315002_INSPECTIONS_20171231

�.A�
NURTH CAR©LINA
Department of Environmental Qual
II

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qrgo'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:I_ �]_� J Departure Time:® County:
Farm Name: AA-� k,, 1AS cU6_'- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Integrator:
Region:V Y (! z
Certified Operator:
�r L� 5{� �`e�
}� S
Certification Number:
u 4
Back-up Operator:
�'
Certification Number:
11354
Location of Farm: Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pog.
Cattte
Dai Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
c7
lt .
Layers
Design
Ca nci
Current
P■o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
blOther
Beef Brood Cow
--her
Other
Turkeys
Turkey oults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes';2r_�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes Afl"No
❑ Yes' -v
❑ NA ONE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

31 -5-002
F`$ciliRumber: - Date of Ins ection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):c
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
s-i�o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,E]rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Ye!..,�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement? /—
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes <o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yeses <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'La<o
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?
❑ YesZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesJ2�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 J30&o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes J;�r_No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes )��'�o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Fdcifi -Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ��o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA ❑ NE
the appropriate box(es) below.
'P
❑ 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?
❑ Yesj2]`No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
JEJ r A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes�o
[] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �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 [3 fVo
❑ 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�o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J2-lQo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes J�TNo
❑ NA ❑ NE
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I [} = Iq (/'7 3
Date:
2/4/2 15

j
Type of Visit: Q't~ompl' ce Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: %d Arrival Time:. i t S O Departure Time: �� County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ! _ Title:
Onsite Representative: G� (r i..� l ( C
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C+urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poul#ry C•apacity Pop.
La er I
Design Current
Cattle Capacity Pop.
ow
an to Feeder
Non -La er I IDai
Calf
Dai Heifer
Feeder to Finish
0 1C Z
Farrow to Wean
lye —sign
I Dly Cow
Farrow to Feeder
IJr,. P,ouitr, C►_a a_ci. P,q ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
M1
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑YesNA ❑NE
Page I of 3
21412015 Continued

49111
FaciliLNumber: Date of Inspection: �(
N?a-ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 040 L__I 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 rest, 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 E2<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ^ '
9. Does any part of the waste management system other than the waste structures require ❑ Yes Flo ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 01No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
10 ❑ NA
❑ NE
❑ Yes
ZNo ❑ NA
❑ NE
❑ Yes
;o ❑ NA
❑ NE
❑ Yes
PIC ❑ NA
❑ NE
[:]Yes
No
[:]Yes No
DNA ❑NE
❑NA ❑NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti;N_,[]
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: 2 i- Date of Ins ection: 1-6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No[C:] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑i 'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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?
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)
❑ Yes �o ❑NA ❑NE
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
rd, [] NA ❑ NE
No NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): ,Explain any YES answers andtor any additional recommendations or any other comments.
Use drawings of faeffityto better explain situa. ons use additional pages as_necessarx). -
�- I- re G 0 rc�-s 1 00 & J 4 rJ
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: T(e) ri% 720
Date: OF Z l
21412014

r
Type of Visit: IZ�Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: dRoutine Q Complaint 0 Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time:Departure Time: County: Region:
Farm Name:V7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 1�' IL 1, i On 5 y k( S
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: 113 5-ti
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pap.
I
Design C«urren# Design C►urrent
Wet Poultry Capacity Pap. Cattle Capacity Pap.
Layer Dairy Cow
Wean to Feeder
INon-Layer I Dairy Calf
Dairy Heifer
Design Current Dry Cow
D , P,oult . C_a aci Plo Non -Dairy
Feeder to Finish
0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
JEL
Turke s
Turkey Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q-ido 0 NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
E]'No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: 41
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): S
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
❑NA ❑NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3`&o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes O/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
I__I No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[3'-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E]"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
L.i j Ko'
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R o
❑ 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
C:f?No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA ❑ NE
_ - -thy ygnopriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑.'1Go
❑ 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
Q-No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FD"'No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued
r

