820412_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental QuA

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: r, O Departure Time: County: &r SO+^ Region:
Farm Name: _ 2 Owner Email:
Owner Name: Pves __F -ay r�vs Phone:
Mailing Address:
Physical Address:
Facility Contact: ,)a 5 "naa Title: Phone:
toLOnsite Representative: Integrator: PO s /
Certified Operator: A lel R M Certification Number: W6 LJ r �6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
WetPoultry C pa is ty Pop.
-
Non -La er
E'
' Design Cu-rrent
Flis-
D , I'oult .",, Cappa I'o .0
Design ourren.t
Cattle Capacity Pop.
IDairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dai
Wean to Feeder
Feeder to Finish
Farrow to Wean 2joM
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1puflets
Turkeys
Turkey Poults
Other
Beef Brood Cow
:I
Other
Other
❑ Yes
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
❑ Yes No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
[g NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
P 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
a 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 l of 3 21412015 Continued

Facility Number: -Lj I Inspection: Date of Ins ti
+-?
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 7❑' No P9 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
No
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
No
❑ NA
❑ NE
? t'
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes]
T
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
❑Other:
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)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t!o No
9. Does any part of the waste management system other than the waste structures require
[] Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
TT
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 Wo ❑ 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 fff Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): COQ54f &-rrV"Jq
13. Soil Type(s): CA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired 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 ofthe 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
[�q No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield [:1120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�? No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t!o No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E?,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Pd No ❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 0
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes bfl No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Signature: " l Date: vh&
Page 3 of 3 2/412015

J
Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 76 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: �Departure Time: .'�County:5q9A490NRegiou:F710
Farm Name: r Owner Email:
Owner Name: j^ �f Phone:
Mailing Address:
Physical Address:
Facility Contact:-�Title: Phone:
Onsite Representative: Integrator: E�_W-wl
V, q
Certified Operator: I �'` Certification Number: ! 1 / I,P
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
,�...: �f, �vwr -� .-•. ,
x Desrgn Current Design Current Design Current
�Y.
Swme a M..Capac�ty Pop. Wet Poultry . @apsctty�Pop Cattle Capacity Pop.
_ z r
Wean to Finish FLayer Dairy Cow
Wean to Feeder Non -Layer Dairy Calf
Feeder to Finish' Dairy Heifer
Farrow to Wean " 'I Design .Current;" Dry Cow
Farrow to Feeder D 9 P,oult . �Ca acr1?o Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other tiF�
Turkex Poults "W .
Other _10t
her
Discharges and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
E] Yes PNo ❑NA E] NE
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 2/4/2011 Continued

Facili N4mber: - Date of Inspection: 2�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 2 Structure 3 Structure 4 Structure 5
Identifier: TL
`
No ❑ NA ❑ NE
No P NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yesj� No ❑ NA [—]NE
(i.e., large trees, severe erosion, seepage, etc.) 99
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes, No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Avotication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo [:]NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable FroWindow Evidence of WW DriftE]Application Outside of Approved Area
12. Crop Type(s): (aK �PA �SS �], / i �� - Uli�<S (/Ue'sc.-�
13. Soil Type(s): �_ ar) e
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ 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
1�1No
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
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 El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P 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
[�fl No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
119 No
❑ NA ❑ NE
Page 2 of j
1/412011 Continued

Facifi umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
El
No El NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
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.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsror" any older comme-nts.
Use drawings of facility to better explain situations (use additional pages as necessary);
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

(Type of Visit: 1♦ Compliance Inspection V Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: DD Departure Time: County: S4-rv`fSvp Region:
.7Farm Name: — /_ Owner Email:
Owner Name: Anes tu�ff T-a*IMs Phone:
Mailing Address:
Physical Address:
Facility Contact: c.yy�qs Ui,l Title: Phone:
Onsite Representative: Integrator: Try Lgse_
ej
Certified Operator: Alex 1'"V, Certification Number: g9( of"
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design
Current
Design
Current
Design Current
SwineCapacity
Pop.
VI'et Poultry
Capacity
P,op.
Cattle Capacity Pop.
li
Wean to Finish
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Layer
Da' Cow
Wean to Feeder
❑ No
t -
n-
NoLa er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Da' Calf
Feeder to Finish
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�]e No
❑ NA
❑ NE
Da' Heifer
Farrow to Wean yipqq
s
Desigti
Current
Cow
Farrow to Feederaci
l'o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
E%154.
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OMNI* &R.
L
Turke Poults
=ther
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:
>FM
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[y] 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
F� I 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
�]e No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412014 Continued

