310012_INSPECTIONS_20171231

�AA
NORTH CAROLINA
Department of Environmental Quality

/ FaciLty Number ❑ - 0 Division of Soil and Water-Conservahoua
/ a m :,
- °O"Other4�igencyn
~ Type of Visit: Corn ce Inspection 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: b f Departure Time: County: Region:
Farm Name: &7 �L � `� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
// ,, ma 's
Onsite Representative: ( L A,7 i � Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design`�,Currcnt = Design Current Design Current
Swine Capacity tyPoP• Wet PoulnY �Ca a `"- ate -
>m.
Wean to Finish [4Layer Dairy Cow
Wean to Feeder Non-Layer Dai Calf
eeder to Finish Dairy Heifer
Farrow to Wean Design Current DryCow
Farrow to Feeder D Poultry. =;,.Ca aci ;Po Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-La-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other I Other
ro-•
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes gNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes N ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(if yes,notify DWR) ❑ Yes &No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes FNo
o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yeso ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

,[Facility Number: - 1 Date of Inspection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes ej No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): �f �/ 3 C 3,7 i/
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? Pe
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 VNo
❑ 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 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 Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 12j[�►- M t d(4 S k" ►!1 in 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? ❑ YesV
❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes WNo
❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes,check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I"Rainfall Inspections Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail provide documentation of an actively certified operator in charge? [:] Yes
o ❑ NA [3 NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes 5..No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [] No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments{refer�to gneshon ) Ezplam any Y _a doa o commenES answe'rs - rya t r
M .
[Ise,drawEngs of facliity 16a, etter ezplain situateofs;{use additional pages asneces ary), q, "' rR T
[ IfkreIS 9q �- 5_— /� Act/ 3 / R to-/ �� R � � � � teh er vz,�
Sl6f4S'eSUC 7 m1'j
yhtj
Reviewer/Inspector Name: j Phone: let -Xi ( ty 2'M
Reviewer/Inspector Signature: raj(�St ��f� Date: 11- - /:5,^/7
Page 3 of 3 21412015

AD Division of Water Resources
iXad ity Number "� - _ Q Division of Soil and-Water Co"nservation
Q.Other Agency..
Type of Visit: QXompliance Inspection Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: QQp Departure Time: County: d4211A Region: L,11&,
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: )o Z_C[e/4 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
- ..
Design:.Current" Design -Current D sEgn Current°-
Swine Capacity Pop. Wet Poultry Capacity Pop Cattle Capacity ; Pop
-,. .
_�
Wean to Finish La er T_ I., IDairy Cow
Wean to Feeder I INon-Layer I I 11)a Calf .ram
Feeder to Finish Da' y Heifer
n
Farrow to Wean Design ',Current,..,,;, Dly Cow
Farrow to Feeder D PoultryCa aci Po Non-Dai `
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other _ Turkey Poults .;
Other F10ther
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes QNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes C a'-No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes Ej^10 ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes 6 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 �o [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Z Date of Inspection: `7 . ZU
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 ;2"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� Z
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 31
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes El"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes _C2'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �j� o ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks) T
9.Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ONo ❑ 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):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes/11 No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ YesjNo
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 YNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑l20 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2/No ❑ NA ❑ NE
Page 2 of 21412014 Continued

Facility Number: - / Date of Inspection: . ;Le> ` LC,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ' Vo ❑ 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 A!j No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes VNo ❑ 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?
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 5�No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge, freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below, ❑ Yes No [] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond - ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33, Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes t ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:] Yes rNo ❑ NA ❑ NE
Comments(refer
s of facilitytabetter.ex lam.staatrons. dse'additional a es as��al=recommendations,or an after comments(refer to,question#€) Ex lain an YES,answers-and/or an addition y
Use drawing ty p '( p g essary).�.
5 u r
aGO - 3So —. 3-"Q y
[ � 73 3
sU rLm-
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Reviewer/Inspector Name: Woo, 6� Phone:
Reviewer/Inspector Signature: Date: 7 C
Page 3 of 3 21412015

ivisionaf Water Resources F'wry „'` `ru §
Facity Number DiAsiomotboil an(I Water COnSC1: at10A�y` a
'V
Type of Visit: OTompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other
0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: lu Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: 1
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
g °Current � gnu^ '
PDesi Current " Design Current
aim f 'Gs a+ ,A,�..,
Swine CapacityPop .: �Wet Poultry »Gapacity �Pop Cattle "Capacl#y Ptip.
Wean to Finish a er >R Dairy Cow
Wean to Feeder Non-La er Dairy Calf
Feeder to Finish Da Heifer
Farrow to Wean ;tj " D g'n 'Current Dry Cow
Farrow to Feeder1)ss, P,oul A ,Ca aci1'o Non-Dairy
i Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
�t
Turkeys
* may Turkey P h oults
;D.t .er y: �..
Other Other
Discharges and Stream impacts
1.Is any discharge observed from any part of the operation? ❑ Yes ONo E] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 'I__I No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes 21'No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ff 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 ON. ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection: v
Waste Collection&Treatment
,4. is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? [—] Yes ;ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure
�3 Structure 4 Structure S Structure 6
Identifier: _!/Z9�� ir ' Z-
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): � _
S.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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;6 No ❑ NA .❑ONE
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 [ZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [DNA ❑ 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 .Qf No ❑ NA ❑ NE
maintenance or improvement? (
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes 21/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 tbs. ❑ 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 -n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ,�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P'No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes &0 ❑ 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 P�,No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and V Rainfall Inspection ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�j No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ectioa: /
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes E!fNo ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes PTNo ❑ 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 JZ 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 0 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 V 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 21 No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes F/_6o ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes [;3/No ❑ NA ❑ NE
Comments(refer to geieshony#() Explain aay,YES answers�,an r any add honal recommendationsor'any�otherficomments ,
Use dTavvih sotfacili to better a tarn situations. use additional; a es=as:necessa "� '<' s
VA L
o?l�dllr !� M w 7 a 10 S tg 1 Lj
z (O(j 60
u(Ca sheu -Fi e( s �
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a r t �e r h
�Fr rd pqo
19- Z lrte'Ws Ap
�`I""V)"'S
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: "x�2
Page 3 of 3 21412014

No V- 5
Jvision of Water-Resources
Facrlity 1ZTaimber a © O Division of So aIId Water Conservation"
Type of Visit: Q'Kom utince Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: one 0 Complaint 0 Follow-up 0 Referral OEmergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; t spr Departure Time: County: Region:
Farm Name: tp,�,f );, f � Owner Email:
Owner Name: '• �— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: r-Q�n _ - Integrator:
��
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_es nY ..f _
DesignCurrent'° _ 1)esrgn °Current; =D �g Current. =_
Sivine Capacity Pop :Wet Poultry Capacity Pop Cattle. : Capac�iy Pop
Wean to Finish La er 't Da' Cow j
Wean to Feeder Non La er Dairy Calf Its
Feeder to Finish Da' Heifer
Farrow to Wean "� Design Cu'rren' t D Cow
Farrow to Feeder ��D "Poultry-,.. Capacity Po ..� �, Non-Dairy
Farrow to Finish . La ers a Beef Stocker
Gilts Non-La ers Beef Feeder 1:
= Boars Pullets 4vl Beef Brood Cow
Turkeys71,
Other . E TurkeyPoults
Other Other
.ggM;
.�, s.,.rbr�,._..-. ."..,+a*�-..•-:. ... ..:«.-. .�a+s s-_.. _,...+A�iRy_.._, .....:.<a..::.:�:. a ,.Yd��; �. -,.arW "�"'b:AM+'+H'A f � ^74'e Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes 2] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes Q No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes 0 No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes Z�No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo [] NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 -Z2tb 21412014 Continued

Facility Number: 113ate of Inspection: /
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? Yes ❑ No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 25
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 21 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 �Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes [Z No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes VI No ❑ NA 0 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 [7 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ❑ No ❑ U]NA , NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ;E NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes [] No ❑ NA [ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ No 0 NA m NE
20.Does the facility fail to have all components of the CAWMP readily available?if yes,check ❑ Yes [] No ❑ NA F'NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes [:] No [D NA VINE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA m NE
Page 2 of 3 21412014 Continued

