820408_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of visit: 0 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 0 Denied Access
Date of Visit: Arrival Time: QCT Departure Time: % ,30 County:SOv1 Region: r
Farm Name: P
Owner Name: 'i--$ 4C.te �s
Mailing Address:
Physical Address:
Facility Contact: a r�^� S L LL y�,/� Title:
N
Onsite Representative: nn fJ
Certified Operator: 0T( If—v\ RWI-0 M
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator: p� SQA
Certification Number:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes r No 0 N ONE
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �� No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA
❑ NE
❑ NA
ligm1ill Ill
I
Design Current
Design
rrent
Design rrent
Swiae Capacity Pop.
Wet Poultry 'gaCa_.pacityfa
Pop.
r @attle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
, Destgn
Current
Dry Cow
Farrow to Feeder
D . P.oult Ca�ac>i#Po
Non -Dairy
Farrow to Finish
[ a ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
F I
Turkeys
Other
Turke_y Points
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?
E] Yes r No 0 N ONE
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �� No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facili Number: Date of inspection: r7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 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: '1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 3 4
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 &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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �3 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 AoDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
IVI 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.
❑ YesNo
❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard C]Waste Analysis [:]Soil Analysis
❑ Waste Tr
nsfers
❑ Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

acility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo [:]NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4No ❑ 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 0 No ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
k9 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?
❑ YesNo
❑ 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
❑ YesNo
❑ 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
P 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
[�p No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1
® No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J10 _q;3-1100
Date: 91 1:2
2/4/2015

Type of Visit: WCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Id Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a Departure Time: Dig? County:
Farm Name: 3 Owner Email:
Owner Name: res J;�ee_ Phone:
Mailing Address:
Physical Address:
Facility Contact: j—&, ""5
Onsite Representative:
Certified Operator:
Yquy-
Title:
integrator
Phone:
&LSA.C,e
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design
Current.
Design Current
Swine p ity Pop.
Wet Roultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish"`
�"`"`
- - a- �'
Daig Heifer
Farrow to Wean
Design
Curretit_- -
Dry Cow
Farrow to FeederDr
1Poult .
_
Ca ace
1?a�
Non -Dairy
Farrow to Finish
I
113eef Stocker
Gilts
Non -La ers
I
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Qthe.r - -_ -
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes )E No ❑ NA ❑ NE
❑ Yes
❑ No
�5 NA
❑ NE
❑ Yes
❑ No
t NA
❑ NE
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 Y of 3 21412011 Continued

Facili umber: - Date 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 P) NA ❑ NE
Structur. I Struc re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� �d y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tpNo ❑ NA ❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ NA ❑ NE
waste management or closure plan? q,
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? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) Y,
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CWP Window Evidence of 'nd Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes V3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[P 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 Qa No
F]Waste Application E]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[:INA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: _ - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [� No
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
1771 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes No
[[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinus of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [ 1 D 'y q -3390
Date: q/zs//6
2/4/2011

(Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: pp County: 54*vq09b&J Region: f ,0
1191, if -
Farm Name: -3 Owner Email:
Owner Name: �t`Es' '� S _ Phone:
Mailing Address:
Physical Address:
Facility Contact:/U,'..pS Title: Phone:
Onsite Representative:' t Integrator:
Pr"ge
Certified Operator: 06,t PLV/ 00- Certification Number: 9q6 q/�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Desigq
Current
Design
Current
Swine Capacity
Pop. Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
NA
Wean to Finish
I ILayer
❑ Yes
❑ No
® NA
77��
Dairy Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Feeder
I INon-Layer
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Daia Calf
❑ No
Feeder to Finish
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D2!g Heifer
❑ NA
Farrow to Wean I -COD
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Design
Current
Cow
❑ NE
Farrow to Feeder
D . P,o_ul
Ca aci
P.o .:
Non -Dai
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
y
Turkeys
Qther
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
® NA
77��
❑ 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
c -Cm No
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
M No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facility Number: SZ-- Date of inspection: 67
-y-
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
F] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: ✓J
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M No
❑ NA
Spillway?:
acres determination?
Designed Freeboard (in):
Observed Freeboard (in):�
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ftK�Rj No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
ONE
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
0 Yes]
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[F] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U3No [3NA [:]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 ❑ Evidencejof Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): G.JD
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
R] No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [�j No ❑ NA ❑ NE
the appropriate box.
❑WUP ED Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes §a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes] No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 7� 2/4/2014 Continued

