820410_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Division of Wate Reso©rtes
1clu
mber Division ofiSoil and Water Gonservatian
go 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 0 Denied Access
Date of Visit: Arrival Time: ` Departure Time: County:cJ� f'1V Sar— Region: F4'�
Farm Name: — F Owner Email: ^�
Owner Name: �t� S f '^'+� M S Phone:
Mailing Address:
Physical Address:
Facility Contact: uLLYI s La" Title: Phone:
Onsite Representative: Ll Integrator: JEr f3 3 .0—
Certified Operator: / f 4 (e'ra 'RLr✓"kQ r-► Certification Number: g96 Y/8
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
❑ No
[ NA
❑ NE
Current
❑ No
Design
Current
Design Current
Sw�oe Capacity Pop.
F WetsPoultry
Capacity
Po11 p.
Cattle Capacity Pop.
fWea to Finish
Layer
Dai Cow
to Feeder
Non -Layer
Dai Calf
Feeder to Finish
'
Dai Heifer
Farrow to Wean rL.t, Z
;s -
Design
Curren.t''
D Cow
Farrow to Feeder
D '` Piiul
Ca aer
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Non-Laye
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
{
Turkeys
I
Ot erakw.Turkey
a [i
Poults
Other;
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
[] Yes
❑ No
[ NA
❑ NE
[jYes
❑ No
[ NA
❑ NE
❑ Yes ❑ No
❑ Yes [�]0 No
❑ Yes P No
NA [] NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Eacili Number: Date of Inspection:
Wase Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
.1(L�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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 ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes No
C]NA
❑ NE
F-1Excessive Ponding ❑ Hydraulic Overload E]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 i d Drift ❑ Application Outside of Approved Area
CcaS4 �
12. Crop Type(s): 4 ly-f'a 55
13. Soil Type(s):
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 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 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.
E] Yes rn0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 (if 3
2/4/2015 Continued

Facility Number; -q10 Date of Inspection:
24.107d the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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:
E] NA E] NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
[—]Yes EDNA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comrreents (refer to questtoni Explainany YES answers and/or any additional recommendations or any other comments. �,^ '
Use'dfa "i of;facili to l*tte�ex Ia�o`sitnations ase Additional es as-necessa P`' : �Af°i,i'� i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r tt o"` 3 3 9 cO
Date: q 12417
2/4/2015

t ype of visit: w t_ompuance tnspecnon v uperauun meview V structure Lvatuanon V + ecnntcat .assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit:�jl7T1 Arrival Time: ;30Qn^ Departure Time: County:J' T Region:
Farm Name: P
Owner Email:
Owner Name: rt �t'�s Phone:
Mailing Address:
Physical Address:
Facility Contact
-.,j a,"_c5 L-&
Title:
Onsite Representative: k
Certified Operator:Z4&22 &'^_ _
Back-up Operator:
Phone:
Integrator: _Pg,4.'L 19
10,
Certification Number: ?q q1
to
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ NoLap
Design C rent.
Design Current
Swine `� Capacity Pap.
WeNPoultry,.
Capac tyi'op
Cattle Capacity Pop.
❑ Yes
�i] No
❑ NA
❑ NE
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
(
Daig Heifer
Farrow to Wean Design Current-
Da Cow
Farrow to Feeder
D Poul
Ca aci
Non -Dalry
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
1pullets.
---^ ---d Cow
O#her 06
Turkeys
Turkey Poults,
aT . ,
Other
Other
-_
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �6No ❑ NA ❑ NE
[:]Yes
❑ NoLap
NA
E:]NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
�i] No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facility Numbcr: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P} No ❑ NA E] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (❑' No N@ NA ❑ NE
Sttuc e 1 Struc e 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? ❑ YesNo [-]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 pian?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ('$ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �]T 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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 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 CropWindow❑ Evidence Dftujnd rift ❑ Application Outside of Approved Area
12. Crop Type(s): Hip I rkryt �t
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [P 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 0 No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ YesFN
o
❑ Yeso
❑ Yes No
❑ Yes No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
r
�1
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
`
Reviewer/Inspector Name: Q. �� Phone: q /6 —If 3 33 3'
Reviewer/Inspector Signature: - Date: q/z'/�'
Page 3 of 3 21412011