�J
Facility Number: Date of Ins action:
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 0 NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ No ❑ NA [Zf NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[]Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] No ❑ NA ® NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No ❑ NA ® NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [:] No ❑ NA �NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0 No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA, NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32.Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes V9 No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [Z No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? V] Yes ❑ No ❑ NA ❑ NE
Comments(refer to question#f): Explain any YES answers and/or:anyadditional.recommendations.or any other:comments.'
Use°drawingsof facility to better explain situations(use:addihonaC.pages=as necessary):`ro� _ k
.., .
3 la5 oaos 1410 5�ru « _fi4lawd,
day Flag Q� &44 wd 1� 1r601"1 Ar7
rlea'41 /9,{r r6ln aL
geal -4) te-, 4�n 110 k kor 4�17S
be/oC-i J a Plelc s crlo� -4r Ut�­ )0 fC/1Mf,
I)eed A Pump 9- hqu 1 a sdr�
plr&lc 40/t
�� G1 40be� r6P ��'� growera�
Reviewer/Inspector Name: Phone: (J 7
Reviewer/Inspector Signature: / Date: pY'
Page 3 of 3 /4/2014

Dwrs�on of Water Resources
Facility NNlumber Divrsron of Sod and.Wa#er Conservat,on
Q Other Agency, V x
Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: p Routine Q Complaint O Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: 12- / Arrival Time: Departure Time: County: Region:
Farm Name: YO Owner Email: —`--�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 17 3 ��� 0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design 'Gurrent Designfl Current Design 'Cu
m �
n
. , ren r t
Swine Capacity Pop Wet Poultry Capacity Ptip "Cattle Capacity op
7]
Wean to Finish Layer Dairy Cow
Wean to Feeder I INon-Laer I I Dairy Calf
Feeder to Finish Da' Heifer
Farrow to Wean ,, Design "Cur"rent ' Cow
u
Farrow to Feeder D Ppii1Ca aci _ 7uPo Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
�w.
Turkeys M
w.
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes ❑'No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes allo ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ;allo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) [:] Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,Ej No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection 2
Waste Collection&Treatment
4. Is Storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes .0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iVl L� 3
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes_.a 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 El No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? [:] Yes [2No ❑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 L21No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ;2,No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes J2 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 ,E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑/ No ❑ NA [3 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ! j No ❑ NA ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ❑ No [] NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes [:] No [DNA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and V Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:] No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 72, Date of Ins tion: Z
24.Did the,faeility fail to calibrate waste application equipment as required by the permit? Yes 01 No ❑ NA ❑ NE
O.
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes P?No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes &No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes 540 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes p/ 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 FZ] 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 JEJ 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 [�TNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(refer to question ft Explain any.YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better,explain situations use additional a es as necessa
g ty p ( P g ry),°a ..._ �.
re corWs
9
Reviewer/Inspector Name: Phone: 2-2
Reviewer/Inspector Signature: (.� Date: (L Y
Page 3 of 3 2/4/20 4

Division of Water Quality
Facility Number FS- T7 - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 7Comptiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:� County: Region: �� r
Farm Name: 6ae FK4-y,ns Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: jY` n']r � � /lf'1 Certification Number: } O
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Designs Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer I Dairy Cow
Wean to Feeder I JNon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current DrySow
Farrow to Feeder Dry Poultry Capacity Pop. Non-Dairy
Farrow to Finish I I Layers I Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes [:] No ZNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ No 2j"NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes [:] No �+IA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
r

s
Facili Number: JDate of inspection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes KNo ❑ 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 �ffNo ❑ 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 4No ❑ 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 WI-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 VI-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes f] No ❑ NA ❑ NE
maintenance or improvement?
I I.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes Z"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_,E-No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes ;�!rNo ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Fr No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes J�!J_No ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes ;?]-No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes J"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes P"No ❑ NA ❑ NE
the appropriate box. r—
❑WUP ❑Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. [] Yes J-No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

♦ I -
Facility Number: - [Date—of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes 4No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J!5 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ;E'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 PT
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 VfNo ❑ 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 PrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additionaf problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes eNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E 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).
1! of
Reviewer/Inspector Name: �V� � � {/ Phone:ors '-4761—a2sh
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Division of Water Quality
Facility'Number _ 3 t - ® 0 Division of Soil and Water Conservation _
Q Other Ageney >,.
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit�Routtine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time:® Departure Time: jQ County: U Region:
Farm Name: �[y�/l•C ".4 LG u\ Owner Email:
Owner Name: A(-6 5 —IQ M 1 L (-AG-44-3 L�-�- Phone:
Mailing Address: P.d . INC CQ r IR
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �y/�/ (A)01 E2 i/�"Ci &-dUSA/ Integrator:
Certified Operator: Certification Number: j%
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current- Design 'Current _ De`ii d��Currenf,
g g g
Swine Capacity Pop. Wet Poultry Capacity. Pop. Cattle Capacity . Pop.:,,.-
Wean to Finish La er Dai Cow
Wean to Feeder I INon-Layer Dairy Calf
Feeder to Finish /y[) Dairy Heifer
- -
Farrow to Wean Design ,Current Cow
Farrow to Feeder Non-Dai. a "
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder '
Boars Pullets Beef Brood Cow s
Turkeys
©thee- Turke y Puults }
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: ( - 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: a
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 41
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
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 Acceptable Crop Window /{]❑ Evidence of,Wlind-Drift, ❑ Application Outside of Approved Area
12. Crop TYPe(s) ��"�► Q c c�(�C'> �HV Vl 31i�t�� L�
13. Soil Type(s): Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes tNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yeso ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
OWUP QChecklists Q Design Q Maps ❑Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑Waste Transfers Q Weather Code
M. Rainfall ❑Stocking []Crop Yield Q 120 Minute Inspections 0 Monthly and V Rainfall Inspections []Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie Numter: jDate of inspection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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 t�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 4 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(refer to question#):Explain any YES answers and/or any.additional recommendations.or any other comments.
Use drawings.of facility to better explain situations(use additional,pages as:necessary) "
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Reviewer/Inspector Name: Anazyno cam? l/y — s Phone:
Reviewer/Inspector Signature: Date: AQ//pl
Page 3 of 3 214.12011

�• 9wivision of Water Quality
Facility Number '3 f - 0 Division of Soil and Water Conservation y
0 Other Agency
Type of Visit: Compliance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I(3.Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: dU Departure Time:® County: Region:
Farm Name: �70 Pi/Lc4 F141M S L L C_ Owner Email:
Owner Name: 0 4L CC Phone: 9!G-d9S-1113(4 y(p
Mailing Address; P•C)• 30x '51 5 � QgCS I R
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: SM j Integrator:
Certified Operator: (Z w • Q oW j11 eC`rtilic�lion Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current_,.
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop. .
Wean to Finish WLayer Da Cow
Wean to Feeder -La er Dairy Calf
Feeder to Finish Q Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry Capacity Pop. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes XNo ❑ NA ❑ NE
Discharge originated at: El structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - J Date of Ins ection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes KNo ❑ 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): 113. 15 S •s
Observed Freeboard(in): Ll d yU/ _21 _
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 4No ❑ 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 M 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 KNo ❑ 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 14'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 tbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofr Wind
. .Drift ❑ Application Outside of Approved Area
12.Crop Type(s): % 1( „ Xl l.J� e r471
13. Soil Type(s): C� V.565o(LC> -
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 IA.
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 9No ❑ NA 0 NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes )Q,No ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes P.No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?if yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
Q WUP QChecklists 0 Design 0 Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application []Weekly Freeboard 0 Waste Analysis M Soil Analysis ❑Waste Transfers 0 Weather Code
❑Rainfall ❑Stocking ❑Crop Yield El 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 l 21412011 Continued

Facility Number: '3 L - rX Date of Inspection: (p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0%
No ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ElYes XNo ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 0
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(refer to question.#): Explain any YES answers and/or any.additional recommendations or any other comments
Use drawings of facility to better explain situations(use additional pages as necessary).
C) 30JL_ 6-e�CRT P1&_r L10) V—C- CJCRI�$'S
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Reviewer/Inspector Name: ��� � �� - Phone:
Reviewer/Inspector Signature: - Date:
Page 3 of 3 21412011

