tie Capacity Pop.
Cat
Wean to Finish
La cr
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
T
Feeder y
r .,.fi
Dai Heifer
Fa ow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P�oultty. Ca act
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
;<
Turkeys
t?ther A. -
Turkey Poults
Other 101
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [!fNo [:DNA ❑ NE
❑ Yes
❑ No
CNA
❑ NE
❑ Yes
❑ No
Q NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No []JNA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes d No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [v/No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: 9L - t1 D Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No [] NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [gNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -3 1.
Spillway?:
Designed Freeboard (in): X
Observed Freeboard (in): L1'6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [►j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [Er No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
18. Is there a lack of properly operating waste application equipment?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes .g No
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes [g No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
ff No
Waste Aoolication
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 [ rNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
[g''No
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ NE
12. Crop Type(s): i� TLVrV'3D .B (CnRA-LL, Z. (;_ 01
[:]Waste Transfers
❑ Weather Code
'`�� R - a-40 �k
13. Soil Type(s): Us ��Q,t I j i Irl . _ R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C "No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff 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
[g''No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
M 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
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2 No
C9"NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: gob Date of Ins ection:/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [✓7 No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes [TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fai I to properly dispose of dead animals with 24 hours and/or document
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'?
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 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 [RI'No ❑ NA ❑ NE
❑ Yes F;R'No ❑ NA ❑ NE
❑Yes Ea No 0 N ❑NE
❑ Yes Eg�No ❑ NA ❑ NE
❑ Yes [!YNo
[]Yes r;Z;rNo
❑ Yes Eg No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:"
214/2011

(Type of Visit: f --'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: routine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: L Arrival Time: Departure Time: County: Region:
Farm Name:�, t -0-20-�� ��� Owner Email:
Owner Name: Co Phone:
Mailing Address:
Physical Address:
Facility Contact: -`�(S 7 j-j-c_sk& Title: Phone:
Onsite Representative: 14ell-e-J _ Integrator: Or.4-,
Certified Operator: t L L Certification Number: / 83h4
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [EKo ❑ NA ❑ NE
❑ Yes [] No E31�A ❑ NE
❑ Yes ❑ No D "' - ❑ NE
❑ Yes ❑ No E:I KA ❑ NE
❑ Yes C- "" ❑ NA ❑ NE
❑ Yes NA ❑ NE
Page I of 3 2/4/2011 Continued
rrentr x D gn Cu
u Cnrrent.
nt Desi�Cmaloffly'
My�ine"
Capacity Pop Wet,PoultryCa actty
PoCattle
p
Pop.
o Finish
La er
Dai Cow
o Feeder
Non -La er
Dai Calf
to Finish
Dai Heifer
Farrowto Wean
Design
@ trent
D Cow
to Feeder"
D PoulCa acity
Po
Non -Dai
to Finish
EBoars
Layers
- Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
-
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [EKo ❑ NA ❑ NE
❑ Yes [] No E31�A ❑ NE
❑ Yes ❑ No D "' - ❑ NE
❑ Yes ❑ No E:I KA ❑ NE
❑ Yes C- "" ❑ NA ❑ NE
❑ Yes NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ET<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
Ea<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
Ka'1goo
❑ 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
[01<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�Io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
g!d
❑ 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 TypeW: V t I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Er<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
k2-1�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2'�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
a4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E&3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ll<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 o ❑ 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 Inspectio;<OPIE]
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 jj4A ❑ NE
Page 2 of 3 2/4/2011 Continued

s,
Facility Number:- Date of—Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5 -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L_I 5_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 v No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑No ®NA ❑ NE
Other Issues
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ENo ❑ 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 [3No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3'<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Ea<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 64o"
❑ 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 pates as necessary).
L 1x0allv-r Oc-,' 54
3 o{-,:�cC J J -&-o ss 4v -&f 's
-�k-e_ C-nrcc CA,
Reviewer/Inspector Name: Phone: 2V —" 3 337
Reviewer/Inspector Signature. Date:
=�-g
Page 3 of 3 ;1214/2''111