4 �
FaciliNumber: - Date of inspection: ?,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pa 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: -13
-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any inunediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[—]Yes [�PNo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ug No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[� No
❑ NA
❑ NE
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)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
Do No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ip 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
� J ❑ Evidence of Wind Drift ❑ Application Outside of�Approved Area
12. Crop Type(s): Oct -4 i Ike-y�uGi at � �1�.�-,�
13. Soil Type(s): ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �j] No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes �p 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 [J Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections [] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No [DNA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: 2_ q 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes FM No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes rid 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
W No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
[-]Yes
® 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
W No
❑ NA ❑ NE
Comments (refer to question d#)Explain any YES answers and/or;any additional recommendations or any other comments,; � .
Use drawings of facilityto'betterexplam,situations (use additional -pages as'necessary)- .. :..;�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: lj] D - y 3 3- 3 300
Date: l�Z1.21"k-
21412014

(Type of Visit: ID Compliance inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: V I Z-� AWCOUnNatpgo Region: Q
Farm Name: Q
Owner Name:(e_SI�—�'�
Mailing Address:
Physical Address:
Facility Contact:
jp (Y�e S LQ=tnrn�) Title:
Onsite Representative: N rfV_- b
Certified Operator: 14 V, 1, e, t[_ / l
Owner Email:
Phone:
Phone:
Integrator:�Gs
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren#
Design
Currentmom
Design Current
Swine Capacity Pop.
Wet Poultry
Capaei#y
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,o
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
DischaLrges 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)
❑ Yes K? No ❑ NA ❑ NE
❑ Yes [] No Pa NA ❑ NE
❑ Yes [] No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [R No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes n No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection:
❑ Yes ® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Waste Collection & Treatment
❑ NA
❑ NE
Required Records & Documents
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rM No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
gpNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
F5 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
2] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
Pa)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
j j] No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (ONo [DNA ❑ 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): LL5S Waxj 6oi- i,_ ral n O! ow_ (,56e�_
13. Soil Type(s):LQQQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ej�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable . ❑ Yes ,® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 49 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Ig No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] 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 Eg No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes a No (DNA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facih Number: - 1 Date of Inspection, 1-7-1404
❑ Yes
(9 No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
P+No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
34. Does the facility require a follow-up visit by the same agency?
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F�5] No ❑ NA 0 NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No ❑ NA 0 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 ONE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
(9 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
oNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P+No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[9 No
❑ NA
❑ NE
Comments (refer touestion Explain an answers an or y ditiona! recommendations or any other comments:
'... p g as uecessary}
Use drawin{sof facih to better explain situations use addrhonala a
g ty P {
._0�*
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

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: 2 Arrival Time: Departure Time: County:,Vk�P&�A% Region:
Farm Name: Owner Email:
Owner Name: ��S C _ m S _J;:�. • Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �I arnQS I 1'Tro Integrator: ?ios4ill
Certified Operator: /•l _ Certification Number: 17'79 p
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
[:]Yes
❑No
JE] NA
❑ NE
[—]Yes
❑No
W NA
Design Current
❑ Yes
Design
Current
ignCurrent
Swine
Capacity Pop.
Wet 1'ouliry
-` Capacity
PoJ=Des
apacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
a -`�'
Dai Heifer
Farrow to Wean
22 { 24
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult ,
Ca aei
Pio ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turke s
Other
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 R No ❑ NA ❑ NE
[:]Yes
❑No
JE] NA
❑ NE
[—]Yes
❑No
W NA
❑ NE
[:]Yes
❑ No
NA
❑ NE
[:]Yes
r] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

>facili umber: -97 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 5a NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 23
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -42— 3111
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 77��
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[j] 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)
[] Yes
0M No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
❑ Yes
[] No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
N No
T�
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
�-� _{❑ Evidence of Wind Drift ❑ Applicaatiionn Outside ooff Approved
,Area
12. Crop Type(s): (s ( l '!1'�c,l Lr�R SS A, ) , ' L! r-x,(f4� w/� {
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�§ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V]a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
0M 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 Fo 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
[] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q§ No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili 'Number: jDate of Inspection: 312S117,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 09 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? 0 Yes [P 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 IM No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
FY -1 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
p] No
fp
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: f�d`r33tJ7
Date: 2
2/4/2011