Division of Water Resources
Facility Number L_ ___Q - '� O Division of Sail and Water Conservation
O 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 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time:/Jy County: 5Prr '1PSw J Region: r--0-0
' Owner Email:�
Owner Name: P"1; -c-r— q;~V .S Phone:
Mailing Address:
Physical Address:
Facility Contact: c5a"s Lcirhk-:;, Title: Phone: r
Onsite Representative: W Integrator: Fre S f�
G c%/
Certified Operator: / � �'8 � �� Certification Number: 19 6 f /"6
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
❑ Yes
Desigtt
Current
Design current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[Layer
❑ No
P NA
Dairy Cow
Wean to Feeder
I iNon-Layer
❑No
NA
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
[:)Yes
Design
Current
Dry Cow
Farrow to Feeder
D , Poult .
Ga aci
Po
Non -Dairy
Farrow to Finish
Layers
® No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E�)No
❑ NA
❑ NE
Discharge originated at: ❑ 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 DWR)
[:]Yes
❑No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:)Yes
❑No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:)Yes
W] 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 2/4/2014 Continued

! ;
Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑Other:
Identifier: A
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
Spillway?:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
Designed Freeboard (in):
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�] No
Observed Freeboard (in):
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
T
❑ NA ❑ NE
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
W 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 in No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 50 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 ;U 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): ~""s -fa( p"`' a �s :` i `-trr �s ► s, aaj,4- out w►
13. Soil Type(s): 045kD
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 �D No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �j 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?
Reouired Records & Documents
❑ Yes P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the 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
® No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑ Check lists p Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�] No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
T
❑ NA ❑ NE
Page 2 of 3
2/4/2014 Continued

K
F'acili Number: jDate of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 101 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
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)
T
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
0 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 uestion Explain an YES answers!andlor•an additional.recommendab ottier comments:
Use drawings of facility: to better explain situations (use addrtional:pages i3s necess°r,any
ary)•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:0- '3
Date: dz
2/4/2014

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:Departure Time: County: n Region: —
Farm Name: Ow`ner�Email':�
Owner Name LC -5- Phone:
Mailing Address:
Physical Address:
Facility Contact: �S [ L2 m Q 1^ Title: Phone:
Onsite Representative: U Integrator: r�f��64
Certified Operator: K�_ Certification Number: 76 "<lk
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Khg 11 10.'
❑ Yes
0 No
❑ NA
❑ NE
Design Current
Design
Current"
Design C►arrant
SwmeCapacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish"
Layer
= I
Iow
❑ NE
Wean to Feeder li''Non-La
er
Dai Calf
Feeder to Finish ....
❑ Yes
[] No
® NA
Da' Heifer
Farrow to Wean 75 COO 241 19
❑ Yes
IQ No
ent
Dry Cow
Farrow to Feeder
D. PoW
Ca aci
P,o
Non -Da'
Farrow to Finish
La ars
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
E5 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IQ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412014 Continued

Facili Number: - Date of Inspection:
❑ Yes
R No
❑ NA
❑ NE
-Waste Collection & Treatment
❑ Yes
® No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Eg NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:_
Structure 5
Structure 6
❑ NA
❑ NE
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
—, -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
WNo
❑ 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
K] 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
V1No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift p Application Outside of Approved Area
A t fn 1 n 1. I i A - A fn1
12. Crop Type(s):
YP ()' C a& V, — —
13.SoilT es.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JD No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R 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
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. 0 Yes ,® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Eg No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: -L41D jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �T No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [D No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 12 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.
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑NA [:3 NE
❑ NA ❑ NE
[DNA ❑ NE
❑ Yes jo No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on-site representative?
❑ Yes JE No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JE No
❑ NA
❑ NE
ments (refer to question ft Ezptain any YES answers and/or any additional recommendations-or.,:anv�othercomments w t °
ruse7drawings
of facility to better epiain situations (nse. additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 M -{ Y3 ` 32p
Date: 1!h Ilt
214/2014