Facili •Number: I - Date of Inspection: /
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ��No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes fo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 6-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0No
❑ Yes E] No
❑ Yes [:fNo
❑ Yes [2fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
0 NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [Zf No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes %[f No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes RNo ❑ NA 0 NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or, any other comments. M .,
Use drawings of facility to better explain situations (use additional pages as necessary). a
FA C- I, 41
perr" : -}- (% e r 3) _ .S 0 z
(A-,CCSPr�Cj fO-o /l _"�0aG
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7 ��
21412015

04
(Type of Visit: Q Compliance Inspection U Operation Review () Structure Evaluation O Technical Assistance I
Reason for Visii: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j D 'j Arrival Time: © Departure Time: j 5- County: z Region:
Farm Name: Owner Email:
� f
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: (Yl A t ,-ZtJ `� (C CS
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
I (33S-14
Design Current Design C►urrent
Design
Current
Swine Capacity Pop. W,et Poultry Capacity Pop. Cattle
Capacity
Pap.
Wean to Finish La er airy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
fii� Dai Heifer
Farrow to Wean
Design Current D Cow
Farrow to Feeder
D . P,oultr. Ca aci P,a P. Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkex Poults
Otheri
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑
Zo
❑ NA
❑ NE
ElYes
[
❑ NA
❑ NE
[:]Yes
0 /4o
❑ NA
❑ NE
Page l of 3 21412011 Continued

Facility Number: -Soo 'L Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes VfNo [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZo
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 M/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes O/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ��Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes j'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [✓No
❑ NA
❑ NE
ReAuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VN.
❑ 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 [lo ❑ 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 WNo
o ❑ NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili Number: jDate of Inspection: D
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ 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 o ❑ 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 P/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 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations of �any4ther; c)mments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V 4�N fL�UElv11- Phon$_ �l� b `13
Date:
/4/201

Type of Visit: 9F Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time: : �_County:
-`—
Farm Name: ►y iTti
�
Owner Email:'
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator: d•Vh
�+
��`�
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
an to Finish
La er
Dai Cow
an to Feeder
Non -La er
Dai Calf
der to Finish f
ow to Wean
ow to Feeder
ow to Finish
t
Dai Heifer
Design Current D Cow
D , Paul , Ca acity P,o , Non -Dairy
La ers Beef Stocker
s
Non -La ers
Beef Feeder
Beef Brood Cow
rs
Pullets
Other
Other
Turkeys
Turkey Po Its
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes L?fNo ❑ NA ❑ NE
❑Yes ❑No ❑NA [3 NE
❑ Yes [-]No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes []No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 4 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Z7No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
m No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
;�3 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Iden#ifier:
Spillway?:
Designed Freeboard (in): 1�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
JZ 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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�2'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [3Heavy Metals (Cu, Zn, etP.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5 CS
13. Soil Type(s): I..�rG�r•���
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes to No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes VfNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P?fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
8_No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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
ff No
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes -PNo ❑ NA ❑ NE
the appropriate box(es) below. TT
[] 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 ZrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
lam''
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Vr 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 r5 No
❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional'pages as necessary).
. J.A-
�'-1r1' 1 d` D. 'D--n
'S-L� aDA L
Reviewer/InspectorName: ti/b _ :_ _ _ Phone:X6"bb!"
Reviewer/Inspector Signature: Date: A-;n-l-�
Page 3 of 3 21412011

(Type of Visit: 'SX mpliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: kootitine O Complaint O Follow-up O Referral O Emergencv O Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �c„T Region:
Farm Name:, �(� U G L U Es ! OUL Owner Email:
Owner Name: I 1 \ (4kU ON Phone:
Mailing Address: •y
Physical Address:
Facility Contact:
Title:
Onsite Representative: M p ib oAf " U ti[[S
Certified Operator: AmC S naloJV '-_)wCe S
Back-up Operator:
Location of Farm:
Latitude:
()E nl� O R 3 fo5666 r
Phone:
Integrato
ti Ce icahon Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet PoultrJ' Capacity Pap. Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
airy Heifer
en I Dry Cow
IJ , P,ou[ Ca aci P,o Non -Dairy
La ers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes O�No
❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 1An35 3 1 - 5760 Date of Inspection:
Wasi�? Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAC001/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1A No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) C
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 ! No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ 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 AcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _'Sc &: Z4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WLiP 0 Checklists E] Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ �'Ste Transfers
Q Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections [3 Monthly and 1 " Rainfall/Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t
No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 3 21412011 Continued