Type of Visit: 40 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time:County: a9mmd
Farm Name: 2 Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region: go
Onsite Representative: arAS L46y16 Integrator: T(py4tQP_
Certified Operator:Certification Number: 177%
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
&ignqb went J
CapacttyPop.
Design Current
Wet Povultry Capacttv�Pop,
Design Current
Cattle C*opacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
,nom >,
Dairy Heifer
Farrow to Wean
AXV'�
-`=�
DesignCu ent
Cow
Farrow to Feeder
D ,Poult
Ca'acr Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other_
�_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes M No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [:]No
�]NA ❑NE
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 EQ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility umber: - Date of Inspection: -
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
(�No ❑ NA ❑ NE
❑ No ® NA ❑ NE
Structure 6
[] Yes l No ❑ NA ❑ NE
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
[BNo
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
n No
`�''
❑ NA
[j NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EP No
❑ NA
❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No [:]NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA [3 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 Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
Type(s): Q
i3.Soil T es: _.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
n No
`�''
❑ NA
[j 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 [] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [N No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Ficilitj Number: -41 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List str icture(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 E] NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [ZA NA E] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes F)C] No ❑ NA ❑ NE
❑ Yes [g 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 ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer -to question ff): Explain any YES answers and/or..any additional recommendations or,ag4?ther comments:
Use drawings of facility to better explain situations (use additional: pages as necessary).
(Z -es I- 91V -d'
� � J i s�� 0i,-, q-(941'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: wo 33�
Date: q:lq'I1
2/4/2011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I � (-� Departure Time: 5D,� ty: S�'r'Ii�01J Region: FPO
Date of Visit: / Arrival Time: Court
Farm Name: r , A
Owner Email:
Owner Name: T rt` S _T'j G • Phone:
Mailing Address:
Physical Address:
Facility Contact: ff3cZre-(WVTitle: Phone No:
Onsite Representative: R� s Integrator: PreS4m'e
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
= =,A Longitude: 0 O 0 d
Discharges & Stream ImlRacts
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
[20 NA
EINE
Design Current
Swine Capacity Population
Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
EINE
❑ Wean to Finish
❑ Layer
❑ Dai Cow
EINE
to Feeder
❑ Non -La er
❑ Yes
EPNo
❑ Dai Calf
EINE
FL�ean
eder to Finish
10 Farrow to Wean 1 Dry Poultrh
❑ Farrow to Feeder
El Farrow to Finish ❑ Layers
Gilts ElNon-Layers
PEJBoars El Pullets
❑ Turkeys
Other -El Turke Poults
❑ Other ❑ Other INumber
❑ Dairy Heifer
❑ Dry Cow
❑ NA
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
of Structures:
Discharges & Stream ImlRacts
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
[20 NA
EINE
❑ Yes
❑ No
®NA
EINE
Q� NA
EINE
❑ Yes
❑ No
❑ Yes
EPNo
❑ NA
EINE
❑ Yes
1#No
❑ NA
❑ NE
Page 1 of 12/28/04 Continued

12. Crop type(s)
13. Soil type(s)
M55
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
Facility Number: &L Date of Inspection
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
qD No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 0NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: i✓
❑ NE
18. Is there a lack of properly operating waste application equipment?
Spillway?:
® No
❑ NA
❑ NE
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
1�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pari of the waste management system other than the waste structures require
❑ Yes
P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
M55
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
qD No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
'WeCo-45 al/Z C(/,,Q
Review•er/inspector Name Mrd�� • MPF Phone: lf7• 33-
Reviewer/Inspector Signature: AA12, Date: I o d O
Page 2 of 3 12/28/04 Continued

J
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 appropriate box. ❑ WUP ❑ Checklists
❑ Desigm ❑Maps El Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�ONo ❑ 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
6j No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[J Yes
M 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
'P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: =^
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

he
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-I",Arrival Time. !�•� Departure Time: 2�L14 County: S� SO/J
Farm Name: Owner Email:
Owner Name:, Y� Pr ms Phone:
Mailing Address:
Physical Address:
Facility Contact: ��4 ' 1 i KM Title:
Onsite Representative:
Gta—iiws; Lando
Certified Operator:
Back-up Operator:
Region:
Phone No:
Integrator: Trwl6je
Q
Operator Certification Number: 1719,6
Back-up Certification Number:
Location of Farm: Latitude: ❑ o Q 6 = Longitude: = ° Q I ❑ u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;4 No
❑ NA
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Yes
❑ Wean to Finish
❑ La er
❑ Da Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Feeder
❑ Non -La er
❑ Dai Calf
HFeeder to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ NE
El Beef Stocker
Gilts
Non -Layers
El Beef Feeder
ro Boars
❑ Pullets
El Beef Brood Co
No
❑ Turkeys
❑ NE
Other
❑ Other
❑ Turkey Poults
❑ Other
Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
1p 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
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?
a. If yes, is waste level into the structural freeboard?
Stn ict re I Stnteture 2 Structure; 3 StnJCtUre 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 't
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes KONo ❑ NA El NE
❑ Yes ❑ No (P NA ❑ NE
Structure i Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes i No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No 0 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 comp) iance alternatives that need ❑ YesNo
ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
f $ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceind Drift ❑ Application Outside of Area
12. Crop types)&mJS O
13. Soil type(s)
14. Do the receiving crops di er from those designated in the CAWMP? ❑ Yes
Wo
El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
P No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
�a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [IYes
Fm No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Comments (refer to question 4): 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):
Reviewerfinspector Name Phone:
Reviewer/inspector Signature: Date:
f / 11/28/04 Continued

,r
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 E] NA [:1 NE
the appropriate box. ElWUP El Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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
t§No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�kNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
1p 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
Qallo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1P No
❑ NA
❑ NE
Additional Commentsandlor Drawirrgs:,� ri 5_ *-
-�
T
12!28104

Type of Visit 4P 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 O�ther,Q ❑ Denied Access
Date of Visit: 8 Arrival Time: /p Departure Time: /� ��, County: � r st9o�l Region:
Farm Name: f� Owner Email:
rte; •,�- _
Owner Name:i ►"� Phone:
Mailing Address:
Physical Address:
Facility Contact: / _ � Title:
Onsite Representative. `-� S b
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o =d =66 Longitude: =1 o =' =
Swine
esign Current
Cap ty I'opulatioa
Wet Poultry
Design Current.
-rapacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑Layer
❑ Dairy Cow
❑Wean to Feeder
❑ Yes
❑ Non -Layer
NA
❑ Daia Calf
❑ Feeder to Finish
❑ Yes
❑ No
_
' *
❑ Daia Heifer
Farrow to Wean
aO3s
Dry Poultry
= Mx
ElD Cow
❑ Farrow to Feeder
❑ Yes
❑ No
—
ElNon-Dairy
❑ Farrow to Finish
❑ Yes
El La ers
❑ NA
El Beef Stacker
❑ Gilts
❑ Yes
❑Non -La Non -Layers
❑ NA
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
-
❑ Turkeys
Continued
Other" `�
❑ Turkey Poults
� �- - _
❑ Other
❑Other
Nurriber�f�Struoetures:
...........:.
Discharges & Stream Impacts
L 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
y,
No
❑ NA
❑ NE
other than from a discharge?
1
Page I of 3
12/28/04
Continued

acility Number: a59 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ONA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qxl
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
PRNo ❑ NA ❑ NE
through a waste management or closure plan?
[--]NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
NbNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo
[:1NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ yes
No ❑ NA ❑ NE
maintenance or improvement?
® No
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo
❑ NA [:1NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KANo ❑ 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 offf A��c__ceptta_blle Crop Window Evidence of Drift/� ❑ Application Outside of Area
(�El }Wind
12. Crop type(s) CXS � rr""�/l�( "'v 5S � 41, /r � , [Y�'6 Og6w7
13. Soil type(s) Acn4
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?
❑ YesNo
Ps
[:1NA
[--]NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
`P No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name i Phon
ReviewerlInspector Signature: Date:
Page 2 of 3 12/28104 Continued

Facility Number: Date of Inspection l- A
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [j3 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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
J9 No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 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 PNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 4 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
C9 No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
[1 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
�9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments aiid/or Drawings: } r
w
Page 3 of 3 12/28/04