Facil' • dumber: -q jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
[] Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[3 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
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EP No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M No
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: V(
Page 3 of 3 2/4/2014

!? . ►u r "7
type of visit: W Compliance inspection V Uperation Review V structure Evaluation V Iecnnical Assistance
Reason for Visit: 0 Routine Q Complaint C) Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: CF D
Farm Name: — 3 Owner Email:
Owner Name: �SC2r 1 Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: ��rS �n� Integrator-
Certified
ntegratorCertified Operator: Q✓ Certification Number:
*-.6
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?
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
Design Current
❑ NA
Design
Current
Design Current
Swine
Capsty Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pep.
❑ Yes
❑ No
® NA
❑ NE
Wean to Finish
FTI a er
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr P.onl
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Turk_qy 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
ED No
❑ NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[:]Yes ❑No
❑ Yes ® No
❑ Yes f D No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

12. Crop Type(s):
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes
Facility Number: - Dateoflns ection: �2
❑ NA
❑ NE
❑ Yes
No
Waste Collection & Treatment
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZpNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
n NA
❑ NE
Structure l Stru� Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 qP
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
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
jo 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
rg No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J5 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
JE] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes D No ❑ NA ❑ NE
❑Yes E]No ❑NA E] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g 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 J] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/1014 Continued

Facility Number: -A4 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g) No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JD 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 [DNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jg No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes !a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ;Q No
❑ Yes ® No
❑ Yes [?!f No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: gIC433- 3W
Date: l
v�kv
2/412014