Division of:Water Qdality A ��
Facility Numberh ,Division of Soiland.Water Conservation
0,
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: ® Arrival Time: Q© Departure Time: County: U� Region:
Farm Name: �N��-E(�S� ,�-� �A2nnS - Owner Email:
Owner Name: —aLl ` u`J 9L Phone: (�
Mailing Address: .0. �X c �.J + �(J��u 1 L.E �C Ot,J`1+
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _� � LaNr E IL Integrator•
Certified Operator: 'ca w . v�wN ��,�p Q-CC Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ° Longitude: °
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑La er ❑Dairy Cow
❑Wean to Feeder 10 Non-Layer ❑ Dairy Calf
Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑ Dry Cow
❑Farrow to Feeder t El Non-Dairy
❑Farrow to Finish El Layers
❑Beef Stocker
❑Gilts ❑Non-Layers ❑Beef Feeder
❑Boars ❑Pullets
❑Beef Brood Co
❑Turkeys
Other ❑Turkey Poults
❑Other j JE1 Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes %No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes 9 No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes Po ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number:-3/ —/cQ 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 ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: p
Designed Freeboard(in): 1(3.S 1 • CS r
Observed Freeboard(in): CQ& D R_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes 6No ❑NA ❑NE
(ie/large trees,severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes O"No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes �No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes g§No ❑NA ❑NE
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes No ElNA ❑NE
maintenance/improvement? 54
1]. Is there evidence of incorrect application? if yes,check the appropriate box below. ❑Yes 09kNo ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN [:I PAN> 10%or ]0]bs ❑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) 50,� j (,
13. Soil type(s) 50000
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 IqNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes kNo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes to
o El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑NA ❑NE
�% � , ' y
Comments(refer to questton#} Ezplatn-any=YES:answers;and)or any recommendations,or any,ot mments.
Use draw,ngs of facility to Better:ezplam situattons (use'additeohal pages as necessary)
w
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: L '
Page 2 of 3 12128104 Continued

a �
Facility Number: 'j f —� Date of Inspecfion
Re uired Records&Documents )�Vo
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes N%No ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists
0 Design 0 Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes)4o ❑NA [I NE
❑Waste Application El Weekly Freeboard ❑Waste Analysis 0 Soil Analysis El Waste Transfers✓✓ ❑�inual Certification
0 Rainfall ❑Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections ❑Weather Code
2,2. Did the facility fail to install and maintain a rain gauge? ElYes No El NA [I NE
1
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No [I NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El 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 A No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes )XNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes V No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes KNo ❑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 gNo ❑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 MNo ❑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 [E[No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes �iNo ❑NA ❑NE
Additional MOM ents and/ror Dr,awings:
. rc - `
5�jy]iv 3 .6 a.S . 1
1
A/TRA GS 3�a_qJ/c�
Page 3 of 3 12128104

I
Division of
Facility-;Number 3 m Division of Sail and Water Conserva#tonA
A
Type of Visit XCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint XFollowup O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: ( QFJ Arrival Time: ! Departure Time: County: Region:
Farm Name: !AAA�g �OMI LLA Pf)QMS , INC• O-� wrier Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e 0 6 Longitude: =° =1 =«
Design Current Design Curren# f Design Current
. �•�
:Swine Capacity Populati©n Wet Poultry. $:Capacity PopuIkfon �„Cattle Cap44, Population
❑Wean to Finish �- ElLa er 1
,,❑Dai Cow
❑Wean to Feeder ❑Non-Layer I ❑ Dairy Calf
ElFeeder to Finish T El Da Heifer
�e
❑Farrow to Wean "❑Dry Cow
Dry Poultry ❑
- �
❑Farrow to Feeder """'""
- '❑�Layers �� Non-Dairy
❑ Farrow to Finish `❑Beef Stocker
❑Gilts ❑Non-Layers ❑Beef Feeder
❑ Boars ❑Pullets a❑Beef Brood Co
— - ❑Turke s
. .
-Other ❑Turkey Pouets "'>.
❑Other f,. ❑Other N beber �
ru e
Discharges& Stream Impacts
1. is any discharge observed from any part of the operation? ❑Yes �No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: — f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ElYes (fy No ❑NA ❑NE
a. if yes,is waste level into the structural freeboard? ❑Yes [:1 No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J
Spillway?:
Designed Freeboard(in): n r f
Observed Freeboard(in): 1 `7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ElNA ❑NE
(ie/large trees,severe erosion, seepage,etc.) )0
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ANo ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes XNo ❑NA El NE
maintenance or improvement? \\
Waste Application
10. Are there any required buffers, setbacks,or compliance alternatives that need ❑Yes ❑No ❑NA NE
maintenance/improvement?
l. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes ❑No ❑NA e(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)
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? El El No [I NA NE
17. Does the facility lack adequate acreage for land application? El Yes [I No [I NA NE
18_ Is there a lack of properly operating waste application equipment? ❑Yes ❑No ❑NA RNE
Comments(refer to queii6 #). Explain any YES answers and/or any recommendatr©nsgorfany«other comments ,. b
Use drawings of facility to better explain situations.(use additional pa44,
ges as necessary) - ;,_ =
CQC-CKtAvG CAN r-R-eF_Q, 7 PL S�u�RA� DABS a� P_A�x/
T
Reviewer/inspector NameJi(�A : � E,t/4/ ig2/1! [ C �,. Phone: 9J(� t!0
Reviewer/inspector Signature: wu� Date:
12128104 Continued

Facility Number: —/ Date of Inspection r �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 appropriate box. ❑WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Annual Certifi ation
❑Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑No ❑NA NE
-23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No ❑NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ❑NA NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ❑No ❑NA ZNE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ❑No ❑NA IVNE
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 krNo ❑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 4No ❑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 ONE
33. Does facility require a follow-up visit by same agency? ❑Yes ❑No ❑NA _kNE
Additional Comments andlor Drawings:
12/28/04

w. Division of Water Quality, n
ac�lity Number 3 /� D Division of Soil and Water Conservation' s
'Q,Otller+Agency
Type of Visit oCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit poutine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: Q® Departure Time. County: U Region:
Farm Name: /(/-�4�1ACENS FA(Mi_�4 Feata L LC_ Owner Email:
Owner Name: &__)4IAC Phone:
Mailing Address: �' a' �X Ei�L f�U/LLE ./VC cv&5)R
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ G __ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=o Longitude: =°=6
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La y er ❑Dairy Cow
❑Wean to Feeder ❑Non-Layer ❑Dairy Calf
Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ElDly Cow
❑Farrow to Feeder El Layers El Non-Dairy
El Farrow to Finish ❑ Beef Stocker
❑Gilts ❑Non-La Non-Layers
❑Pullets ❑Beef Feeder
❑ Soars El Turkeys ElBeef Brood Co
Other ❑Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
I. Is any discharge observed from any part of the operation? ❑Yes ANo ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes o [I NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Fac'iQy Number: 1 — f 2_ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes K14o ❑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: 1 a 3
Spillway?:
Designed Freeboard(in): _j 9 .
Observed Freeboard(in): e2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes PNo ❑NA ❑NE
(ie/large trees, severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes e*o []NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes �No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ElNA ElNE
(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 ElNE
maintenance/improvement? Aq
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑ Yes �No
❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of(Acceptable Crop Window ❑Evidence of Wind, �
Drift El Application Outside of Area
12. Crop type(s) �1 CGEZ-/N W te 'T V_]
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes 0 No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes diallo ❑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
ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑NA ❑NE
� +. aavS ando ykn y -
nts..0 mts:®(referto,q ' yira
�Usedrawings of factlfty to better explain situations- (use addrhpnaltpagesas,necessary-) u=,< y.�. ,_ .
C) '09 01C CA"
pu �-
p IC- AC_7-1UC—_
CALId3QF}1i0N SHE. ►S r—c�G�- �?�1��0� �IE�b� QE S ��I�IE }J
ReviewerAnspector Name Npa - - —� Phone: C1 16
Reviewer/inspector Signature: Date: (.9
Page 2 of 3 12128104 Continued