JR r-, S1K4S 1-2Z-zD 1V
8Z H 1;40&
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: %-Z1- ]O Arrival Time: 1:30,ft— I Departure Time: 3%i5 ,,, County: S2,"-/75Afni Region: /-Re
Farm Name: c- ___ C_ SoUj__ Owner Email:
Owner Name:. Ca ka-y- y- _ -, Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�`�.,''4I[_ Title: —�� Spi-� Phone No:
Onsite Representative: integrator: Z�:nAd V
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =S =td Longitude: = ° =' F-1 "
Design Current
DesignC►urrent
"WetPoultry
Design warrent
Swine Capacity Eopula6on
Capacity Population
Cattle Capacity Population
❑ Wean to Finish'__j
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
[I Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean / O $7O
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑
Non -Layers
❑Beef Feeder
PE3Boars
❑
Pullets
❑ Beef Brood Cowl
❑Turke s
Other
El Turkey Poults
Number of Structures:
❑Other
❑ Other
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L�7,
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
El No
,.,/
NNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
,L�I
SNA
❑ 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
❑, Ngo
,,��,,��
BNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L�7,
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
��oo
L21�o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number:
Date of inspection 'L1-2ei
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z
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 0 <No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes E TNo ❑ 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 ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No El NA El 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
ETNo ❑ 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 > ]0% 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.
1
Crop type(s) �< _ '
\
(/0 S J
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Er'N'o [INA
El NE
15.
Does the receiving crop and/or land application site need improvement? [3 Yes
E,
o El NA
[INE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes
�E
l.7 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
3 o ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
E? ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and._oireany recommendations or an} other comments
Use drawings of facility to better explain situations. (use additional pages as necessary). m
Reviewer/inspector Name -c V tI�S Phone: 9lD. 4(33 , 33027
ReviewerA nspector Signature:�-,e � Date: / — Z 1 Z 0 /'O iDddeb
12/28/04 Continued

Facility Number: :RZ — Date of Inspection ! Z! ZOlD
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.
❑ W1JP E3 Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ffXNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes a<. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2<0
❑ NA
❑ NE
❑ Yes
gogo
[INA
El NE
ElL7 Yes
�L�<.
No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑Yes
N
El NA
El NE
ElO Yes
gogo
❑ NA
❑ NE
❑ Yes
IJ N10
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
OrNo
❑ NA
❑ NE
12128104

31015 /0--67_2-a0y
Msion of Water Quality
FE=Fad1rityNumber�Q� 0 Division of Soil and Water Conservation
0 Other Agency z:
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outme 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: >r'��''O Arrival Time: Z ; 30 Departure Time: County: ,L'
Farm Name: T�� __ Owner Email:
Owner Name: c Y +r+��--CC-5 4 r; s- _<_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��/��� / �rr.�Jf C_&
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
Region:
Phone No:
Integrator: (fo < 1'- r `-I— _
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' Longitude: 0 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
! 1 10 Non -La ei
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'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current:
Capacity Population.5
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Covq
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
EZI,
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 L`3'No ❑ NA ❑ NE
❑ Yes ❑ No ©-�A ❑ NE
❑ Yes
❑ No 0-tq-A- ❑ NE
❑ No G ice❑ NE
❑ Yes
❑ Yes
EMoT El NA ❑ NE
❑ Yes
lstvo ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � o ❑.NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L'I"No Lam] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L`TiVo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
[IYes
9'90 ❑ NA
❑ NE
through a waste management or closure plan?
[]PAN [:IPAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
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
o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
,EM7
3 5o
L� No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
13.
4. Does any part of the waste management system other than the waste structures require
❑ Yes
LTNo ❑ NA
❑ NE
maintenance or improvement?
❑ NA
[INE
15.
Waste Application
E,<o
Ngo [:1 NA
El NE
16_
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:1 Yes
,--,��
BlTo ❑ NA
❑ NE
maintenance/improvement?
,E
Digo' ❑ NA
❑ NE
18.
11.
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN [:IPAN > 10% or ]0 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.
i
� f f' C,,L 6rFt �Q
Croptype
tYP '
(s) R CL v :. ,JY"t ci / /✓
() .t
� .S
13.
Soil type(s)
14,
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ NA
[INE
15.
Does the receiving crop and/or land application site need improvement? Yes
ElLY
E,<o
Ngo [:1 NA
El NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
,,
o❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
,E
Digo' ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[]No: " ❑ NA
❑ NE
Reviewer/Inspector Name y .1UK
�w�S Phone: �O ��
Reviewer/inspector Signature: Of Date:—iCJ - C1
Page 2 of 3 12128/04 (:onfinued