r)
43 l "'15 ',)1 r—f-/ 3 _
I?ivision of Water Quality
Facility Number ®- LQg ©Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint 4 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: O: County: _4;i-)
Farm Name: P 3 Owner Email:
Owner Name: r r"Q-e— c C , Phone:
Mailing Address:
Physical Address:
Region: Y-+' —
Facility Contact: I_0.1'+1e S Y4yvL Title: Phone:
Onsite Representative: Integrator: Tre4L*
Certified Operator: G2 +L 12cwka ^ Certification Number: f 96 //,6
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 p 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 N No ❑ NA ❑ NE
[:]Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No W NA ONE
❑ Yes ❑ No
[:]Yes P No
❑ Yes [)�d No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued
Dpiur nt
��Caagi
Depsi
Curpent
Design Current
Swine
p
P]o
3= ry
Wet�Foult , .
Ca aei ty
Po
P.....
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
Dajg Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
z0op
Design
Current
Dairy Heifer
Dry Cow
Farrow to FeederNon-Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-_
Turkeys
Ut le
, ., :.
Turkey Poults
Other Other
Discharges and Stream Impacts
1- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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 N No ❑ NA ❑ NE
[:]Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No W NA ONE
❑ Yes ❑ No
[:]Yes P No
❑ Yes [)�d No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facility Number: E! - ypg jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: .::&
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): F -I'/
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
4@ No ❑ NA ❑ NE
[] No [4 NA ❑ NE
Structure 6
❑ Yes U No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
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
[A No
❑ NA
[:]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ 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}�" j No ❑ NA ❑ NE
7111,
❑ 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 Crrorp Window !!❑ Evviide�nccee of irk
Drift ❑ Application Outside ofApprovedArea
12. Crop Type(s): C oos- altwl.�!»'I l7�'s t'k ) : �w" Graft ' agf% [
13. Soil Type(s): CaB , .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�§ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes N No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�3 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes % No ❑ NA ❑ NE
❑ Yes [$ No ❑ NA ❑ NE
❑ Yes CS No ❑ NA ❑ NE
❑ Yes NJ No ❑ NA ❑ NE
❑ Yes M No
[:]Yes Q! No
❑ NA ❑ NE
0 NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011
Facili Number: - Q Date of Ins ection: z{
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
yu
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating trot[-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
r%No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i -e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes % No ❑ NA ❑ NE
❑ Yes [$ No ❑ NA ❑ NE
❑ Yes CS No ❑ NA ❑ NE
❑ Yes NJ No ❑ NA ❑ NE
❑ Yes M No
[:]Yes Q! No
❑ NA ❑ NE
0 NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: ® Compliance Inspection V operation Keview V structure Evaluation V l ethnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Z Arrival Time: O Departure Time: /1; County: -Qy
Farm Name: r3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: F -40 -
Facility Contact: `&CL Title: Phone:
Onsite Representative: � S Lao -2.1b Integrator:
Certified Operator t.Certification Number: /7726 -
Back -up
t(96Back-up Operator: Alain Certification Number: 1?96Y112
Location of Farm:
Latitude:
Longitude:
CurrentDesign
[]Yes
Current
Design Current
,WDesign
SwineCapaerty` Pop.
WetEPoultryCapi3city.
_
Pop.
Cattle;; Capacity Pap.
a. Was the conveyance man-made?
❑ Yes
Wean to Finish
La er
❑ NE
Dai Cow
Wean to Feeder
Non -La er
NA
Dai Calf
Feeder to Finish
t 't
Dai Heifer
Farrow to Wean 2-7-51
Design
Current
Cow
Farrow to Feeder
D . Pou1tCa aci
P,o ,
Non -Dairy
Farrow to Finish
La ers
❑ NE
Beef Stocker
Gilts
Non -La ers
C]NA
Beef Feeder
Boars
Pullets
Beef Brood Cow
--
Turkeys
W ..
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[]Yes
P 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
U No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesNo
C]NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facility Number: - Date of Inspection:
Waste CoDection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA E] 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
®No
❑ NA
❑ NE
waste management or closure plan?
E] Yes
T
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
§D No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
E] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
TT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EP No
❑ NA
E] NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
� '�I Crop Window ❑ Evidence of Wind D}rift [D Application
/Outside of Approved Area
12. Crop Type(s): C.gJ4ST&"" S� 7�IR-� 1: St,,,�
� � �/1�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
[:]NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
T No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
[3 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
E] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
T f No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P
No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes q9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes TM 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?
[:]Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
_Q NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 949—f-03"-39Cx?
Date: �Asqh.2_
2/4/2011

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 0 Denied Access
Date of Visit: Arrival Time. Departure Time: County:- Region:
Farm Name: 3 Owner Email:
Owner Name: Tre S-6 Phone:
Mailing Address:
Physical Address:
Facility Contact: 9avv4, _ Title: Phone:
Onsite Representative: Integrator:reS-u�
Certified Operator: 2fiW`�� Certification Number:IF
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
rv�
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes '� No ❑ NA ❑ NE
Discharge originated at: E] Structure ❑ Application Field ❑ Other: �`
a. Was the conveyance man-made? ❑ Yes ❑ No P�,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[im NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued
Design Current,
-'
Dest - Cu`rr`ent
Design Current
SwineMc.apacity
Pop Wet Poultry
`..s
Capacity�PopT-
Cattle Capacity Pop,
-e m
Wean to Finish
Wean to Feeder
Layer
]Non -Layer
Dai Cow
Dai Calf
Feeder to Finish
rv..
Dai Heifer
Farrow to Wean
[I
Design Current
Cow
Farrow to Feeder
D : Poul
Ca act Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
a
Non -Layers
Pullets
Beef Feeder
Beef Brood 17-1-
owTurke
Turkeys
s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes '� No ❑ NA ❑ NE
Discharge originated at: E] Structure ❑ Application Field ❑ Other: �`
a. Was the conveyance man-made? ❑ Yes ❑ No P�,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[im NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facili Number: I Date of lns ection: — I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes KNo NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in): 14
Observed Freeboard (in):
r
5. Are there any immediate threats to the integrity o t bserved? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 1P
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yesf� 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 T No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Q§ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidyzue of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): L7Y_44
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [NNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EpNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EP No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 171 No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes © No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [N No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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?
Comments (refer to question ft Explain any YES answers and/or any additional recommex
of facility to
5-14e 01s1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
o P.
as
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes PD No ❑ NA ❑ NE
❑ Yes M No E]NA F]NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ons or any other comments.
Phone:
Date:
2/4/2011