Ip
FA
Division of Water Quality
Facility Number �- Z O Division of Soil and Water Conservation.
- O'Other Agency
Type of Visit ompliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access L9i�
Date of Visit: O1 Arrival Time: Departure Time: County: Region:' T'
Farm Name: P— 2, Owner Email:
Owner Name: ! r R t&✓ rriS Phone:
Mailing Address:
Physical Address:
Facility Contact: `e Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=g Longitude: = ° =I 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current.
Capacity - Population "
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©i
b. Did the discharge reach waters of the State? (1 f 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 F NA ❑ NE
❑ Yes ❑ No 9 NA ❑ NE
❑ Yes
❑ No
)ffNA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
12/28/04 Continued

`f t.
Facility Number: a. — Z Date of Inspection
No
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 ❑ NoNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structwe 5 tructure 6
Identifier: �A
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
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 O yes�] No ❑ NA ❑ NE
maintenance or improvement? fl
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
Reviewer/inspector Name-6�Q�STIw- WDIJ -7 AQ LE Pbone: 101/33 �](�
Reviewer/Inspector Signature: Date: as
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) t`J — S m 6r
13.
Soil type(s)-
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
12 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
RSNo
❑ 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. (ase additional pages as necessary):
w
Reviewer/inspector Name-6�Q�STIw- WDIJ -7 AQ LE Pbone: 101/33 �](�
Reviewer/Inspector Signature: Date: as
12128/04 v Continued

Facility Number: — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Lp No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yeslo El NA [INE
the appropirate box, El WUP El Checklists El Design El Maps El Other f]`'
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Cade
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
!93qA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes�jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�KyNo
❑ 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
9 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesrNo
o
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
lo
❑ NA
[:1 NE
If yes, contact a regional Air Quality representative immediately
l
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes[
No
[:1NA
E] NE
General Permit? (ie/ discharge, freeboard problems, over application)
{{
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time- Departure Time: County: N52&=e5C^ Region: iW
Farm Name: P- a
Owner Name: 'PreLJugg2
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 8144
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
D Phone No:
Integrator• I �sTsP
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 1-7] o 1-7] 1 0 l{ Longitude: = e = i it
Design Current
Design Current
Design Current
❑ Yes
Swine CapacityPopulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ No `eNA
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder 10 Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
❑ Layers
El Non -Dai
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
E] Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- ---
❑ Turke s
- -
Other
❑ Other
❑Turke Pouits
❑Other
Num her 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?
Page I of 3
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No ZNA
❑ NE
❑ Yes
❑ No ENA
❑ NE
❑ No `eNA
❑ NE
❑ Yes
❑ Yes "LJ No -❑ NA EINE
❑ Yes ��No [:INA ❑NE
12/18/04 Condnued
A

ef /kq
r
FacilityN.qmber: S;L,-y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ETNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: oQpt- gB
Spillway?:
Designed Freeboard (in): ( Y
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 EfNo ❑ 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 1K No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19No ❑ 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)X54-CL(6 G-06 r6 G_0
13. Soil type(s) GA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers and/or any recommendations or any other comments. mlf "
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
Reviewer/inspector Name Phone: 9ro'Y33-336wo
Reviewer/lnspectorSignature. _1 Date: q�o�
Page 2 of 3 `" 12/28/04 Continueg
/�

>Facilit)rNuntber: a — ?. Date of Inspection
Required Records & Documents/Ov/0�P
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IV No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes . ANo [INA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps [:1 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
46No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
No
❑ 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
eN o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
52�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (9 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: rr2--
Farm Name: P- .� Owner Email:
Owner Name: pr <__5 + a! <_ ^^ F12" "'-5 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: oe%A- Integrator:
Certified Operator: 12 a � 16 o r t '�r y 0 4C Operator Certification Number: %9
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =' =' =" Longitude: = o = = u
Design Current Design Current
Swine Capacity Population. Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Dov d 3dL
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I' Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity,- Population-,
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 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 CO No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: g,?-- `i la. Date of Inspection
,`_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: i C�
Spillway?:
Designed Freeboard (in): _ J " s ! 3 114 G
Observed Freeboard (in): all " 3911
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
El Yes No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 5 No ❑ NA ❑ NE
❑Yes ®No El NA EINE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures tack 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? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) rn u�a h 0,5
7- �QG)OD�u �L S, ij6+YG SISPFS. P�CCS� C�v�f`�k� {o tJar� -fit] 7%
V
Reviewer/inspector Name., ,' ;jam ' ;, ,, Phone:
Reviewer/Inspector Signature: Date: ylJ 71 e J_
13. Soil type(s) (' r a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes
[11 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Qd No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comineuts (refer to question#)EspiawianyYEB:answers and/or any recammeadahons ora y other earnments.
Use drawings�of iacrlity to better egplainlrtuationsw (nse i dditi6nal'pages as�necessary} , , -
7- �QG)OD�u �L S, ij6+YG SISPFS. P�CCS� C�v�f`�k� {o tJar� -fit] 7%
V
Reviewer/inspector Name., ,' ;jam ' ;, ,, Phone:
Reviewer/Inspector Signature: Date: ylJ 71 e J_
12/28/04 Continued