Facili Number: &W 5 - 50 Date of Inspection:
24, Bid the If4cility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ko ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [-]No NA ❑ NE
Otherlssues
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
)4
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes *o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP? ❑ Yes A, No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or ady other, comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
� . � . CPS-►g�T�c�a.� ��� o�iQ I
�1► C3. 1 L4 sL_,Qr, & C-,)LCmjpT T)z 001 y
m ,Air cam olio � VL- -+/I i
� � P w �}��w0'T�-�d
CAS Nr� � PW co i
rCcv a60u.I
Lodz" >
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / % Cq
21412011

1Div`is'ion of Water Quality
Fffcm dumber 3 4 - S5S ®Division of -Soil and Water Conservation
Other Agency
Type of Visit: ZrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Iteason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: ul Ue- L t U 51 pC r- Owner Email:
Owner Name:
Mailing Address: (� . C) • zO
Physical Address:
Facility Contact:
Ic F-S
Phone: 916 -0 1- )161
/ 6jvr Cu u,E /Yc a8-365 -G�oO I
Title: Phone:
Region:
Onsite Representative: l !�-� �C.� r—czS Integrator:
T 90kt Certified Operator: A M �5 �LZrUN S c �)Cr S Certification Number: 9 35y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
C**able
Design
Capacity
Current
Pop.
Wean to Finish
Layer
aja Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Feeder to Finish to 710,
airy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D ► Pout a C_a aci P,o
Layers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: 3 1 - S S Date of inspection: /
WastViColleetion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ����"'' � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes !!!!❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: S�
Spillway?:
Designed Freeboard (in): �9.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 7�
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes t7777CCCC 7T 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 [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals {Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window _ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): CL-NC(4q*A4 -C
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 9
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? pq
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists []Design 0 Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesIsfers
No
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ �iaste
Q Rainfall 0 Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [N No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: IDate of Inspection: p
24. Dld the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ❑ No 14 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes j No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 77��
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. 0
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) 0
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 04 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 0 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
L .,y
omments (refer to question Explain any YES answers and/or any a itiona recommen attonsor. any other comments - �»�r
Use drawings of facility to better explain situations (use additional pages as necessary).:.
CAu 6 (LA Tow/ DuE 00l l
Sca.,a_ i6e (AXE nA ? r U N 71 _ 001 Lf
• A.
No U.,31 G 5 INC C G CT P010
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9102� (0 '
Date: �C
V412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 5d Departure Time: County: u /Y Region:
Farm Name: 1 f 1 T LJCrI UUPS 1Z0--K Owner Email:
Owner Name: fflp UON swces Phone:
gin ' "))o) -f 6toor
Mailing Address: ?.o. ?t W C001 #b"7— 0LJ UC—:, AC
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: JlJJKf5
Back-up Operator:
Location of Farm:
Phone No:
Integrato�r-�:3
Operator ert—Tiication Number:
Back-up Certification Number:
Latitude: [=' =' = Longitude: = ° =' =
Design Current
Desigu Current
Design
Current
Swine C•apaeity Population
Wet Poultry
Capacity Population
C•atile Capacity
Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
91 Feeder to Finish
t-113-T
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ Turke Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
ElNA
ElNE
❑ Yes
4No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Flcility Number: 3
Date of Inspection /d -
Waste Collection & Treatment
4. Is storage, capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAC00,1`4
Spillway?:
Designed Freeboard (in): 9•
Observed Freeboard (in): > S
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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes OkNo ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement? A
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13.
Soil type(s) UW cm
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
§4No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes
o
to
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or an3 "recommendations or any other comiaenfs l
Use drawings of facility to better,explain situations.,{use additional°.pages a"s, necessary): "t
W • f-I
L N
L
er/Inspector Name M NcF iq C 1N 5 Phone:erllnspector Signature: Date: 5 �2--l]O
Page 2 of 3 12128104 Continued