I"ype of Visit: ! Compliance Inspection V Operation Review V Structure Evaluation V '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: _0AAAM001J Region:
Farm Name: Owner Email:
Owner Name: Tr-LO5�_ rn s G Phone:
Mailing Address:
Physical Address:
Facility Contact: %4_ Title: Phone:
Onsite Representative:... an Qs t.arylk Integrator: nC t?
Certified Operator: Certification Number: 177 16
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
-°� Design
Current
Design Gnrrent
❑ NE
Swtne
ap.
a. Was the conveyance man-made?
Wean to Finish
La er
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Daig Cow
❑ No
Wean to Feeder
Non -La er
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish
❑ Yes
-
NA
Dairy Heifer
2. Is there evidence of a past discharge from any part of the operation?
Farrow to Wean
No
Design
❑ NE
Dry Cow
❑ Yes
Farrow to Feeder
D 1?ouI
Ca aci
PLo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
Othe
rkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[�} No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/42011 Continued

Facili Number: Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ja No D NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No / NA
Siruc e 1 Structure 2 Structure 3 Structure 4
Identifier: .9
Spillway?:
Designed Freeboard (in):
d !/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ NE
DNE
❑ Yes P No D NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
H 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
1:7/1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
'--'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
%
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[MNa
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes n No ❑ NA D 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 �❑ _E_viddeeJncce of Wind Drift �?❑_A�pplication Outside of Approved Area
12. Crop Type(s): �-M6-w CJS Cg_ S Tat.,) r.5M , moi+-+, orlie.I� I [ A9r't`1
13. Soil Type(s): N8
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? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Co 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 CA WMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes i No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ 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 3 214/2011 Continued

Facili Number: Q Date of Inspection:207117, j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IN 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 �fl 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:
[3 Yes 't-1
No E] NA ❑ NE
❑ Yes �f�' No [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes M No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7K /2-
2/412011

I ype of visa: v uompuance tnspecnon V uperauon tcevtew V structure Evamanon V I eenmcal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 161,111D Arrival Time: (? Departure Time: County: S�M P -CC V Region: CPO
Farm Name: P Owner Email:
Owner Name: �(�s i'1 XVK—It Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C�'►FS
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1 !b
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance mart -made? ❑ Yes ❑ No 6NA ❑ 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? ❑ Yeso ❑ 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 l of 3 2/4/2011 Continued
Desrgn
Current
Design
Current
Design Current
Swinepacity
Pop.
Wet Poultry
&A act
Pop.
Cattle Capacity Pap.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean$9
Design
Current
D Cow
Farrow to Feeder
D , P.ouItt,
Ca aci
`- Aop..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance mart -made? ❑ Yes ❑ No 6NA ❑ 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? ❑ Yeso ❑ 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 l of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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?
TT
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
[9 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`t—' 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 E No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑—A+pplication Outside of Approved Area
12, Crop Type(s): C0,2- ` SS &) I � I C-QOIl a_nVt
n 1 '
13. Soil Type(s): l�
14. Do the receiving crops differ from those designated in the CAWW? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rp No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [j2 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 [4 No ❑ NA ❑ NE
❑ Yes [�g 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/.2011 Continued

Faciti Number: jDate of Inspection: qA/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [)9 No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W 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?
t(''r_ilL''7-1 q -�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
DNA ❑NE
❑NA E] NE
NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
❑ Yes &J No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes 2 No
❑ Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: '
2/4/2011