L
pe of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
ason for Visit Routine Complaint QFoliowup QReferral QEmergency Q Other ❑Denied Access
0 1
Date of 5 wal Time: Departure Time, p� County:" y-�M1� Region: �`-�
Farm Name:
=3
Owner Email:
Owner Name: _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative. Integrator:
Certified Operator: Operator Certification Number: 17746
7
Back-up Operator:
Location of Farm:
Latitude:
0
Back-up Certification Number:
D, E:111 Longitude: EJ 0 +
MCI
[:]No
(PNA
esign
Current
ypulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
❑ an to Feeder11E]
Non -Layer
I
El Yes
❑ Dairy Calf
❑ Feeder to Finish
I
❑ Dairy Heifer
Farrow to Wean 2CCO
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Col I
❑ Turkeys
Other
❑ TurkeyPoultS
Number of Structures:
❑ Other
❑ 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)
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 10 No El NA El NE
❑ Yes
[:]No
(PNA
[:INE
❑ Yes
❑ No
Q3 NA
❑ NE
A
❑ NE
❑ Yes
❑ NotA
El Yes
�o
❑ NE
❑ Yes
'W No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35 LM
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
Structure 5 Structure 6
❑ Yes r No ❑ NA ❑ NE
❑ Yes � No El NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes � No ❑ NA EINE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O?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 `D No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V3 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 ❑l Application Outside off Area
12. Crop type(s) Inj�RC '-"'r (O� g �xt5i �J 1 5/w
13. Soil type(s) CXb
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 N El NA El NE
51 No ❑ NA ❑ NE
1P No El NA El NE
t�dNo El NA [:1 NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name �.�;'� 1 , Phone: 9 Q 33 3�n
Reviewer/Inspector Signature: Date: jo Ito
Page 2 of 3 12/28/04 ' Continued

i
Facility Number: Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E9 No ❑ NA ❑ NE
the appropriate box_ ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes U 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
[P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
55No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:1 Yes
F] No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
$1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
[V 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
Ep No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�allo
❑ NA
❑ NE
Page 3 of 3 12/28/04

64
It
Type of Visit * Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: o Arrival Time: 12.,30NM I Departure Time: f!t.'w County:
Farm Name:
Owner Email:
Owner Name: IS-cP T CLY7�r sCr Phone:
Mailing Address:
Physical Address:
Region: F Q_
Facility Contact:/ Title: Phone No:
Onsite Representative:Integrator-
Certified
ntegrator:Certified Operator: Operator Certification Number:
7196
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 ='
= Longitude: =0=, = u
Design Current
Design Current
Design Current
Swine Capacity Population
We# Poultry Capacity Population
Cable Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Laver
❑ Dai Calf
❑ Feeder to Finish
EpNA
❑ Dai Heifer
Ed Farrow to Wean 0
Dry I?oultry
❑ D Cow
Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑ Gilts
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co w] Ell
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Turke s
W No
Outer
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
12/28/04
Discharees & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes P
No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
10 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EpNA
❑ 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)
El Yes
❑ No
��qq
N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