8z -L1a &
Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BTo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [T No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design [I 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
B o
❑ 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
EM
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M<
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U tvo
❑ 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
[�go_
❑ 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
ff 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
a7To-
❑ 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
ffNo ,
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or. Drawings:
AL
Hw
12/28104

i
��►�s 9-0�-08 �
015vrsion of_Water Quality....
FlactlityNunnber �� y�Olo Division of Soil'and �VaterConsenahon
Other Age
ney
Type of Visit
Compliance Inspection
0 Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
outine O Complaint
O Follow up Q Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: 9:V5_,4,-, I Departure Time: County: Region:
Farm Name: (fo h y C_ 1-a rw1 S _C-_5/ Owner Email:
Owner Name: ro ttr2 rrr` e- i'tro!j Phone:
Mailing Address:
Physical Address:
Facility Contact: L_L `S i3ca-�.�r�If[ Title: 7e-14 �ipc� . _ !Phone No:
JF
Onsite Representative: Integrator: _ Co�40 1�5rrNS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: E:T0 0' = Longitude: = o = t =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder IEJ Non -Laver
Feeder to Finish
Farrow to Wean 6�
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La rers
❑ Pullets
❑ Turkevs
❑ Turkev Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: E:)Structure ❑ Application Field ElOther
a. Was the conveyance man-made''
Design Current
Cattle Capacity Population
El -Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached eaters 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 ofthe State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No LS NA ❑ NE
❑ Yes ❑ No dNA ❑ NE
❑ Yes ❑ No LI IVA ❑ NE
❑ Yes Zo
El NA El NE
❑ Yes ❑ NA ❑ NE
12/28/04 Continued

1
Facility Number: :?Z—ff0e J Date of Inspection
Waste Collection & Treatment l
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
WNo
o ED NA ❑ NE
a. if yes, is waste level into the structural freeboard? El Yes ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
L' I No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
ZNo
❑ NA ❑ NE
through a waste management or closure plan?
ETN, El NA
[INE
at,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta711C
Do improvement?
notify DWQ
any of the structures need maintenance or Yes
El7.
❑ NE
11 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Zo
❑ 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
E4o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
El NA [:1 NE
maintenance/improvement?
7No
t I. Is there evidence of incorrect 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 ❑ Eviideence of Wind Drift ❑ Application Area
\of
rOutside
12. Crophpe(s) (ey�H�cir'i �t�:GJ'ilyv� icf��r.C:,v Gf�,S.J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
El Yes
7N9 ❑ NA
EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETN, El NA
[INE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Reviewer/Inspector Name F_Ki L %v e, S- - — - -- Phone: 4/6, 5433 , 33.3b
Reviewer/Inspector Signature: Date://— SOS
Page 2 of 3 12128/04 Continued

Facility Number: $Z — 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 appropirate box. ❑ WUP ❑ Checklists
❑ Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IBJ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesElNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElzoYes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 7v"b
fo ❑ NA EINE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ElNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Co ❑ 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 EdNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [(No ❑ NA ❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes❑ NA EINE
33. Does facility require a follow-up visit by same agency? 1:1 Yes rN ❑ NA ❑ NE
❑ Yes � ElNA ElNE
El YesZo ❑ NA F-1NE
Additional Comments aiid/or:Drawjn s:,,
Hw
Page 3 of 3 12/.28/04

qpi j?=MS 1.,J44_re d 9 -f$-zoo % pg
® Division of Water Quality
Facility Number Q O Division of Soil and Water Conservation
O Other Agency
Type of Visit 4'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `j X3--0 % Arrival Time: /Z,'pA Departure Time: Z : ZO County: Region:
Farm Name: t _ _ <4 Owner Email:
Owner Name: C,0 i'avi4 VA", :S Phone:
Mailing Address:
Physical Address:
Facility Contact: �tx r ft` S -&&yLJ i t. K _ Title: Phone No:
Onsite Representative: Integrator: Co 4cvt`c 41h7h Fe_-&A�LS
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑o =, = Longitude: =o ❑' = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures:ED:
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 r No ❑ NA ❑ N£
❑Yes
� No
[:]NA
El NE
❑ Yes
0 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P] No
❑Yes
PNo
El NA
❑NE
❑ Yes
J21 No
❑ NA
❑ NE
12/28/04 Continued

,J

M
Facility Number: 19 - O(a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
�Z No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�a No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�Z No
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%ori 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ ApplicationOutsideof
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ra No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment'?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name Wc K, R*,cy Phone: 9/0, X33, 33010
Reviewer/inspector Signature: Date: `/-/3— ZOO 7
12/28/04 Continued

Facility Number: 5'Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. El WUP ❑ Checklists
❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[.A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V 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
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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28104

i
® Division of Water Quality
Facility: Number L Z �f p {p O Division of Soil and Water Conservation
a Other Agency, ✓ ro� i
x
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
_2 S=Ob
Arrivai Time:
Departure Time: County: a ,Q50;k1 .,_
Farm Name:
C O L.-, Q
k;,r _ &70Ly C—
! 7t Owner Email:
Owner Name:
Ccs fn
C cr`i cc � 4u_Ai
Y +,..�� Phone:
❑ Yes
EX No
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Region: 10CZiQ0
Onsite Representative: CLAU-:6 4___&aXI LAIL _K Integrator:.; e 5 F"�V+v-
Id
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = Longitude: ❑ o =.
❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Laver
❑ Feeder to Finish
Farrow to Wean 150 & 1574
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl I
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 discharue 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 q No ❑ NA EINE
❑ Yes
N No
[INA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
EX No
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
EXNo
❑ NA
❑ NE
12128104 Continued

L
Facility Number: gZ — y p (Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [4 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
ii
Observed Freeboard (in): 4L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
Q9 No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�n No
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
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
M No
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
N1 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[Xj No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
iiWindoww
12. Crop type(s) �jet'►til�dr:A (nn� 4 ��3 GJ S�14 Cl Grtt,i✓ 6D L S 'S'eo%
13. Soil type(s) _ W 0.gya V, �7Lt,� j1l�/5�,, , L��ct w/ a a,/
I i 1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�n No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
Reviewer/inspector Name Phone
Reviewer/Inspector Signature: Date: 0
12128/04 Continued

i .
Facility Number: YZ -i" I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I 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 P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 52 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[N 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
M No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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?
El Yes
}�
[N 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
U9 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 foilow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Additiinal Commenfs and/or Drawings
12/28/04
12/28/04

Type of Visit 48 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ���n�on Region:
Farm Name: _ C a k a rt !t= +�� La P_ " s C -_ 4.1 Owner Email:
Owner Name:
Phone:
Mailing Address: /\+ C _
Physical Address: ���,c ,- Coates.- �� ofd, /�c r, ^T _
Facility Contact:
Title:
Onsite Representative:
Certified Operator: �wr-� s s _ V3 a r L—) i e -
Back -up Operator:
Location of Farm:
Design` Current
13wute uapactty, ropuiateon
❑ Wean to Finish
i
❑ Wean to Feeder
❑ Feeder to Finish i
❑ Farrow to Wean
p Farrow to Feeder /.2 'o J 49.6
❑ Farrow to Finish
® Gilts a 73
a B oars
Other
❑ Other
Phone No:
Integrator: a k Gr t C-1
Operator Certification Number: 19 J7
Back-up Certification Number:
Latitude: [=O = Longitude: 0 e= s
Design Current
Wet Poultry Capacity Population
❑ Layer I_
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La crs
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Cattle
Design . Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA EINE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 9.2 — y06 Date of Inspection /Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 ~
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P 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
WNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
©No
4. Does any part of the waste management system other than the waste structures require ❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
® No
❑ NA
Waste Application
17. Does the facility lack adequate acreage for land application?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
❑ Yes
N No
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
[2 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) A s
13. Soil type(s) Iva lrl,r111 M u v: &C- /��a.• �aY
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
©No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%[]
Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Reviewer/Inspector Name ET.
Reviewerfinspector Signature:
Phone:
Date:
12/28/04 Continued

Facility Number: bl —mol Date of Inspection a /s---'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP [_1 Checklists L1 Design ❑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
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[M NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
L0 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
W NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 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
EINE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5 No
❑ NA
EINE
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
D9 No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
JM No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12/28/04

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune: O�
Not O erational Below Threshold
© Permitted © Certified 0 Conditionally CeTet� 13 Registered Date Last Operated or Above Threshold: ------•
FarmName: •..................... ' �.......__......--............ -..... .----4 ........... _....... ....._........ County � .......______..._...._ .._._............�
Owner Name:.. _. ......... .... .. Phone No: ................. .. ..�
-Mading Address �60 1N>c f� !i? !c ...... _ ----- ------------- 2� H%vk /J a
Facility Contact: ---- C �` :S g i c i! - Title: --------- .. Phone No:
Onsite Representative:
Certified Operator:._.. S. S ��'�' � C -Il Operator Certification Number. aT C 7
Location of Farm:
04wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �` �" Longitude �• �° �
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes B-96`
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) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rain?
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
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2<0—
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identif ter : .......... .......... _............ .............................. ................................. .. ..............._.... ----- ---•--............ ....... ........
Freeboard (inches): 45
12112103 Continued

Facility Number: — p faDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ief trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes OeNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [2 -Ko -
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Leo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [7 No
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenanodimprovement?
❑ Yes
R o
9410
liquid level of lagoon or storage pond with no agitation?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
io
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
roads, building structure, and/or public property)
12. Crop type i
ffONo
Air Quality representative immediately.
13. Do the receiving crops differ with those designa in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑.W'
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Ergo—
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16- Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor lrsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
9410
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
Ld'Ro
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
�o
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
ffONo
Air Quality representative immediately.
IFComments (refer to ggestson`�)� E>rplam any YFS answers amd/or airy %�ecom�en�dat�ons�or any o_ommeats: a� � �'
� � �
{trse �"
Huse drawrngs of faciLty to better explain sttnatwa�. addbt�onal�pages as necessary) geld Copy ❑ Final Nates
;
Reviewer/Inspector Name'E
Reviewer/Inspector Signature: Date:
12/12103 Continued

Facility Number: — 06 Date of Inspection o
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?
NPDES 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?
❑ Yes 9No
❑ Yes 13 -Ko
❑ Yes Q'No
❑ Yes 2-56—_
❑ Yes 0
[:]Yes
0No
❑ Yes lr No
❑ Yes No
❑ Yes ErRo
❑ Yes GWO_____
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
1)�,120 Minute Inspections ❑ Annual Certification Form
FC—PRo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.
mintnLs and/6r Drawtr►gs _
� - s �_�-
J
12112103