i Fatuity Number: Date of Inspection b y
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes kNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes KNo ❑NA ❑NE
the appropirate box. 0 WUP 0 Checklists El Design 0 Maps El Other
2l. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes �No ❑NA ❑NE
Q Waste Application ❑Weekly Freeboard 0 Waste Analysis 0 Soil Analysis [D Waste Transfers ❑/nnual Certification
EI Rainfall E]Stocking O Crop Yield 0 120 Minute Inspections []Monthly and I"Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? Cl Yes No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes §4No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes kNo ❑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 XNo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes AN o [INA ElNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes gNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes No ❑NA [INE
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 fgNo ❑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 M No ❑NA ❑NE
General Permit? (ie/discharge, freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes �No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes XNo ❑NA ❑NE
A>ti a1Co nmen sand%or Drawings: -
a� oct a A
1� a��o� 1 ,� 1• �-1 �.5
1 , 9
f �� ��S�og IAtD1G(4Til LI m E NEE E
�p�L
r OivS T F TG S
Sams
r(�LOSi UI�
Page 3 of 3 12128104

r
f
Division of Water Quality /
Facility Number �j 1 M-3
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 g) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:I-1 Departure Time: County: t.1 Region:
Farm Name: Owner Email:
,/}�
Owner Name: I f !0ZV K LA3 NA C-G L-k Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
GN N L >v��� g �N
Onsite Representative: Integrator: yy
Certified Operator: U , Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e ❑. ❑{I Longitude: 0° =i
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑Layer ❑Dai Cow
❑Wean to Feeder ❑Non-Layer ❑Dairy Calf
Feeder to Finish IFSC&O ❑Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑Dry Cow
❑ Farrow to Feeder ❑Non-Dairy
El Farrow to Finish ❑Layers
❑ Beef Stocker
❑Gilts ❑Non-Layers
El Pullets ❑Beef Feeder
El Boars ❑ Beef Brood Cowl
- --- ——- — ❑Turkeys
Other ❑Turkey Poults
❑Other . 1 ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes Wo ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(if yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes _N No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes XNo ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

i
Facility Number: — Date of Inspection !a
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes J4No ❑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: OA 6J 1 44 w A4 W
Spillway?:
Designed Freeboard(in): �
30 p
5 9. � , 5
Observed Freeboard(in): 3 p y 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes Do 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 ❑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 V No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ,M1 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 El
maintenance or improvement?
Waste Application
l0. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes No [_1NA ElNE
maintenance/improvement? 10
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
[:]PAN ❑PAN> 10%or 10 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)
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 -f�TNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes T No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes 4�j No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes .RNo ❑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):
. CoL + ���LKAt T -- (s E r c-o y- �'T w 1 (Z-GLC=S
dUe.C_L_ F-A�iL Laos g C��
Reviewer/Inspector Name wiAAI0 ),N 6-3 1 Phone: 9 0"�CD_4Sdn
Reviewer/Inspector Signature: a"P-b Date: (P�a(yl)
Page 2 of 3 12128104 Continued

Facility Number: -- Date of Inspection
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? O 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 ❑Desig
n ❑Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and V Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes Lq M No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes (A No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 51 No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes El No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes i�No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ONo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes K No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes �No El 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 R No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes Fx ❑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 rVNo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes KNo ❑NA ❑NE
Additional Comments and/or Drawings:
Hy
Page 3 of 3 12128104

r( I�
Division of Water Quality l�
Facility Number 13 2 0 DiAsion of Soil and Water Conservation te/
- - - 0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visits Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
' '
Date of visit: L �JJ Arrival Time: ; Departure Time: nty: L Region: ' �d
Farm Name: 1Ztn Owner Email:
Owner Name: A/ _ h�AGf Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
On site Representative. 011P) l 1� Integrator:
Certified Operator: �iPf.G Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 =6 =« Longitude: =0 0 r 0 11
1
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La er ElDai Cow
❑Wean to Feeder ❑Non-La yet 1. ❑Daja Calf
Feeder to Finish S fl-0 I ❑Dairy Heifer k
El Farrow to Wean Dry Poultry ElDry
Cow `
❑Farrow to Feeder El Non-Dairy
❑Farrow to Finish El Layers
❑Non-Layers ❑ Beef Stocker
El Gifts ❑Beef Feeder
El Boars ❑Pullets
❑ Beef Brood CovA
❑Turkeys
Other ❑Turkey Poults
I
❑Other J J[:]Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes vNo ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑ Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(if yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes 11 No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes J[J No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes XNo ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes No ❑NA [I NE
a. If yes, is waste level into the structural freeboard? ❑Yes 7-1
No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,W f zn&ZZ a
Spillway?: /✓O /Vo A
Designed Freeboard(in): a !!5- l'q,Jl /1,S
Observed Freeboard(in): 2(p S,5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No El NA El NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes [VNo El NA _ ❑NE
through a waste management or closure plan? /
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes o ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑Yes yNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes XNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑ Yes 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 l❑Evidence of Wind Drifl ❑Application Outside of Area
12. Crop type(s) f,Pl1')G/DA—L!/1 . 5,0-LO F� 4!��f 2, �: ����44 +/S
13. Soil type(s) CSpL�Sn.Pn
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes JJ No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes/ko
XN
❑NA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes o ❑NA El NE
17. Does the facility lack adequate acreage for land application? El Yes LG No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes XNo
❑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):
y la 1. 46 2_/
d 73 O.73
!.3
Reviewer/Inspector Name Phone: /D 7?,(o 2
Reviewer/Inspector Signature: Date: D
12128104 Continued

Facility Number: Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes �No ❑NA ❑NE
the appropirate box. ❑ WUp ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
,PI
❑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? El Yes "!No
El NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes X�No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes No El NA El NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes XNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes Z'No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes XNo ❑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 El NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes No ❑NA ❑NE
General Permit? (iel 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 )dNo ❑NA ❑NE
Additional Cog
,ament,s and/or Drawings:
64-7 97-z.>Jc
10,
AUv G1�. 57,E ��sQGzc�s
WZGc_ /IJiG�/J lQ 7 n/�Nf-
�oDQ
12128104

Division of Water Quality
Facility Number ::�
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit WRoutine 0 Complaint O Follow up O Referral O Emergency O Other [I Denied Access
Date of Visit: Arrival Time: 1�, Departure Time: County: Region: t'��
Farm Name: �L LL Owner Email:
Owner Name: G/C _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
U& L
Onsite Representative: Integrator: R2Dt�'J
Certified Operator: F � Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =c Longitude: =c=g
i
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑Layer ❑Dairy Cow
ElWean to Feeder 1, ❑Non-La er ❑Dairy Calf
Feeder to Finish g 8Z'f' - -_ - _ - T - ❑Dairy Heifer
❑ Farrow to Wean i
Dry Poultry ❑Dry Cow
❑ Farrow to Feeder I El Non-Dairy
El Farrow to Finish ElLa Layers
❑Beef Stocker
❑Gilts ❑Non-Layers
� ❑Pullets El Beef Feeder
❑ Boars ❑Beef Brood Co
,_�__� ���� — ❑Turkeys -
Other ❑Turkey Poults
❑Other ` 10 Other Number of Structures: ©�
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes XNo ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) - ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes X.No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes No ElNA ElNE
other than from a discharge?
Page I of 3 12128104 Continued