Facility Number: Date of Inspection i//.2 7
.
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 RI No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [1] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[B 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
Otherlssues
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
[0 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
[3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
tgs:
Rdditionai Comments andlor llrawitIiiii�1111111111 1-01101
- �t + , CL . v_- . it o �_ p )CIA 10"17',
a 3 - 5-,
L L}
1� j `{' c �a,�� 3 � � t Y7 G r a '�r� v IG � '�'� � a 1L � r, �+� v++ b r�-�� 5 Y 7 �i S � � C.Yib ✓L S[ C� GC., �C..e.��`
12/28/04

1
Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit @ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: - �D� Time:
Q Not Operational 0 Below Threshold
0 Permitted Q Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ----- ........
FarmName:........... P-.2 ................................... .... ....... ................................... County: .... SRt7..� .. �..... ..L� ......
Owner Name:-P�e��...a��r `�..._..........____ Phone No:
Bailing Address:g--............-_,.__
Facility Contact: L} pad I T -I
!tle- Phone No:
Representative: R6nL_ir A_ ALC �oo f'_... .................................. Integrator:...
Certified Operator:-_, ,.,Ran Ul-_,_, IiJ Q�eiFft. - Operator Certification Number.... Irl _.....
Location of Farm:
D -M -Wine ❑ Poultry ❑ Cattle [I Horse Latitude �• �� �_��� Longitude �• �� 46
swine _-
Swine _ Crgcty
Wean to Feeder
Feeder to Finish
ED -Farrow to Wean or�r o nD 4gL,2 o O
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Non -Layer Non -Dairy
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes M'Ko'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made'? ❑ Yes [moo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) [] Yes EKo
c. If discharge is observed, what is the estimated flow in gallmin? —fes
❑ Yes @-Mo
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes EgoKo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Eg' o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes QAIo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._��....d............. ......... .......... . . . ........... . ................. - - - - - - --------------- --------- - I . .......... . .........
Freeboard (inches): 30
12112103 Continued

j lFacitity Number: SA -- 1i I -;t
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes 9 -No
❑ Yes [9 -No
❑ Yes Eg ' o
❑ Yes [g4qo
❑ Yes ONO
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
D -N6
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Ewo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12-
Crop type (f oet S rn c Lj ; n
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[}No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
B No
b) Does the facility need a wettable acre determination?
❑ Yes
❑4+10
c) This facility is pended for a wettable acre determination?
❑ Yes
&No
15. Does the receiving crop need improvement? ❑ Yes SVo
16. Is there a lack of adequate waste application equipment? ❑ Yes M -No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑..No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑.No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [9 -No
Air Quality representative immediately.
Comments (refer to question #) Explain aay YFS answers and/or any recomanendaboas ar asy ot)rer comuiemts. —
Use drawrags of fac�iriy to btteT eacplarn suaattotas�(use'addrtwival was nrY) [geld Copy ❑ Final Notes
�-
x
r 1
Reviewer/Inspector Name %='i�C �rsy;•/Pz
:'_ :'
Reviewer/Inspector Signature: AaiAQ Date: 3 — cJ -G L/
12112103 � Continued

Facrlity Number: g.2 — [/ « I Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 93 'No
❑ Yes [}Nb
❑ Yes U -No
❑ Yes M -ND
❑ Yes 0440
❑ Yes e-Nio
❑ Yes E9 -No
❑ Yes [Wo
❑ Yes MJW
❑'Yes ❑ No
❑ Yes allo
❑ Yes [Wo
QA5es ❑ No
MXes ❑ No
❑ Yes E1W
10 -No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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