. -A
EnQFar_Q1!i:ty
Date of Visit:
Farm Name:
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
7 Arrival Time: Departure Time: l County: `'A_"',f'k0K_' Region:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �1"�r 1C"l f7�J Title. Phone No:
Onsite Representative: `-"""'r Integrator: D1, 1 c'e
Certified Operator: Operator Certification Number: /7�Qf�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =I ❑ 41 Longitude: = o = t ❑
I Design Current
❑ No
Design Current
Design Current
ji
Swine Capacity Population
Wet Poultry
C«opacity Population
C►side C«specify Population
❑ an to Finish
❑ Layer
❑Dairy Cow
❑ NE
❑ an to Feeder
Non -Layer
❑ Yes
[� No
❑Dairy Calf
❑ NE
III0
❑ Feeder to Finish
�No
❑ Dairy Heifer
0 N
Farrow to Wean I 1BT4
Dry It ultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
10 Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
El Turkey Poults
❑ Other
❑ Other
Number of Structures:
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 CgNo [:INA ❑NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
[jR NA
❑ NE
ERNA
❑ NE
❑ Yes
❑ No
❑ Yes
[� No
❑ NA
❑ NE
❑Yes
�No
0 N
0 N
Page 1 of 3 12/28/04 Continued

t :ti
Facility Number: Q Date of Inspection I lull IID J
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
Mo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
ON ❑ NE
Structul 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? ❑ YesNo
❑ NA [:1NE
(ie/ large trees, severe erosion, seepage, etc_)
to
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 46 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
RNo
❑ 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.
MNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑// Evidence Wind Drift ❑ Application Outside of/%Area
'off
�
COQ � � SJ►''t �(' oKes4
12. Crop type(s) U � r[ � trowr\
- -
13. Soil type(s) Uxy
14. Do the receiving crops differ from those designated in the CAWW? ❑ Yes
®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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
(A No [I NA ONE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Use drawn sof faciqu sfion # E p Ian an YES answers and/or any recommendations or any other comments.
{ 9 )p y
g oto better�ex lam sr#uafions.{use additional pages as necessary):
AL
Reviewer/Inspector Name l,t#? Phone: lc973 33M
Reviewer/Inspector Signature: Date: I-01-1/10
Pa2 1212810 Continued
ge 2

Facility Number: Q Date of Inspection
Re uired 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 appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 16No [INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IX NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C9 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
15 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
t91 No
❑ NA
❑ NE
General Permit? (lel 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
P,No
❑ NA
❑ NE
Page 3 of 3 12/28/04

r`_
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance f
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: Arrival Time: Z� Departure Time: I 05.W#1 County: &5 L ' [ S01V Region:��
Farm Name:
Owner Entail:
OwnerName- -Pr--c Phone:
Mailing Address:
Physical Address:
Facility Contact:r- yme'l _ Title: Phone No:
Onsite Representative: V Integrator:
Certified Operator: ffikL
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O
=d
='. Longitude: [= o [� s =46
Design ►urrent
Swine Capacity Popuiation
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ Laver
Design Current
Cattle Capacity Population
❑ Dairy Cow
F-1 Wean to Feeder
❑ Non -La er
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
ElDai Calf
Feeder to Finish
❑ Dairy Heifer
arrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
c. What is the estimated volume that reached waters of the State (gallons)?
Non -La eraPullets
❑Beef Feeder
PCIGilts
Boars
❑ Beef Brood Cowl
El Yes
❑ Turkeys
,�,I
J 1 1vA
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
No
❑ NA
❑ NE
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[rNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[�INA
❑ 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
[:1 No
,�,I
J 1 1vA
❑ 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
0 No
❑ NA
❑ NE
other than from a discharge?
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? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Stn cc pre I Slntctmr 2 Structure 3 Stntcture 4 Structure ; Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� R
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
`�' No
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
r
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?
15. Does the receiving crop and/or land application site need improvement?
❑ 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
❑ NA ❑ NE
S. 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)
El Yes
' Ko
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[A No
❑ NA ❑ NE
maintenance or improvement?
FrNo
❑ NA
Waste Application
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
� �
L"No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of inconect application? If yes, check the appropriate box below. El Yes
_/
R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑E�vidence of Wind DrTiift- [:]Application Outside of Area
12. Crop tyPe(s)CC0
PV1 Q5 JY►t • C% -(Mtn
13. Soil type(s)
14. Do the receiving crops differifiom those designated in the CAWMP?
❑ Yes
RrNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
El Yes
' Ko
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[(No
❑ NA
❑ NE
IComments (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 ` pA I V JlAzhC ,-izZ Phone:
Reviewer/Inspector Signature: Date:
IZ%2"4 Continued

Facility Number: Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [:1 Maps El Other
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LTNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L7 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
ETNNo
F-1NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Ej'*No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
ffo
[__1 NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O/No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L�'J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LTNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[❑ Yes
E(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,.,/
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
����
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
El Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U"N"o
❑ NA
❑ NE
12128/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 10 Departure Time: County: rte 0� Region:
Farm Name: ��f�,, — Owner Email:
Owner Name: �I`QST' f==firms �+7 tC r _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator• T?VS
4W_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' 0 Longitude: =0=& =,
�'.
'
-
Design Current `- _ ._
- -,-
Design �Cu rr ent `� Design Current
Swine .--
Ely
Capacity Population «'met P4u1{�
Capacity P p lahon` Cattle Capacity Population
❑ Wean to Finish
I 2101-ayer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I ❑ Dairy Calf
❑ Feeder to Finish
F
❑ Dairy Heifer
Farrow to Wean
Dry Poultry-
❑ Dry Cow
Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
4 ❑ Non -Dairy
ElFarrow to Finish
E] La ers
E] Beef Stocker
❑ Gilts
❑ Non -Layers
` ❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Yes
�_ ❑ Turkeys
=
Other
❑ Turkey Poults
❑ Yes
❑ Other
❑ Other
Number of 5tructufps:
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes A 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
[__1 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
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�JNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
11 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ej 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 FjNo ❑ NA ❑ NE
mai ntenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EDNo ❑ 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
pWindow]j El Evidence of Wind Drift ❑//ApplicationO,�utside of Area
12. Crop type(s) �'� &LVVb t tAe7 &Ckss Cf�Qyl 1 -5m, CZZ4%' oor=O(/
13.
Soil type(s) a�
r
01 1
Facility Number: Q Date of Inspection
14.
Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & Treatment
l] No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PqNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NoNA
ElNE
Structu e l Structure 2 Structure 3 Structure 4
Structure
5 tnicture 6
Identifier:
Does the facility lack adequate acreage for land application?
❑ Yes
;9 No
Spillway?:
❑ NE
18.
Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
Q5No
❑ NA
❑ NE
Observed Freeboard (in): 3
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
19 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ej 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 FjNo ❑ NA ❑ NE
mai ntenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EDNo ❑ 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
pWindow]j El Evidence of Wind Drift ❑//ApplicationO,�utside of Area
12. Crop type(s) �'� &LVVb t tAe7 &Ckss Cf�Qyl 1 -5m, CZZ4%' oor=O(/
13.
Soil type(s) a�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l] No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
V3 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
;9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Q5No
❑ NA
❑ NE
COtnlnent5E(re�er t0 gUe5tIon #� EYPIaIn aIIy i�' S,�anl$FVCrS flnd�Or anj' rQCOmtilCndfflLlORS Or ally Other COmIIleIItS.
'Use drawls s°of Cecil/ `to berte"r�`ex' Ifltn s�tnattons a nse addlho©al a es as [necessat �
Reviewer/Inspector Name Phone: EsD
Reviewer/inspector Signature: Date:
Page 2 of 3 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q 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 T No [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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 n 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
LCi 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
[;4 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

30 Division of Water Quality
Facility Number a. 10 O Division of Soil and Water Conservation
- - - O Other Agency
Type of Visit Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit IgMoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:�sDO�—i CArrival Time: Departure Time: 7�
Farm Name: r J Own'
Owner Name: --R Q_ �GU MS Ph
Mailing Address:
County: Z&r"* Region
er Email:
one:
Physical Address:
Facility Contact: Title: Phone No:
- f _
Onsite Representative:
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
Back-up Certification Number:
Latitude: =0
=g
=is Longitude: = 0=' E--] W
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other - - -
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ 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 a,,' ,.Capacity Populateon
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c- What is the estimated volume that reached 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 P No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
IP NA
❑ NE
❑ Yes
❑ No
FANA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

`Facilitty Number: Z— �fl Date of Inspection o�
Ir -
Waste
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ElNE
Structure 1 Structuur 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 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?
11. Is there evidence of incorrect application? 1f 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 CropWindow El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) --6-0 sm C
13. Soil type(s) eta -6
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
§allo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
E�l No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
T No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gg 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):
A.
I
T
Reviewer/Inspector Name MIN PbN � r Phone: t 3 ,33Q
Reviewer/Inspector Signature: Date:
' 12128/04 " Continued

t ,+
Facility Number: — Date of inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1&4o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes '"No [:3 NA E]NE
the appropirate box. El WUPEI Checklists El Design ElMaps E]Other fm
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'PNo ❑ 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
10No
❑ 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
91No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONO
❑ 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
LSI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
C
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Wo
❑ 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
12/28/04

Type of Visit *'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County. r t Regiov-4a
Farm Name: r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
&_4ff4WQL.
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =1 0 =I = 11 Longitude: = o =I
= "
Design Current
Swine Capacity Population
Design
Wet Poultry Capacity
Current
P
Design Current
5 -D —ac i t-yj Papulation
❑ Wean to Finish
❑ La er
No
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
;-w
a. Was the conveyance man-made?
❑ DaiEy Heifer
arrow to Wean
❑ Farrow to
,� I
E/NA
EINE
❑ Dry Cow
Non -Dairy
❑ Farrow to Finish
Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ No
❑ Beef Feeder-
eederBoars
Boars
❑ Pullets
❑ Beef Broad Ca
--
❑ Turke s
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
Qther
❑ Turkey Poults
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Other
10 Other
❑ NA
Number of 5tructures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No ❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
[--INA
❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
,� I
E/NA
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
Ngo
l
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑
L1 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No ❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

Facility L4umbepc IS—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA Cl NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No LJ -NA ❑ NE
Structure I �tntcture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): zip
Observed Freeboard (in): Jed
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ 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 VfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Eallo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EI/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [O/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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0�0
❑ NA
❑ NE
Reviewer/Inspector Name Phone: 0 3
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6N o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R�� No
El NA
El NE
IT Does the facility lack adequate acreage for land application?
El Yes
[!3 No
❑ NA
EINE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
5;KNo
❑ NA
❑ NE
Comments (refer to question-# ): Explain any YES answers and/or any recommendations or anyjother comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):'
Reviewer/Inspector Name Phone: 0 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12Y28104 Continued

Facility Nt mher: Z.—f} 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Pl�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4YNo [INA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�,Xo
❑ NA
❑ NE
29.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ NA
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
30.
At the time of the inspection did the facility pose an odor or air quality concern?
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
Cd No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNoo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Mlqo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
FfNo
❑ NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M' o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
eNo
❑ 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
EINE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L'7 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

®Division of Water Quality �'
E.1"TacLy Nl1ECl er p o2� (d O Division of Soil and Water Gon eervafion
Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: yI17ItiS"nArrival Time: 'moo Departure Time: County: 50 *~EPSON Region: Rc�
Farm Name: l' " S Owner Email:
Owner Name: er ems r--!3 c. Fe r w%_> Phone:
,'Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: R ,y J,1_i
6u.
-,
Integrator: F,-= -1• ¢g, r
❑ Yes
❑ No
Certified Operator: -, k o Il
,.�Ir
ob 4-
Operator Certification Number: 17 -7 r4
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = = Longitude: =0=,
o=, ❑
Design,:...Current Design Current
Swine Capacity. Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean 0.pov DG S/
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other J.
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ 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'?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
Number of Structures:
Design Current.
Capacity. Population
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
12/28/04 Continued
i

Facility Number: g.2 - -A,o Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 191 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2\ Structure 3 Structure 4 Structure 5 Structure 6
Identifier: aw1-a
Spillway?:
Designed Freeboard (in): � q k -9 % �o' /-) 1.7715'6
Observed Freeboard (in): mmP ';LgL,44 4
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?
R] Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
[]NA [-INE
(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
N No
❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN [--IPAN > l0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 9 CX S4-
13. Soil type(s) r,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
M No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© No
❑ NA ❑ NE
/^ dark- c. &d 6--e- QvGc.)
o-� t Qgat, 1.). 6-.1�-'
Reviewer/Inspector Name�g"N o.we Phone:
Reviewer/Inspector Signature: Date: 1 /-,37/aS
12/28/04 Conhfnued

1 aeility Number: g a — y ro Date of Inspection `f 1171 pr
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 5D No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes x❑ 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
N 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
3.1.
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
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
m No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Ql Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 3 O Time:
NNot erational Q Below Threshold
®-Permitted E erifiied. 0 Couditionally Certified 0 Registered Date Last Operated or Above Threshold: ........
Farm Name: ......._....._. ,6--- .................... -.......... ...... .................. _... County:..
Owner Name: r n, s Phone No:
1V uhng Address:.._.
Facility Contact: ..... R471�• - -a�3f� ?�f�Q �...� Title: .. . ................ . ..................... . ........... Phone No:...
Onsite Representative:. �4e�c% -- ��L _�-----...--------- W... Integrator: --- ...._---___---
Certified Operator:---..%�q _ . 6—kr– F-0–c�L ---------- Operator Certification Number:...,,L29 g�.__._.--
Location of Farm:
&Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 46 Longitude • 4 1.4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ yes U -No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'? ❑ Yes EWb
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yeSd
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑-Nv
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes C9 -No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3
Identifier: _. ................................... a .......... ... .._........
�....�....�.-.......
Freeboard (inches):�
12112103
Structure 4
❑ Yes 0wo
Structure 5 Structure 6
Continued

e
i
Facility Number: — y
Date of Inspection 0
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 maintenance/improvement?
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 maintenance/improvement?
❑ Yes U -No
❑ Yes B -N -o
❑ Yes Q -No
❑ Yes ❑NO
❑ Yes [fib
❑ Yes 9No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Q -No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cpy�ts, .Sr�ryl� ras2s:�r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 63NO
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes Q -No
❑ Yes R -mo
[--]Yes PNo
❑ Yes ❑No
❑ Yes &No
❑ Yes 9 -No
❑ Yes ❑No
❑ Yes [-No
❑ Yes D N"o
�,Conunents (refer bo�gtnestznn �-�Explam any YES answers and/or any recommeadatzoas or any other oomieQeats. �- �' � ���_ ,
Use drawings iacty to better explain sitnat5{oredrttonal pages a5 necessary3 =Geld Copy ❑Final Notes = = w
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Reviewer/Inspector Narueigr �( :`f
..-`=p�, --
Reviewedlnspector Signature: Q Date: 3- c1 `U
12/12103 Continued

Facility Number: Date of Inspection F7 - •c
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
❑ Yes 0-K'o
❑ Yes ❑bio
❑ Yes ❑filo
❑ Yes [ti]No
❑ Yes aHo
❑ Yes EWo
❑ Yes D -No
❑ Yes Ewo
❑ Yes C9 -No
❑ Yes [i Ko
❑ Yes EI -No
r(M13es EKo
ICnra❑des aNO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [WO
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
U—No- violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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