. `' ,-, -
Facility Number: — 2 Date of Inspection
Waste Collection& Treatment -�
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes XNo ❑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: M(d/ y ?-
Spillway?: D N& /11�
Designed Freeboard(in): lS
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ElNA ❑NE
(ie/large trees,severe erosion, seepage,etc.) to
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes No ElNA [INE
through a waste management or closure plan? X
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No El NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks) X
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 X
No [I NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside
/off�Area
12. Crop type(s) 4e504 L1114
13. Soiltype(s) 6'ac,03t3D'Aep _
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes XNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑NA ❑NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes X-0 No ❑ NA ElNE
17. Does the facility lack adequate acreage for land application? El Yes No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ElYes XNo ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments. a
Use drawings of facility to better explain situations.(use additional pages as necessary):
/GAnrZLG �tslvF_ Z 3 f-;
Reviewer/Inspector Name 1 Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ZNo ❑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 El Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes )21 No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1°Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ONo ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes/E�No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 0.No El NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes VNo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes [/No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes No ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes ]No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes XNo ❑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 PNo ❑NA ❑NE
Additional Comments and/or Drawings:
649M,_4 Z,15Z14 Ae2- ,X-A'5 49010,1VO 646,0a,-J 40
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 r]_ O Division of Soil and Water Conservation
0 Other Agency r;rc
Type of Visit ZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 06 b Arrival Time: t 0 l3 OS Departure Time: County: OCP .ej ) _ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -zR,LG t3Moi,,> 1 Mp A)iC WNAc s;`� _ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o 11
Longitude: =o❑i ❑
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer I I ❑Dairy Cow
❑ Wean to Feeder ❑ Non-Layer I ❑ Dairy Calf
® Feeder to Finish ❑Dairy Heifei
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑ Farrow to Feeder I ❑Non-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
El Gilts ❑Non-La Non-Layers
❑ Pullets ❑Beef Feeder
El Boars ❑Beef Brood Co
--- -- ❑ Turkeys
Other 10Turke Poults
❑Other ❑ Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes E31 o ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a_ Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(if yes,notify DWQ) ❑Yes �❑No [INA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ElYes L"J Nc ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: 1-L Date of Inspection 1 �5
Waste Collection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: WW M W Z_
Spillway?:
Designed Freeboard(in): 1,ci .S; _ _ I Ck
Observed Freeboard(in): a.7, 011 > L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑yes E(N ❑NA ElNE
(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 E No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes G3 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 ElC Yes �No ❑NA ❑NE
maintenance or improvement?
Waste AplAication
10. Are there any required buffers,setbacks, or compliance alternatives that need ❑Yes LEI No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑PAN> 10%or 10 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) 13CP t0^UDfl LW) cog S Go
13. Soiltype(s) Cm upsaa�N_6
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes � El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes IJ No ❑NA ❑NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑yes LJ No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes 9/No
'� ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑NA ❑NE
6q
Comments=(refer to,questton„ 'Explain any YES answer sand/or any recommendations or any other comments ,
Use dravvtngs°of factLt} to better ezp�atn sttuahons (use addtbonai�pages,as necessary) �� a
I..�� At3l�E Act, ari< A 's�—►,.AY Dma4
1L�te.Q C-oP'r �F t'lNR1Uf;�- ��c-tc��1(r- �riT}� TLJECo*-.DS,
Reviewer/Inspector Name �au�. �jaR�� Phone: (510)7 tro__7Z;'b5
Reviewer/Inspector Signature: Date: 101 t 3 OS
12128104 Continued

Fa4511ty Number: 3+ — a Date of Inspection 1A_oT5FH1
a
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 J!(No • ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑ Design ❑Maps El Other WNo
21. Does record keeping need improvement?If yes,check the appropriate box below. ElYes ❑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 Ej`No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes L`7 No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ffNo ❑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? ❑YesQ'No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes 04o' ❑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 21 o ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ETNo ❑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 EK ❑NA ❑NE
General Permit? (iel discharge, freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes E No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes No ❑NA ❑NE
A�ddltlO al Cotnmellt5Fdlid/or'DraWings j V
?i a
12128104

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3�'• __t- .t
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d.as�?�..rr� —...z .T:.�.z� ..S:aaa». •a .i�.sr.-x;-��'-s,:�._,..=-:�=�'. '�r"�.:' ���c.�e.iax.y_ '. ,� ..,s•».�'.'Y- :3'.�''�:
Type of Visit Com liance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: !O !S oy Tune:
r Not Operational C Below Threshold
Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _WMbtJK W1b�,1,�� __ ._ _ . ._ ..�. _ County: DuPtTN) _. . .._.. . _
Owner Name: . _ __.._.___ Phone No:
Mailing Address:
Facility Contact: . . Title: Phone No:
OnsiterRepresentative:��GdI?- 38 _ _ Integrator. _ C8a&6tLC_S
Certified Operator: _ ,_ ,_,_ .,,,.� Operator Certification Number:
Location of Farm:
T
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� ��� Longitude �•�� �«
Design :Curt * `. ' Des3ga 3''Cnrreat Deszgaga +Cniremt
'Swine Po' "Poultry -- Po onCattle "an
f t 3
tiOII. � =Po
PWKemtoFeeder SlA_ y �iyFinish $4�{a 7 q Non-Layer Non-Dairy Weanarrow to Feeder Other
Farrow to Fmisha ac
-To#a � E
Gilts 3
Boars
Discharges&Stream impacts
1. Is any discharge observed from any part of the operation? ❑Yes ["No
Discharge originated at: ❑Lagoon ❑Spray Feld ❑Other
a, If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes 0<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _----- 2= -____ 3
Freeboard(inches): 7-1 3 2• 2-7
12112103 Continued

Facility Number: 1 — z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes U'lvo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes [/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? [fY,es ❑No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes <O
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
❑Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance!unprovement? ❑Yes 2<0
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes
❑Excessive Ponding [IPAN ❑Hydraulic Overload ❑Frozen Ground ElCopper and/or Zinc
12. Crop type C S W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes N
14. a)Does the facility lack adequate acreage for land application? ❑Yes [ o
b)Does the facility need a wettable acre determination? ❑Yes 04
c)This facility is pended for a wettable acre determination? ❑Yes 9
15. Does the receiving crop need improvement? []Yes �2o
16. Is there a lack of adequate waste application equipment? ❑Yes �To
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑Yes 0 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes V
(Ni
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes
roads,building structure,and/or public property) /
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes,contact a regional ❑Yes U44
Air Quality representative immediately.
..r -z c --- �-ti--- --- --ram. - »--�, —,--�� - �•ez�--• =�- --��;
pCom (refer tad gIIts6ora�)�l�lam�y�71ffi'aaswers and/or nay _ar iii�y�atlte�oomts, -.�.= ,,.
t[jse�rsvvtags o!'fttt�ty�better��la:a sttaattoas.(�eadr�onal�Pa��nr3'k���Field Copy ❑Final Not -.=
._,e.....-W .�..... ...__...,.:s_d��'`_,-a,�,.....�...M...�.va..;w.' ...,........ f�:a�"�:�eC.�r_.._.,.2 �.^'-.;v sue.-��%k-.�....-rW:..-�.:-..� .®.�..�e;=. �.w..—.._.:....'�-.=.-.�^' .::.`�'•ts�«.:: -�a
T) LA(saoN 3 Ds[LC- W6 ,t-, 0EE43 Z•ST 0- G2. JS WOXK. SoYv,� at-� F�A;' •
(3�L cs �be� To � Gt-�.►w�vEv Fn,ar� CoGE a� F.L�t,r�s,
T
n
r
• err _ _�,,,. x �� ..n,
Reviewerllnspector Name d, :g.�,,. Yam. __ .
Reviewer/Inspector Signature: Q Date: /4
12112103 Continued

Facility Number. Date of Inspection
Required Records&Documents
21'. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? !
(iel WUP,checklists,design,maps,etc.) ❑Yes U
23. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes �No-
[I 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 M is
25. Did the facility fail to have a actively certified operator in charge? ❑Yes [ 4o
26. Fail to notify regional DWQ of emergency situations as required by General Permit? ,_,,�
(iel discharge,freeboard problems,over application) ❑Yes 21"0
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? [:]Yes O'No
28_ Does facility require a follow-up visit by same agency? ❑Yes ��O
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ lJ
Yes 44o
NPDES Permitted Facilities
34. Is the facility covered under a NPDES Permit?(If no,skip questions 31-35) O Yes ❑No
31. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes [rNo
32. Did the facility fail to install and maintain a rain gauge? ❑Yes 31�0
33. Did the facility fail to conduct an annual sludge survey? ❑Yes WNNo
34. Did the facility fail to calibrate waste application equipment? ❑Yes
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes VNo
❑Stocking Form ❑Crop Yield Form ❑Rainfall ❑Inspection After 1"Rain
❑ 120 Minute Inspections ❑Annual Certification Fort
© No violations or deficiencies were noted during this visit. You will receive no farther correspondence about this visit
�--
•
12112103