Facility Number:-3/ — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. 0 W`Up ❑ Checklists Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
❑ Yes XNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
E] Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Y(aste Transfers ❑ 9riinual Certification
El Rainfall El Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and l" Rain Inspections [D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
UIo
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes ❑ No �NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
o
to
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Additional comments and/ror Drawings
r
12128104

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
®
Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Addre
Physical Address:
Facility Contact: � Title:
(�
On site Representative: 1 + 1 AQ_1CyV UI�CS
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: v~ P 5 Y Y
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g = Longitude: = ° = N = it
Design CurrenFj1DTSi�@upr_qnt
apacity Population
Wet PPu—l--M*C-ai3Ma—cit,*Poi)ul=ation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -La er I
❑ Dairy Calf
❑ Dairy Heifer
Feeder to Finish (3
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non
-Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes )ANo [I NA ❑ NE
El Yes "••""A��,��` No ❑ NA ❑ NE
12128104 Continued

Facility lumber:
Date of Inspection
Waste Collection & Treatment
4. -Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGC DIV
Spillway?:
Designed Freeboard (in): �.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes fit' No ❑ NA ❑ NE
❑ Yes X No ❑ NA Cl NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 kNo El NA El NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ 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) L-LA AIC 4 ("U&i
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
C,No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
[I NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
to
❑ NA
❑ NE
Gommeltt' s (refer to�q�estton'#).�1E?icplain;any YES•answers antllor any recommendations or any other commepts.
Use drawings ofrfacilityto better:explain situations, (use additional pages as necessary}:
w.
5i'rb1 ocl
jjpgIo% p.43
cl1 al01i o• y�+
to /9 6 o.sy
Reviewer/Inspector Name 1 _ m Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection obi �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
No
❑ NA
❑ NE
the approprrate box. 0 WUP 0 Checklists 0 Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ /aste Transfers ❑Anuat Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections [] Monthly and 1"
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ANo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?r
❑ Yes
❑ No
❑ NA
ONE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
jai No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
'�o NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1ANo
❑ 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
0 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
IV
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE_
Additional Comments and/or Drawings:. ..
(2A C K -TO SeE_ Attu-T C14 -1Q G"TI CVV CI F HG_ H 4s `
AQE� t_aW_y_ q-u'g- lOV5 C' AUG Q_ I can')— 1 Ir r %JGT tr-A-X Sjo O/VF_ " Idyl
ycei4s - �Encti `09 5LLADGE StA_\Lu�L:� , v .
A)MwgDA GAInt1� S �A To
NC-MSN9- Dw4 CAL 4; ,,V AmRNC'rq'/vC_-3
j g-q C_p(Mj/rR t_"bG'P_a St- 3 50
�, r t✓� �Ax t coP� Tc� MY L- S��CS
C`nQ-- �t�Gs � r�s Nc� ► #~1 �A c� R�3au ► i i� s AT10� b23 I C N F9z Pk
Page 3 of 3 I2128104

Division of Water Quality
Facility Number M
O Division of Soil and Water Conservation'
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
��
Date of Visit: County: t'i(_ /AJ Region:
Farm Name: �y Owner Email:
Owner Name: 1 ' i A RJ 6A/ ��11C S Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
(��
Onsite Representative: 1 Y) A CU (�)AI )cG- S
Certified Operator: ^ � n fil e✓ S , MAP- JON IC F_ S
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _ jp� T�) & QE=� D G.,v %
Operator Certification Number: I q `3s
Back-up Certification Number:
Latitude: [= o = = Longitude: ❑ o = 6
Design: Current. Design Current ` Design.
Swine Capacity Population. Wet. Poultry , Capacity Population Cattle Capacity I
1❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
" ® Feeder to Finish 1 C T
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other — -- -- -- --------
❑ Other -
❑ 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: ElStructure ❑ Application Field ElOther
a. Was the conveyance man-made?
❑ Dairy Cow
[I Dairy Calf
❑ Daia Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
El Beef Brood Co
E:
Number of Structures:':
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
El Yes
toNo
El NA
❑NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facilitq Number:
Date of Inspection 'may
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:. Liq GCX V _
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
El Yes Ld No ❑ NA ❑ NE
❑ Yes 6No ❑ 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 ,N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,VqNo ❑ 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? 04
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [-IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ 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
j� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
OdNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
[INE
v[A,No
Comments (refer to question ft Explain any YES answers and/or any recommendations on anyother.comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
S cz <_)1V G) O 0 PT) ON b Al c 19 L I
Reviewer/Inspector Name ro o pa t, Phone: 916 ID
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