}
t
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ir No ❑ NA ❑ NE
a. if ves, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Stni ure I Stricture 2 Structure 3 Structure 4 Structure 5 Stvucturc G
Identifier:
Spillway?:
❑ Yes
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in):
No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[X No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
17. Does the facility lack adequate acreage for land application?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
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 El NA [--]NE
8. Do any of the stuctures lack adequate markers as required by the perm it? ❑ Yes
�j No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
�No El NA F-1NEmaintenance
or improvement?
Waste A��lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
#lNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
( No
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
ONo
17. Does the facility lack adequate acreage for land application?
❑ Yes
t§No
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[j NA C3 NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name C4, 77! Phone:
Reviewer/Inspector Signature: Date: D
!Z/28R4 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ maps p ❑ 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 IRNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
[__1NA
❑ NE
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
Elj
'L No
NA
El[324.
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
El}
n No
Cl NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
99 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0490
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
n 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
tp 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
f#No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
$No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
55 No
❑ NA
❑ NE
12128/04

Division of Water Quality
FT&IiRV N Um— U Fe ra 1 sion of Soil and Water Conservation
� Other Agency
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 F`
Date of Visit: Arrival Time: / DO Departure Time: % /%j"t' County: - Region: /�
0
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Rtr--1C& Title: Phone No:
Onsite Representative: LQY1(�� 5 Integrator: P/V57� 9p_
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ I ❑ « Longitude: =0=4 ❑
Design Current
SwineCapaciry Population
❑ Wean to Finish
Des�go Current
Wet Poultry Capacit} Papulation
❑ La er
Design Current
Cattle _ Capacity Population
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
Farrow to Wean
'r a
❑ Dairy Heifer
❑ Dry Cow
pryPotiltry
❑ Yes
Farrow to Feeder
-
❑ La ers
Non -Dairy
❑ Farrow to Finish
❑ Yes
❑ Beef Stocker
❑ Gilts
avers
❑B Feeder
Boars
❑eef
Pullets
❑ Beef Brood Co
r
❑ Turkeys
0}.
❑ Other
Turkev Poults
El-
❑ Other
Number.-hof}Structures:
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�§ No
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Plo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P3NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�§ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�INo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

13. Soil type(s) el'ho, —
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IP No
Facility Number: Date of inspection
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
n No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No toNA ❑ NE
Structure I Structur 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in): l!
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JoNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
"No [:INA ❑ NE
through a waste management or closure plan?
rf
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
;*No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA [INE
Y,
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
P} No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Area
El
l�Ctc�.�n
���I�g
12. Crop type(s) AE(PPst►ti
13. Soil type(s) el'ho, —
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IP No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
@omtnentsr(referto`questton,#) Eaplam any YES•answers and/or any recommendations or any other comments.
�w,
Use drawengs of factlety to better ex Iain stir oM� ""*�
t p r (use add bonal�pagesasneCessary):
Reviewer/Inspector Name F.44W."--AM-Phone:( -3300
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 ' Continued

Facility Number: o -k Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'qlo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JP No ❑ NA ❑ NE
the appropirate box.
❑ WUP [:1 Checklists ❑Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F1 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ YesNo
ip
[INA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
n No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

J
40 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 40 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: 7 aSOi Arrival Time: Departure Time: ' p0 t4 County: �� Region: ?EWO
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: — PZL�' T Phone No:
Onsite Representative: k Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow- to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [ o F --I ❑ Longitude: ❑ ° ❑ I =
Design Current Design Current
Capacity Population Wet Poultry . Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'!
Design Current .'
Cattle Capacity:Population .:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ®i
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes " No
❑ NA
❑ NF_
❑ Yes ❑ No
_P NA
EINE
❑ Yes ❑ No NA
EINE
El Yes El No
LNA
❑ NE
❑ Yes TNo
[jNA
ElNE
❑ Yes �No
❑ NA
❑ NE
12/28104 Continued