�Nlm � DI 1slon�OfVY,�atQuality� .. •, -_ _ .� - � _ � L�
u � „-A03DOiviston of Sal anWater Conserve "on
- _ #her�+igency
Type of Visit 19 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit %Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number
Date of Visit: f T Time:
3l /
NNot Operational Q Below Threshold
M Permitted M Ce/rrtified ❑Conditionally Certified ❑Registered Date Last Operated or Above Threshold.
Farm Name: ...... Q.j?.k......G(/ le-
....... ............................................... County: .....�sl.Gt�E?_!�m -------------- ------ ---_
OwnerName: •------------------------- ------------------------------------ Phone No: --------------------------------------------
Mailing Address: ...........................................
FacilityContact: ............................................................Title:: ............................................... Phone No: ......................................
Onsite Representative: _ r!,lQ.1 �n e!�4 Integrator:._ _-
Certified Operator:................................................. ............................................................. Operator Certification Number:.--.....................................
Location of Farm:
s
s
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �• �� Du
Desrgn :Current ;Design Current Design Current
Swiine
'Ca--pacity'PofJulation Eoult _
�T Ca aci Po- ulation Cattle Ca acii 'Population
❑Wean to Feeder ❑Layer ❑Dairy
®Feeder to Finish -'=❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish - To#al Design Capacity=_
❑Gilts
❑Bears otaUSSLM-1
-
I ❑Subsurface Drains Present ❑Lagoon Area I[]Spray Field Area
.* NumbeFof Lagoons
Holding.Ponds/SohdyTraps `❑No Liquid Waste Management System -
Discharees& Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes ,®No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes J4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 10 No
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes UNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. ........../ -----Z----... .........�..--—----
Freeboard(inches): �G

u�v�iv1 uunnnueu
Facility Number. 3 — r7 Date of Inspection r 7�
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ®No
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
(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 mainteaance/improvement? ❑Yes T&No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes ®No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ®.No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ®No
It. Is there evidence of over application? ❑Excessive
Ponding ❑PAN ❑Hydraulic Overload ❑Yes ®No
12. Crop type f/,!�/r��r l � �i,►�!f ��Y.�1 DG!'/ft��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes g No
14. a)Does the facility lack adequate acreage for Iand application? ❑Yes WNo
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)nis facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes J.No
16. Is there a lack of adequate waste application equipment? ❑Yes JNLNo
Required Records& Documents
17. Fail to have Certificate of Coverage&GeneraI Permit or other Permit readily available? ❑Yes JS No
18. 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
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes El No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ®No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes R No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ®No
23. Did Reviewer/Inspector fail to discuss reviewhaspection with on-site representative? ❑Yes [> No
24. Does facility require a follow-up visit by same agency? ❑Yes ®No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes Pallo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cn(reie°#'moo q` #ion. . : Tzpian any S'attsyvers;andlor an �reca"mmeni7ations orany=o er 411115
o e
Us'�de ra �ngs ,�i #o= e e •' laip•sr#ua ions:(uses dd�#iona � a esas•necessa . :
_ � � � ,� ❑Field Cop ❑Final Notes _ _.
/�ecorG�S d—��► ,h �oo�C ��i� �
Reviewer/Ins ector Name grc _ `,
p 0 -nR_ a.' ..4. = •2a'x f iS- c.= '- �.S.i_ a"E�.. _,-L."'L.* : +I. F+' l
Reviewer/Inspector Signature: Date:

Facility Number: 3 — Date of Inspection u z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑Yes ®No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes ®No
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes ®No
roads,building structure,and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes F[No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e.broken fan belts,missing or
or broken fan blade(s),inoperable shutters,etc.) ❑Yes [N No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes K No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes JK No
AdditlinalCommentsandlor�Daw�ngs: '- tom' _, - :' - � - '-
O510310I

aw3a, W-1
.eQ DOthe., cei aQ....aar
ig
u 0& W t
01
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visii Routine Q Complaint. O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Bate of Visit: ®Time:
Q Not Operational Q Below Threshold
#Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or 4bove Threshold:
j.
Farm Name: .......1 \G. ,W \Pip........................................... County: ....._('1............................
OwnerName: .................................................. ....................................................................... Phone No: .........................._................
.....�.... .� .� . . .
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ............................... ...
MailingAddress: ......................... r�.................................------ --•-....... ..............---------•-•--•-----•............I........................ ..........................
Onsite Representative: � � l k
�'`.........��� 1`! Irate rator:
Certified Operator:................................................... ............................................................ Operator Certification
Location of Farm:
A.
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �•�� ���
Desigrk-z urrent �- Design Current _ Design -•_Correa#
Ca aci --Po ulation Poultry Ca ai i Po ulation Cattle ;. _ Cs ci Po alatiop
Wean to Feeder ❑Layer i 1 EDairy Feeder to Finish Q ❑Non-Layer Dairy
❑Farrow to Wean
[3Farrow to Feeder ❑Other
❑Farrow to Finish Total-Desi l-a„,C
Gilts g Pa _y
❑Boars Total SSLW
Number o[Lagoons ❑Subsurface Drains Present ❑mood Area ❑Spray Field Area =
HoldrngaPcinds".Solid T raps. ❑No Liquid Waste Management System
Xa �
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes )<No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes, notify DWQ) ❑Yes ❑No
c. If discharge is observed.what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes WINO
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes XNo
Structure I Structure 2 Structure 3 - Structure 4 Structure S Structure 6
Identifier: .................................... .................................... ................................... .................................... .......... ....................................
Freeboard(inches): aM -3 d 31
5100 Continued on back

i
Facility Number: — a- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes XNo
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
(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 A(No ok
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes W No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes JKNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over application? ❑Excessive Ponding ❑ PAN ❑Hydraulic Overload ❑Yes No
12. Crop type S g
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes �rNo
14. a)Does the facility lack adequate acreage for land application? ❑Yes allo
b)Does the facility need a wettable acre determination? Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? 'Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes KNo
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes 'O No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes VNo
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes D<No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes JjrNo
21. Did the facility fail to have a actively certified operator in charge? ❑Yes %No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes t�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes allo
24. Does facility require a follow-up visit by same agency? ❑Yes [(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes JoNo
•yiit;a(io[is Ri-d$f eiendbs-ftrb hotco O(Wing th' Mspt!-Yop*M_teoiye 0 rui�thgr . .
corres oridenke'alyauf this visit:
Cotmnxnts(refer toquestion#) ExpWin any YES answers and/or auy'irecatnmendations or any older comments.
�.-
i7se draw ngs:of facility tti better exphtuii situations (use addittgnal:pages as iriecess t rp)
r
-�-
�oa�. .(1 ep, c,, miss l .,— C\cry e4 C Q+r
Reviewer/Inspector Name ti,�` Y :_ r_
Reviewer/Inspector Signature: Date: 5100

+ Facility Number: 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 Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes ;TNo
28. Is there any evidence of wind drift during land application? (i.e.residue on'neighboring vegetation,asphalt, ❑Yes J'No
roads,building structure,and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes 9No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e.broken fan belts,missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Oyes ❑No
Additional omments an orDrawings:
1) �\s�� Ql/��G10 \\�,pL 4'-'1 �!�'•� ]�^�e�1\ Cam\�"1 'r ��``1 4ji"1� C¢,_� �� `
lie P 'I
``L! ��tl�� �av'e. �rG►��e. O�^� �l�'C�� �� +�t� �����. �CC�,SS
ISM roe-�C�4 s��� -ter �1�'�c�� S�l� l-.Q�-..y �►w� .-��y;, r��e��
5100