+ .L�
ZI
Facility Number: 3 I JjIj 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 ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
D�No
❑ NA
❑ NE
El Yes
�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ONO
❑ NA
❑ NE
❑ Yes
❑ No
�tNA
❑ NE
❑ Yes XNo
❑ Yes hi No
❑ Yes " No
❑ Yes \ No
❑ Yes ANo
❑ Yes ONO
El NA El NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
(Additional Comments and/or Drawings: i
Page 3 of 3 I2128/04

Division of Water Quality
111 [Facility Number _�� Sj�� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 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.
Date of Visit: Arrival Time: �; /00 Departure Time: /� County: CZ Region: �f1;oy
Farm Name: _ Z22
fiLG'!/�_ _rJG rJ� S7GLr' Owner Email:
Owner Name: ':S1/&'!4
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: / /� ��e7�n/ �111kr _ _ Integrator:
Certified Operato 2 �f7fgN �rS Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = I =16 Longitude: = ° = 6 =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish d /
El Farrow to Wean
❑ Farrow to I-
EJ
❑ Farrow to
❑ Gilts
Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA
❑ NE
zyJ1
❑ Yes No
❑ NA
❑ NE
12128104
Continued

a Facility Number: Date of Inspection 2/ U
3l-
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesZNo []NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �
Spillway?: /1/0
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ 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 [I 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 /2fNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ElNA ElNE
maintenance or improvement?�VNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes1�No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes XNo
[INA ElNE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy 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) �fR 644
13. Soil type(s)/�JCyCj/2�'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes P"No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes�No
El NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes/X o
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
0, Svz4 f<'ePprz s —
0/3 a��
o. 419
?/i
9.5,9
Reviewer/laspector Name Phone:01161
Reviewer/Inspector Signature: Date: O
12128104 Continued

Facility Number: S 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 XNo ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �/N o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TransfersTTTT❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
❑ Yes
'0"No
❑ No
A
Y-11
❑ NE
ElYes
No
NA
[I NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
[--]Yes
roNo
[:]No
ZYNA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes /� No
❑ Yes No
ElYes �/No
❑ NA ❑ NE
❑NA El NE
❑NA ❑NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
Additional Comments andlor Drawings:
Clq10,
�/1Di✓l ��✓G l� j Q Gy � /,
12/28/04

Type of Visit F Compliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit 0Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
0
eparture Time:
Z j unty: 0 Z/J
Region:
Farm Name:
L�✓�
GyU���aCK
Owner Email:
Owner Name: All�dN �i/k�5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:All&:570A) +� 5 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = g Longitude: = ° 0 = u
Design Gurrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Da Calf
Feeder to Finish 0
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Non -La drs
❑ Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 1 of 3
❑ Yes XNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ YesxNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104
Conhinued

dr
Facility Number: 31— Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9NO
❑ 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: JV
Spillway?: 0
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 XNo
El NA El 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 XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes JZ 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
ElNA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
/P1No
❑ 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 ofjWind Drift ❑ Application Outside of Area
, /❑
12. Crop type(s)
13.
1
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/� No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Z No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
LdNo ❑ NA
❑ NE
IComments (refer to question ##): Explain any YES answers andlor any recommendations. or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C_ /' / - �- " I �" 0, �?- �'- /: �o
I Reviewer/Inspector Name I -62 I Phone: 2 I
I` Reviewer/inspector Signature: /1Date: I`
Page 2 of 3 — " 12/28/04 " Continued

s
Facility Number: ,13—5�"j9D Date of Inspection
Reauired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0No
❑ 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
W(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ Nox
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
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
K(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
[I 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
El 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
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/11,No
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

jr
T`
sion of Wa#er Quality
Facility Number .31 ion of Soil and Water Conservation
0 Other Agency
Type of Visit Xcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q/J Departure Time: ounty:
Farm Name: f . CZ�/� / :ryx_ S-oC/; Owner Email:
Owner Name: A,��O� S��«s Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A49M10 46C,,4 S
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
a
Latitude: =
Region: ,;eO
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
❑ « Longitude: = a =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population .
-- ❑ La er
❑ Non -Layer
Other
❑ Other -- - — -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 )ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
/No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number:J -jam
Date of Inspection QS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I�
Spillway?: 4
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑Yes El No El NA ❑NE
Structure 5 Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes )INo ❑ NA L❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X
No ElNA ❑ 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 fi�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. ❑ Yeo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence I Wind Drifl ❑ Application Outside of Area
12. Crop type(s)6,eiYklOA
13. Soil type(s) �ji%C�SjC(.pG
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes X No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ NA ❑ NE
/F1No
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 �1
❑ NA ❑ NE
18. Is there lack of properly operating waste application equipment? ❑ Yes No
❑ NA ❑ NE
�ga,
�'-KlLh�yt3+e�Sf� ���.p9a
nts�(refe 4 questron #) EaplaEn+auy,YES. answer•.siand/or any recarupiendations or any other comments.
;$ *ate . 3i a tH
wrngsof(facility4o-better ezplam s�tpatzons pages as necessary
jMdjr
y�(use�add�hanal
2��25 cupC�.:Sy2r�,��/ �✓.O � .4�7o�J '9�,,8�P�lr�O•�.1 Gc�uc �'�
Reviewer/Inspector Name Phone: /Q
—706,
Reviewer/Inspector Signature: Date: Z
O$
12128104
Continued

r ' `
Facility Number S60 Date of Inspection l Q�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes �No ❑ NA ❑ NE
the appropirate box. ElWUP El Checklists [I Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead.animals within 24 hours and/or document
❑ Yes
)ZNo
❑ 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
10
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JZNo
❑ 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:
2f &)w
6_X-+Zij (49 a tCR5 tcg'o ) 60e 10// - 5131, 1qPPLzer47-zoVJ3 i1/0c.d
�PR mud f} ��• �7� G �A 5 A &
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit of Routine O Complaint O Follow up O Emergency Notilication O Other ❑ Denied Access
Facility Number Date of Visit- !O B Tune:
- - ... - .,... .. 0 Not erational C Below Threshold
$Permitted ❑ Certified [] Conditionally Certified 0 Registered Date Last Opera oar Above Threshold:
Farm Name: County:
Owner Name: 2 ��� , , _ , 'Phone No:
MaRing Address:
Facilitv Contact: - —Title: __. _^ Phone No:
Onsite Representative: A—)ei�'q 11 t ..i<e'4s Integrator: A6,
Certified Operator: , „ _ _ _. _ , .._ - , . _. Operator Certification Number.
Location of Farm:
Swine 0 Poultry 0 Cattle ❑ Horse Latitude r-�• 4 " Longitude • 4
Discharges & Stream Impacts
1_ Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes 12 No
❑ Yes Vf No
❑ Yes JZ No
Structure 6
Identifier:
Freeboard (inches): .65
12112103 Continued

facility Number: —,5�7D2 Date of Inspection D 2$
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes 2fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2' No
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 maintenancerimprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes m No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerrmprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding [IPAN ❑ Hydraulic Overload ❑ Frozen Pround M Copper and/or Zinc
12. Crop typel/�i4i�%�� 1 . ��inRic. J
13. Do the receiving crops differ with those designated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Plan (CAWMP)? ❑ Yes
0 No
❑ Yes
RrNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
O No
❑ Yes
P�No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes PfNo
❑ Yes ONo
❑ Yes Z No
❑ Yes 01No
❑ Field Copy ❑ Final Notes
---Wee e,D S LN NIzDE�L ,
/1 n �t1F� �� l x-5
�Q
dA0
Reviewer& Spector Name (
ReviewerAmspector Signature:
Date:
12/12/(13 Continued

Facility Number: ?�Z Date of Inspection D O
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes JXNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ 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? ❑ Yes in No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes PI No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
27. Did Reviewerfimpector fail to discuss reviewCmspection with on -site representative? ❑ Yes 12 No
28. Does facility require a follow-up visit by same agency? ❑ Yes Q No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes J6 No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12/I2fO3

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: t Z 0 Z Time. � 3
S D �
10 Not Overagonal Below Threshold
O Permitted ©Certified O Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: 1 ; Y F L d e.310 G k- I-' k@� _ - - - County:r � ✓2 II V1
Owner Name: GI,- ' On .S ke If Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
1 -1
OnsiteRepresentative: �a/ °''1 -s �,'i�, J , s �Q �`r41� Integrator:-Tubl,O"deft
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 u Longitude
Destgu Current Design Current Destgrt Current
Srreoe Ca acit� ':Po ulatmn Point Ca achy :3Po nlati©u Cattle Ca actty 'Polat�on
El to Feeder ❑ La er r ' = ❑ Da' 4
El Feeder to Finish i ❑ Non Laver I I I[] Non Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish :Total Design Capacity` e W
❑Gilts `'
❑ Boars Tots1`SSL-
Netmber of Lagoons ;�� N ❑Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Holding Pontls'l. Solyd`Traps ❑ No Li uid Waste Management Svstem41
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? r
❑ Yes ,�I No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. I€ discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z`No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes,2'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: If
Freeboard (inches): 50
05103101 Continued

Y Facility Number:.3 lO Q Date of Inspection iz d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
IeNo
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
El Yes t No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes Z No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes [�-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ONO
Waste- Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes2o
11. Is there evidence of over application? El Excessive Ponding El PAN ❑ Hydraulic Overload
El Yes ,E{NNo
}}
I2. Crop type ... ��YrH u!� �igL-f ,rigf( GrCtih �Ve�SQeG{ —
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 �eNo
b) Does the facility need a wettable acre determination?
❑ Yes -,E:rNo
c) This facility is pended for a wettable acre determination?
❑ Yes ZfNo
15_ Does the receiving crop need improvement?
❑ Yes �No
16. Is there a lack of adequate waste application equipment?
❑ Yes j2rNo
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ANo
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes Z No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes �ENo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ErNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? []Yes ,ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ;2NO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes jEfNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit,
Comments (refer to question #) Explain arty 1 ES sas�rers'andbc any recommendations or anv ©titer comtnenls.'
Use drawings of factiltty to better ezplam srttiations.,(ttse additianal:pages as necessary) i ❑ Field Cotes "—
❑ Final Notes _ t
c.,�ll'�7 is vex' y Well kef e "'er,0 A,-e t,�,e1ker.
aiL. Crop ae-e w1ell �-t�a���`sl�ed. T�,e
�-► p t4-fe 01 r A ci ! c� Jc n a �, are we l [ r►� �t n , c v �e 0(, —f 'lame W Q �a b je a C r e-1
tiarS �C qnd�M/ . SlkT7ptAi11 -Ja 9r4 � nEW
)r'JOoh 9av✓c-�kR� 4deJ6 wlc"'14CLih?I�S
oiOSp( p'der;
f
Reviewer/Inspector Name it
Rev iewer/Inspector Signature: 21A Date: l2 D
05103101 ` Condnaed

Facility Number: 3 1 _:IF6A Date of Inspection
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
orb roken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
additional Comments and/or`Drawing§
05103101
❑ Yes ❑ No
❑ Yes Z No
❑ Yes Rio
❑ Yes '� No
❑ Yes No
❑ Yes XN1 1
❑ Yes ❑ No