Facility Number:
Date of Inspection 07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NoNA ElNE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
c/
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 0
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes F 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) SYh •
13.
Soil type(s) CaA
AL
Reviewer/Inspector Name Q *l Phone:3310
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
P 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
I;i 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):
I
AL
Reviewer/Inspector Name Q *l Phone:3310
Reviewer/Inspector Signature: Date: 07
12/28/04 Continued

Facility Number: 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. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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)
J
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�No
❑ NA
❑ NE
12/28/04

Type of Visit 9A�'ornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Qtlkoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:rival Time: Departure Time: County: Region:
Farm Name: r` —3
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
= 0 « Longitude: =0=1 =1 "
5_0
Discharges & Stream Impacts
Design Current
Design��C►urrent
Design C•urreat
Swine
Capacity Population Wet Poultry
Capacity�Population
Cattle Capacity Population
❑ Wean to Finish
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
El Dairy Cow
❑ Wean to Feeder
__+_I
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish;
El No
�r
El Dai Heifer
2' arrow to Weans
U Roultry
tT
El No
El Dry Cow
El Farrow to Feeder
-,;
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ No
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Beef Brood Cowl
: ❑ Turkeys
Other❑Turkey Poults
NA
-- -
❑ Other
' ❑ Other I
Number vfStructttres�
Page I of 3
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�f
&3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
C1 Yes
El No
�f
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
7NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
L] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�VN
[__1 NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes❑
NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:"6Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
StruK
e I Stryleture 2 Structure 3 Structure 4
Identifier: 9
Spillway?:
Designed Freeboard (in): Z�p
Observed Freeboard (in): 3 5 U
❑ Yes Gj<o ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No E31NA ❑ NE
Structure 5 Structure 6
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 D o ❑ 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 ErNo ❑ NA ❑ NE
8. Da any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rNo ❑NA ❑NE
ElYeso ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 'VNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes 214o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name '
_ Phone: V3
Reviewer/Inspector Signature:
Date:
Page 2 of 12/2S/U4 Continued

Facility Number:— (� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ 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 F1 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O 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 InspectionVNo
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RdNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L7No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ENo
❑ 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;VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9<0
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
- No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RdNo
❑ 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
B<o
❑ 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
VNo
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128/04

r
® Division of Water Quality
Facility Number �' a —---(? ODivision of Soil and Water Conservation
Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: jq1dj1;5:j Arrival Time: $ : 2v Departure Time: County: S cr» Region: r Pz-
Farm Name: P-3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: R e xjAa I 1 as t- Integrator:
Certified Operator: '3 arc, -_04. i- Operator Certification Number: _ L7%Q1,I�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o E T [--]" Longitude: = ° = I 0 u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 10 Non -La e►
❑ Feeder to Finish
® Farrow to Wean 12, 000 07
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ®�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 Qq No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:INA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 8,2 - y I?,p
Date of inspection /.27 /6-1
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: a fi — Q Yje
Spillway?:
Designed Freeboard (in): k 2 X 6 �7 /96
Observed Freeboard (in): 54'
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes U No ❑ NA ❑ NE
❑ Yes ® No ❑ NA EINE
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 EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E� No ❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 16c 0.5
13.
Soil type(s) Ca
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�rAVJI No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation designs or wettable acre determination, E] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
7- 42160.1I1 �',U i ha}s Ac v G 'I I e -as . P/C4LJ c Gan -ii r L.—c- 4-6
Reviewer/inspector Name,� '��"�� Phone:
Reviewer/Inspector Signature: Date: yl-? 7Io_5-
12/28/04 Continued

Facility Number: ..) — 41DS 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 Q No ❑ NA ❑ NE
the appropirate box_ ❑ WUP ❑ Checklists ❑ Design b El Maps El Other
21. Does record keeping need improvement? If yes, check the approprta a box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® 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
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DO No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[j] 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
5 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[,] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
© No
❑ NA
❑ NE
12128104