� 1 Division of Soil and Water Conservation Operation Review
1 Division of Soil and Water Conservation :Compliance inspection
ivision of Water Quality Coinpliance Inspection <`
Other Agency, Operation Review,:::
_..
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number j Y Date of Inspection 5 �3 IJ
Time of Inspection o?; 24 hr.(hh:mm)
0'Permitted ©Certified © Conditionally Certified [3 Registered R]Not Operational D Last Operated:
Farm Name: ........ U ...................V.Y.*. !+ -t .l............-......................---....... County: ................. .. .. . ..J..V.. .............. ........
f
Owner Name: ............ . Phu a No: ---..._.....--...
................................................... ....-................................-................................
Phone No:Facility Contact: ..... pA�`�.............. :.... lil .. ........................ . .... .
'� ` Title: .......
Mailing Address: f
.L.................................... ......... . . ..-....... .... . .... ... .
Onsite Representative: .... .. ....."� ,,���} . . tegrator:........... }�..............................:....
Certified Operator:............ .... . . ...........-.......................................... perator Certification Number:..........................................
Location of Farm: J
i
Latitude �'�' �•� Longitude �• � � z
Design Current Current 2„ Design Current.:-'-'
Capacity Population 1oultry =
—Capacity Pa Cattle
Capacity Poaulation on '
❑Wean to Feeder ❑Layer ❑Dairy
EV
eeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
ElFarrow to Feeder ❑Other -
❑Farrow to Finish = Total-Design Capacity
❑Gilts _ =V _
❑Boars ToW SSLW
(Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
v Holding:Ponds L Solid Traps ID No liquid Waste Management System
m_ ...-
Discharaes&Stream Impacts
I- Is any discharge observed from any part of the operation? ❑Yes XNo
Discharge originated at: ❑Lagoon [].Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State? (If yes, notify DWQ) ❑Yes []No
c. If discharge is observed,what is the estimated flow in gal/min'.? %VA
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes I0
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /RivoI "ffw �NW#3
' 39 '
Freeboard(inches): .......... �.................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/trees,severe erosion, ❑Yes E)KNo
seepage, etc.) T``
3/23/99 Continued on back

Facility Number: '3 — a-- Date of Inspection
6. Are t't ere structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(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 §(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes '�10
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ''\\
elevation markings? ❑Yes ` N0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over a lication? ❑Excessive Ponding ❑PAN ❑Yes '0o
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes XNo
14. a)Does the facility lack adequate acreage for land application? ❑ Yes ❑No
b) Does the facility need a wettable acre determination? ❑ Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes �No
16. Is there a lack of adequate waste application equipment? ❑Yes ' 0
Required Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ;No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design, maps,etc.) ❑Yes %N0
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis& soil sample reports) ❑Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes KNo
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ;No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes t;�No
24. Does facility require a follow-up visit by same agency? ❑Yes 9ko
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ElYes %NO
�,N6.i6lafibris,oir dl f cienCiES.* rE'hbfe.[�(l&iiiii this'vlslt.•Yotk Wiil-teoeiye i10,futth I . . .
COrI'eS OII[Xence. OUttliiSVlslt«'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.".".".'.'.'.'. '.'.'.'.'.'.'.'.'.'.'.'.'.'.
tomfnents_(refer t'_ uestign#): ,Expla►n any YES%answers aind/or ariy'recommendations or any other comments
Use,drawings of facility to better explain srtuatrons (use:addit>onal,p"ages as necessary)
:- - _
,e1
_#r
� . JK11
of 3�aoDU t Sant{�x�.e.cL w�-� revs 3 c M11 S .T'-7o76 7 O...U"I ... 54 %'Z� -t, I sv ( $
'r t OU P.,4-e 1 w SG SV /%V ( L13.lad
I3YKI rcv,s-r.s are 4, rrcerd4
Reviewer/Inspector Name `
Reviewer/Inspector Signature: Date: !7
3/23/99

Facility Number: 3 — 1 Y 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 ❑Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes XNo
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e. broken fan belts,missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 9Yes ❑No
Additional.-.Comments and_or ravings: ,
3/23/99

©Division of Soil andWater.Conservation-UperattonRevtew ,
t _�Division of Soil and°Water Conservation-Comptrauce Inspection x
x
Dtvision of Water Quality -Compliance Inspection -�
s
Other Agency Operatioit;Revtew _ = =s
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 6:L 24 hr. (hh:mm)
PPermitted ©Certified (7 Condiitionallyy Certified © Registered [3 Not O eratwnal Date Last Operated:
Farm Name: ..........RZA.........Uw. .........1 .Y. .... County: _..... u�1�ll�...................................... .......................
...................................... . 1
Owner Name:
. ............ .......... ............ _.. Phone No: .�°�10.�-Z .-.. ?�!L
FacilityContact: ................................................. ............Title: ................ `` ......... Phone No: ......................... .
MailingAddress: G ...&A.......55.......................... ... ......... .... ......... ......... .. .. C!�lOtlt.l�.� .. .................................... .. ........
} 1...
Onsite Representative: .....� ..CV11 ..1, .r..,... 6.(� ("I,, d . Integrator:.........0 s ......................
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
0.��.....!`{t� ^...sib. .... ° .......5.......... .Y.......7..�..:. ...rt+t. 5......SAS. .._..1�. .....5 .:� OZ.:.....................................I.......
............._.. .....
,
.................................................................................................................................................................................................................................................
Latitude Longitude �• �� ��= __
Design Current =TDesign Current Design- Current
-Swine_ Capacity . Poultr _ Catley .. :Capacity Po ulation rt:
❑Wean to Feeder ❑Layer I I ❑ Dairy
Feeder to Finish g ❑Non-Layer I[] Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish
ToW Design Capacity �6
❑Gilts
:.:❑Boars Total SSLW
r-- §Number of Lagoons Subsurface Drains Present ❑ Lagoon Area Spray Field Area
;,.
Holding Ponds/Solid Traps ❑No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made.'? ❑Yes No
b. If discharge is observed,did it reach Water of the State? (If yes,notify DWQ) ❑Yes No
c. If discharge is observed.what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑Yes No
2. Is there evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes KA No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Nt07- AW1
Freeboard(inches): 32
.................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes P No
seepage,etc.)
3/23/99 Continued on back

Faci tty Number: .'� — �Z Date of Inspection to z,
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes RNo
(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? rWYes ❑No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? Yes to No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes .n No
Waste Ar2plication
10. Are there any buffers that need maintenance/improvement? ❑Yes ®No
11. Is there evidence of over application? ❑Excessive Ponding ❑ PAN ❑ Yes ®No
12. Crop type - �rm^,r�n �_P - _<�w-1( Ira In —
13. Do the receiving crops differ with tho a designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes RNo
14. a) Does the facility lack adequate acreage for land application? ❑Yes 19-No
b) Does the facility need a wettable acre determination? ❑ Yes JR No
c)This facility is pended for a wettable acre determination? (2 Yes ❑No
15. Does the receiving crop need improvement? (UYes R No
16. Is there a lack of adequate waste application equipment? ❑Yes ®No
Required Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes M No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) U Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes k No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 0 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes glNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
No-vi61ati6 is ot•&fidendes'•w' e're nateq•during#his;visit:-Yoi�Will receive titi further;
Torres oridei�ce A' ' this:visit:
Coin �.: .. a - _
ments:(refer to:question#} Expla►n any YES nanswers and/or ariy,recommendattons flr any oNter comments:
Use;drawings of facility_to.better,-' I;iin.situations (use additional-oages as necessary)
Reviewer/Inspector Name FOjA x. m sk .a a - c s ti
... ­ f
Reviewer/Inspector Signature: Date: 2�
3/23/99

Facility Number: 31 — L 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 []Yes '®No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Yes ❑No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation,asphalt, ❑Yes O No
roads,building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes rS�bNo
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e_broken fan belts, missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes E1Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? WYes ❑No
AAditional,Comments and/or Prgvipgs.
aret~s ors la�po%'\5 ! L -k vw 1, s�+o�lc� be �ve���i,4ec�. Sr+GIt 0"
z ol� �Lna1� ���5 sl>1c�1� Le- "IM3 �Orj—
)4(-) �V
`709Q� , �wO s{noA t
CA d00-� nOi M6A -fir) s � Ile-/0)Or e�.
L dal 1 I �
3123/99