C
Type of Visit 0 Compliance Inspection Q Operation Review 0 lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 3 ' _T Q Tune:
tO Not Operational 0 Below Threshold
permitted GlllfertiiGed. [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: -•••. ....-.
Farm Name: .......Q..........J.._...... P .................... _....._. _. .._ .__ ___ ._. County. , S m�P aa� __ ...... • iP17.. _.
Owner Name:_l .�P,i<,Lr�� Far!rS -- Phone No:
Mailing Address:.. P.�,.._. �zs...... y1.g...............-����-f-----
Facility Contact: ..-.Ruad's. l ------- Title:.. ....•......................................... .... Phone No:
Onsite Representative:.. . - ----- _...._....._.._._...Integrator: -.-&e
Certified Operator:.._.A_gcA//..../
Operator Certification Number: .... L `Z.'Z
Location of Farm:
twine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 6& Longitude • 4 «
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q44'o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes M�Ko
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
El Yes [91<0-
c.
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a iagoon system? (If yes, notify DWQ) ❑ Yes Q-Fdv
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [; .Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G: Mo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yest[g.Ko
QQ Structure lDD Structuure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. „1..3....r.52�....__----............ .......... ........................... ........ ...... —......................... .................... .........
Frechoard (inches): ('
121121+03 Continued

Facility Number:
Date of inspection.i6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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?
8. Does any part of the waste management system other than waste structures require maintenancehimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes (No
❑ Yes Ewo
❑ Yes [ o
❑ Yes Eg PXo
❑ Yes EM
❑ Yes [g -No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes MVo
❑ Excessive Ponding ❑ PAN ElHydraulic Overload ❑ Frozen Ground [ICopper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes D o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
I6. Is there a lack of adequate waste application equipment?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes Q o
❑ Yes EINo
❑ Yes �o
❑ Yes GINo
❑ Yes LINO
❑ Yes E3No
❑ Yes Flo
❑ Yes ado
❑ Yes S -No
iCo is {refecto question #) 'F.a:plaus any YES answers and/or any recommeadahoas or amy other commenw --
=Use drawings of faci4ty to better explain situateoas.`{use additronal pages as nei�sary)a Cop ❑ Final Notes
Z
Reviewer/Inspector Name fVj�''� (. _�
ReviewerAnspector Signature: /3 Date:
12112103 Continued

• I Facility Number: g 5 — ti/ Date of Inspection 3 -p
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
B-90
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
„5Vi- Vex or? C/ He �a/tt�ra7�.o�t p� t"-5 e appl�Ca/f%M eqa
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
BWO
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ ilb
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
esra4/_SA.4-9 5 0"'1 9 rc7s5 Cove,-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Flo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
El -No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
MWO
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
EBWO
28. Does facility require a follow-up visit by same agency?
❑ Yes
C3rNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PWo
TNTDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
M-Ye—s
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[}Io
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EK
33. Did the facility fail to conduct an annual sludge survey?
Q -Y -es
❑ No
34. Did the facility fail to calibrate waste application equipment?
ETfes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
MW
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Ig—No violations or deficiencies were noted during this visit_ You will receive no further correspondence about this visit.
-�= - - r _ 75
ddtttonal Comments and/or Drawings--�~; a t
._orn�..en g
..,,.,.. �evr .-a._.... _,_'�:'Ji,-.-�-t ..�I. _� �."• .T ,.Y3, _YnC- .x -..Yr
r.�,'i'».. y...�,,.
33 onc/ : 3 I Mr, t�4 re �� 6Y i led l �i� / /i C
�
„5Vi- Vex or? C/ He �a/tt�ra7�.o�t p� t"-5 e appl�Ca/f%M eqa
Gvdt,lcl 6e �,`rl,`s�P� kA enc/ a¢ 4ejpA,-1 poor,
�`!f, UArP7cappr S�a��� T"iiur �'�jPj,are Sk//
warlll'
'�'7g O #7
esra4/_SA.4-9 5 0"'1 9 rc7s5 Cove,-
1 �11 I
0L, S�oPS e /a9oDi1
Far'.., loOks- gooe
1�e corals fool good
12112103