. [3 Division of Soil and Water Conservation [3 Other Agency n
4 [3 Division of Water Quality
.. ...^.'-....
Routine O Cam laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection o elf
F_Facility Number 1 1L
Time of Inspection l Z'-o 24 hr.(hh:mm)
Registered t$Certified [3 Applied for Permit R1 Permitted JE3 Not Operational I Date Last Operated: .........
Farm Name: County:.....�.V. lug................... .................
OwnerName:............... • & L........ ........!l �................. Phone No: . .... 4.......................................
.........
Facility Contact: ........................ ............Title: . Phone No:
MailingAddress: :.......�.�..&?(........M'!5..................................................................... ......... LuJL �.C............. ................... �.$��t.....-•--
f"'
N10Onsite Representative:............. A......W . .... .........................I......................... Integrator:......---.Calr.n_qs....................................................
Certified Operator.,................ ..................... ............ ... Operator Certification Number;................----..
Location of Farm:
e. .......`.rKK..).. ..... .r. o. ......S.R aw" ....................................---..-----................................---
............... ............................ ............ ........ ...
Latitude Longitude �• �' 0"
Design: - Current Design Current Design Current
- _. x 1-
S, � ' Capacity Population Poultry
Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish I0 Non-Layer I 1 ❑Non-DairyL I EJ��'
Farrow to Wean
❑Other
❑Farrow to Feeder
❑Farrow to Finish Total Design CaP i' ,,.es
ra
❑Gilts
❑Boars Total SSLW
r
Number€rf Lagoons!Holding P©nds,0 Subsurface Drains Present ❑Lagoon Area Spray Field Area
�.
x yN F x ❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes No
2. Is any discharge observed from any part of the operation? ❑Yes [St No
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 Surface Water?(If yes.notify DWQ) ❑Yes R No
e. If discharge is observed,what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system`?(If yes,notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes UANo
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes EP No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ( No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes No
7125/97

Fac4ty Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes No
Structures(Laeoons,Holdine Ponds,Flush Pits.etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes No
Structure i' Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifer: . ............. ......l�. ................. .....[+!1le!,� ..P.W.. ... ............... ...................-----...........
................. ............... .........
Freeboard(ft): ............. ............. ............. 3 Z-
10. Is seepage observed from any of the structures? ❑Yes IM No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ❑Yes ®No
12. Do any of the structures need maintenancetimprovement? Yes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures tack adequate minimum or maximum liquid level markers? ❑Yes 19 No
Waste Application
14. Is there physical evidence of over application? ❑Yes MNo
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
j_ .1!!.J
15. Crop type .............t v .fr...------........ ..........................................................................................---.....................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes ONo
17. Does the facility have a lack of adequate acreage for land application? ❑Yes k$No
18. Does the receiving crop need improvement? 1 ❑Yes kj No
19. Is there a lack of available waste application equipment? ❑Yes No
20. Does facility require a follow-up visit by same agency? ❑Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes JM No
22. Does record keeping need improvement? ❑Yes Q No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes 19 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ( No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes ®No
E No.violations-or. d6 ciencies:were-itoted'during this;viAL'-You:wiU receive ao fruitier'
: corrO06fidence.about this:visit:-: ; . : . : : : : : . : . . : : : : : . . : . :
�om�ae�tfs firefer to questiim�)�ExPI and Yl��answers and/ar and�ndattons or any other comments
ra1I1�S fl11�1 t0�]Ctt SIt11Ht1(15.(1�addrtitinal pa 'eSS nec4�Ssa['y),
H ,. ,�
o �
iGy01n )gQ 1tVt)Ck".
��k ��l,w, ors a� (a�z3��� 54►�[� b� °`�1��\c� ko
. 7/25/97
Reviewer/Inspector Name' { � �
�.t 'Ifllf� ;;sue _
Reviewer/Inspector Signature: - Date:

� .❑DSWC Animal Feedlot Operation Review ,
p
in
DWQ Animal Feedlot Operation Site Inspection
Routine O Complaint 0 Follow-up of DWO ins ection O Follow-up of DSNVC review O Other
Date of inspection Q"1
Facility Number 31 Z
Time of Inspection ;OD 24 hr.(hh:mm)
13 Registered ©Certified
t`` 3 Applied for Permit §1 Permitted 0 Not Operational Date Last Operated:
Farm Name: ADNX-4�L ...5aY.M................... County:........ 0-r-1..................................... .......................
OwnerName:.......l..'. t(WIA...........WW ........................................................ .... Phone No: ..L�k1u I -.3L. Lr.................................................
Facilitv Contact: .....(531)......&!.WA........................................Title:...... ..................................... Phone No. �... `� ....�?`Irr ..........
MailingAddress: .....7.g4.x........,�%!5...................................................................... ............AEG.................................... .z.W8.......
^ t
Onsite Rep resentative:.....�7t J.......9MJD..4ii ................ Inteurator:.......Ceuy.o.I.5.................................................-.........
Certified Operator;.................................................. .................................. Operator Certification Number:.......!UTL...................
Location of Farm:
k. .......da. .....y ..Mctir. ........ . .sue..,.. r4tAa�i�.�.... .ttr ta.....rxou...4n......S.fZ...1�4. ... ti�rm,......� .....o.s:.........
�ti.�s....-.ems.- .....of......sib..1SP ..-.....br......ifi�t�.....r�r dn..... �d ......Avr
.�e. .. ........................................... ..................................................
Latitude Longitude
Design Current Design Current Design. Current,;,- .
Swine Capacity Population Poultry Capacity Population Cattle Capacity .Populatioq
❑Wean to Feeder ❑Layer ❑Dairy
51 Feeder to Finish d ❑Non-Layer I I I[]Non-Dairy
❑Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity .
❑Gilts
❑Boars Total SSLW �3
Number of Lagoons/Holding Ponds Subsurface Drains Present ❑Lagoon Area Sprat Field Area ,u
❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes JgNo
2. Is any discharge observed from any part of the operation'? ❑Yes JgNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes -KNo
b. If dischar�tic is observed.did it reach Surface Water'(If yes, notify DWQ) ❑Yes No
c. If discharge is observed, what is the estimated flow in ,allmin? +
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ElYes ,M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ER No
5. Does any part of the waste management system (other than lagoonslholding ponds)require ❑Yes JM No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes liffNo
7- Did the facility fail to have a certified operator in responsible charge? ❑Yes JZNo
7/25/97
Continued on back

Facility Number: — Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes ®No
Structures(Lagoons,11oldine fonds,flush fits,etc.l.
9. Is storage capacity(freeboard plus storm storage)less than adequate? ElYes Od No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......Mh?.�.............. fV�,t3..L............ ... .-.-M1�3
Freeboard(ft): ........ :5..............I.. ...........1•.5................ 3.4
. ........ .. ................................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑Yes [allo
IL Is erosion,or any other threats to the integrity of any of the'structures observed? ❑Yes [RNo
12. Do any of the structures need maintenance/improvement? '®Yes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes [ i o
Chaste Application
14. Is there physical evidence of over application? ❑Yes ®No
(If in excess of WMP,or runoff entering waters of the State,`notify DWQ)
15. Crop type .........l� S �....... nnuC .......................................:�D6acf.Q...................................... h+F� �.....�c'i2tlY1......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? {} Yes ❑No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes &No
18. Does the receiving crop need improvement? Yes ❑No
19. 1s there a lack of available waste application equipment? ❑Yes qNo
20. Does facility require a follow-up visit by same agency? ❑Yes EZNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes NJ No
22. Does record keeping need improvement? R Yes ❑No
For Certified or Permitted Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ®No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ® No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes No
O No violations or deficiencies.were noted during this visit. You-Mill receive-no further
eorresp6ndence about this.visit:.,-
Comments(refer to question#) Explato,any,,YES ans�iers andfor any recom mendattons-or any other comments
Use dfoa o g9 of facility to better explatn'sttuahons (use add�honal pages as necessary) P :r
Iz. Moue. cantos„or, jaga�. wa S shou(� be, r�seer��1N- tn�t � In MEJ �De. aw o "'1
I OL
to.'f weed i 5 �I�nVJ ;r. f r e{j j6 iy Vkj �' CcaSfr i 6rmUk. Q. �IA14 CIAu
z.Z_ at�ar�evtt''' ak. -O ?1(lnl ,rlseCT �cbr co>^ ro1 y a{+ y 1`s�osa� c�. k`i5 s�sM be to
dart. ��rr�go o� SkD� 1 �� by- rt)A ~lumber awn} fi dd hvr)\ber-. -rTeO YiAa s
n I 5 t� + i z ion• a�t rJ i m`5 4& M rc}S S� O(jj) be CoAS J'Sk . o a�ro sho4d be
I - y
a es�IM1Gt'I-[EJ `1 rt `�t0.h. 7/25/97
Reviewer/Inspector Name ' Gh
Reviewer/Inspector Signature: A _ Date: