310379_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qua!

7
Type of Visit: C) Complia nspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
�� r� m.ra�i�irr�mm.mrrr�i um�i�irrrr•.r�.
Date of Visit: 1L ► z /i Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
17 z3Z
Swine
Wean to Finish
Design
Capacity
C►urrent
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Dairy Calf
Design Current
Capacity Pop.
an to Feeder
I
iNon-Layer I
eeder to Finish
12-20
j zo
Design C►urrent
D , P,oult , Ca aci P,o
Layers
Non -Layers
Daily Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
(—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N NA ❑ NE
❑ Yes 0 No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3
21412015 Continued

[Facility Number: - 7 Z jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-No ❑ NA C ] 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: 12—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�5_9
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments neat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes I ❑ 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 ZNo ❑ 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):
111
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?
❑ YeseNo
1 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ 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 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ff No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E5No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ N ❑ 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

Facili Number: 7/ - 3 ZjjDate 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 l 0 ❑ 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 [:]No Vj_NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes ❑ O ❑ NA
❑ Yes P<No"'E] NA
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes ❑ NA
❑ Yes 01q0___13 NA
Comments_(refer to,`questi©n #)-. Explain any YES'answers and/or any additional recommendations or any other cofiiments "
Use<drawings of facility totietter ex lain situations, use addltional a es as necessa
P . (_ P g rJ!)n4 (-.-o Cr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Phone: �- %`i L 73 o44
Date: ! �i
2/4/201

Type of Visit: Q Compli Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Qekoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ZZ Departure Time: j 2 0 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: /-f " S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: . Z Z 3
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design C■urrent
C►apacity Pop.
Wea o Feeder
Non -Layer
Dairy Calf
ceder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
I)r,,y P.oul_tr,
Ca acity P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Qther Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
t2 L o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ErNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facility Number: j - 7 % Date of Inspection: 7
b
Waste Collection & Treatment
4. Is.storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to —❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�No[:]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ 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
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 Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box,
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
E0Z
❑ Yes
❑ No
❑ Yes
r�No
Yes
❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall 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 NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number; `3 1 - 7 Date of Inspection: 16
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 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CnlNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑'1Vo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[:DNA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rN ❑ NA
❑ NE
Comments (refer -to question #):-Explain any YES answers -and/or any, additional recommendationi'or any other com►ilihts..
Use drawings of ficility to better explain situations (use additional pastes as necessary).
r— ter'r" , � 'lc ,, r(s t,..c �� /mac P
O 31-3 l^ y
P i Ws ,
SPr. �_ V W & r /�' d D b` "`�''`� v- bn t.� 3a D �a 7 ^ &n At /�"•
A. ,zc(
� Z 7-(we
_Y"
Alc- z��(�3
Reviewer/Inspector Name: CV,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I l 0 7 9 b 73
Date: 1 V (? If rp
21412015

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi
Report No.
FY17-SLO22412
Client: Herschel 1 Wanda Jenkins
Advisor:
Predictive
Cypress Creek Farm
692 James Rd
' Soil Report Mehlich-3 Extraction
Wallace, NC 28466
"'*°►p��'' Links to Helpful Information
Sampled County: Duplin
Client ID: 378962
Advisor ID:
Sampled: Received: 11/30/2016 Completed: 02/07/2017
Farm: HERSCHEL JENKINS
Sample ID: HJZ2
Recommendations: Lime
Nutrients (Iblacre)
More
Crop (tonslacre) N P206
K20 Mg S Mn
Zn
Cu B
Information
Lime History:
1-Bermuda hay/past., E 0.0 60-80 0
120 0 0 0
0
0 0
Note: 12
2- Bermuda hay/past., M 0.0 180-220 0
220 0 0 0
0
0 0
Note: 12
Test Results [units - WN in glcrif; CEC and Na in meq/100 cO; NO3-N in mgldm;j:
Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-I
Zn-AI
Cu-I Na ESP SS-1 NO3-N
1.43 1.15 5.8 79 1.2 5.9 234 10 67 11
32 49 46 46 212
212
200 0.1
2
North Carolina
Tobxco Trust fund ConuniWm
Reprogramming of the laboratory -information -management system that makes this report possible is being Funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Trox

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomc
Report No. FY17-SLO22412
Henschel / Wanda Jenkins
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of sail several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at on
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-I
potassium index
ib/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
Mn-All
manganese
Mn-availability index for crop 1Mn-Al2
only on reports for greenhouse soil or problem samples.
Mn-availability index for crop 2
Mn-i
manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
M-O
mineral -organic soil class
notations appear on the soil report, refer to Note: Secondary Nutrients and Micronutrien In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.gov/agronomi/pubs,htm.
NOs-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagr.gov/aaronomi/oboart4.htmi find information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
W/v
weight per volume
The first seven values (soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-Al
Zn-I
zinc availability index
zinc index
remaining 16 (P-I, K-1, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-1, Zn-Al, Cu-1, S-1, SS -I, Na, ESP, SS -I, NO3-N (not routine)
available)] indicate levels of plant nutrients or other fertility measurement. Visit www•nca r. ov/a ronomi/u rst.htm

NCDASCS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No.
FY17-SL022413
,aNlH'lukt41,
Client: Herschel I Wanda Jenkins
Advisor:
Predictive
Cypress Creek Farm
692 James Rd
Soil Report Mehlich-3 Extraction
Wallace, NC28466
f"q1� Llnka to Helpful Informatlan
Sampled County: Duplln
Client ID: 378962
Advisor ID:
Sampled: Received: 11/3012016 Completed: 02/07/2017
Farm: HERSCHEL JENKINS
Sample ID: HJZ2
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tonslacre) N P2O6
K2O Mg S Mn
Zn
Cu 19
Information
Lime History:
1-Bermuda hay/past, E 1.3 60-80 0
30 0 0 0
0
0 0
Note: 12
2- Bermuda hay/past, M 0.0 180-220 0
90 0 0 0
0
0 0
Note: 12
Test Results [units - WN in glcrrrl; CEC and Na in meg1100 crw�; NO3-N in mg/drrP]:
Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-I
Zn-AI
Cu-I Na ESP SS-1 NO3-N
1.55 1.02 8.2 71 2.4 5.3 336 61 54 13
44 85 68 68 795
795
377 0.1
1
North Carolina
-j
Tot uco Trust fund Commission
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
Steve Trox

NCDA&CS Agronomic Division Phone: [phone] Website: www.neagr.gov/agronomil
Report No. FY17-SLO22413
Herschel / Wanda Jenkins
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
a
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
as%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at on
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K2O
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
Farmers and other commercial producers should pay special attention to mlcronutdent levels. If $, pH$, $pH, C or Z
M-O
mineral -organic soil class
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micron&]Untss. In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.gov/agronom!/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncaar.gov/agronomi/obAart4.htnind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information,, read A Homeowner's Guide to Fertilizer
P206
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
WN
weight per volume
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
Zn-t
zinc availability index
zinc index
remaining 16 [P-I, K-1, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cud, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine)
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaar.aov/agronomi/uvrst.htm

Type of Visit: o nee 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:
S
Arrival Time:
Departure Time: Lu_]� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: d a, Cam (, ,!n S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: rj 7 Z 3 I:
---—
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
an to Feeder
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
C►►attle Capacity Pop:
airy Cow
Non -La er
airy Calf
Feeder to Finish
`3W Z
Design C*urrent
Dai Heifer
D Cow
Farrow to Wean
Farrow to Feeder
D , P�oult . Ca aci_ P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
10ther
Beef Brood Cow
Other
Other
1
Dischar es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes 0<0 ❑NA ❑N1
❑Yes ❑No ❑NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes rNg"
❑NA ❑NE
❑ Yes
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page 1 of 3 21412015 Continued

R
Facility Number: - 3 % Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]I o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_Z__
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
\fn
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EZ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesF3/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes / No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ 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
EYNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Id l� ❑ 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
EA -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
❑ Yes
Q 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
0 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
f❑
Q �❑ 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

Facili Number: jDate of Ins ection: Q 4-
1
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
❑ YesEr'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
Q o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[J'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
Uj 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
dNo ❑ 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
dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 N:, �❑ 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
FD No ❑ NA ❑ NE
Comments (refer to question.#) :ExplainanyfYES answe.rs,and/or.any additional recommendations or -any other comments .
lUse driWings of facilitV to'be'tter'eip"lain sitiaiioinsluie:.addfflonM 0a
Mes,,as necessary).paMes;asnecessary).` �«.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
�C, c an
Phone: T ! 0-79 & -7
Date:
21412015

Di'vi"sign of Water Resources
Facility Number ©-Lj Division of Sail and Water Conservation /
QQ Other Agency 1/
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: f / Arrival Time: '© Departure Time: ® County: L//1/ Region:
Farm Name: 1Aey_scyF_cr -SE/vlu/vs C,_gem oC Owner Email:
Owner Name: ECG SGNF C— J CN ya S Phone:
Mailing Address: V 9a MSS L<4 W ALL A c r ! Y C 91941 (o �
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C►►opacity Pnp.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pnp.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1) . P.oul
ILavers.
Design Current
Ca aci Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes �No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) []Yes ❑ No [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 21412014 Continued

a
"FacilNumber: Date f
�i
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: LAGQau i LL�Gdoly
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): go-�
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[-]Yes
VkNo
❑ 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
Wo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tg(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 C❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S(:?, QL9Z T E5Clwt`
13. Soil Type(s):
LC.F
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ Yes No
D Yes No
❑ Yes
'ANo
❑ Yes No
❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
OWUP OChecklists ❑Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis [] Soil Analysis 0 Waste Traansters
M. Rainfall Q Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes A No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NI
0 Weather Code
Q Sludge Survey
❑NA ❑NE
❑ NA NE
Page 2 of 3 21412014 Continued

acili Number: - Date of Inspection: III/ 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes b� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1] 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
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?
0 Yes
No
❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
Reviewer/Inspector Name: 6&,4AU214 6l41,YE5, Phone:
Reviewer/Inspector Signature: - LtArmv Date: L at
Page 3 of 3 21412014

type of Visit: QJCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
2eason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �/j� Arrival Time: = I11� Departure Time: County:fL(j1J!'iYj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: lP3d T
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
INon-Layer
I
Ell
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder I
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
P,ouItr,
Ca %city
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharp,es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PfNo DNA ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes E fNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

.i.
acilfNumber: jDate of Inspection: 01
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
ZNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �N.[:] ❑ 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 KNo ❑ 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 ?fNo ❑ NA 0 •NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 9?fNo ❑ 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 0 Yes YrNo ❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 6�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �(No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
?rNo
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes WTNo ❑ 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 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J?:rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

'Vacillty Number:7A' jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by'the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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? 0 Yes KNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes. KNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes YfNo ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes V6 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:\1&6t�
Page 3 of 3
Phone: — &)— 2DJb
Date: 910,1
21412011

• � IDi'vision of Water Quality
.Facility Number 3 - 3 9 ©Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: / J j Arrival Time: j Departure Time: 1 S County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: 14 C— LS C}4 [ L \ E/VjQAJ
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
J�
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Gapacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Layer
Non -La er
DairyCow
DairyCalf
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P,oul _ ,
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
-Turkey Poults
Other
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
[—]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes No
❑ Yes I
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Fat-li .N,umber: jDate of Inspection: f
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: ' 9.
Spillway?:
Designed Freeboard (in): �J�
Observed Freeboard (in): Ll
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes V,No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop TYpe(s): � �� cs� sn
Y�
13. Soil Type(s): LpS Goq_ 3 �A , (t AU jL'L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
D 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 o
❑ 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
❑ YestNo
No
❑ NA
❑ NE
the appropriate box.
QWUP El Checklists ❑r Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
= Waste Application o Weekly Freeboard Waste Analysis Soil Analysis a Waste TransFers
❑ pp ❑ Y ❑ Y ❑ Y ❑
Q Rainfall [] Stocking Q Crop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes t
No
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility. Number: -S j - 3-} 9 1 IDate of Inspection: f j
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 777�]��� No ❑ NA ❑ NE
the appropriate box(es) below. 7�C
❑ 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 D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ 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 PNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes KNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes jANo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary).
'51 513
11 a-� j�� 14.9
L~; g2�-1,OAl }fit A C� �L
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f 1 h
214,12011

Type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: 11 l Arrival Time: Departure Time: County: �u C!�/ Region:
Farm Name: ,A&V_SCifCL_ JeIK/N S �A 9�,14 Q Owner Email:
Owner Name: EQ SC F>}E �— �� �NI�:N S Phone:
Mailing Address: LP9 9 SAMC s � W G�CLACE oLA l 0
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
+ `
UO(urAg-P' fa
6asu+F-,-- NUNS
Integrator:
Certified Operator:
gj&q SGHG(.L
lIV S eN ruNS
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i_=�p`3 L
Swine
Wean to Finish
Design Current Design Current
Wa Vit—VAffiPnn. Wet Poultry" Capacity Pop.
La er
Design
Cattle Capacity
Dai Cow
Current
P.
Wean to Feeder
Non -La er
EEJ
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P�Oult6 Ca aci_ Plo -
D Cow
Non -Dal
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

jFaciHty Number: - "S Date of Inspection: J /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
' a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: OC
Spillway?:
Designed Freeboard (in): �f , S )9. S C
Observed Freeboard (in): i 0
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? 0
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? K
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No DNA ❑ NE
4 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): �j��-�p� sct"e
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 ❑ Yes U[No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑ Checklists 0 Design Q Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ Yes Ig No
❑ Yes No
❑ Yes No
❑ Other:
❑ Yes 1A No
Q Waste Application Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ Waste Transfers
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
Q Weather Code
0 Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is•the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. 7�
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
�q
❑ 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
[A
❑ 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
I 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 drawines of facilitv to better explain situations (use additional vaees as necessarv).
lolgln 1.
C� 1 l sol L S AMP1 s slex r (SU l V'&Sut.TS N6T 9 00C yE7
a �]
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 110 (O1`1
21412011

Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1119 ko I Arrival Time: Departure Time: County: �L�� Region:
Farm Name: i1 mofC- o`
�&VowS F�2W& R Owner Email: nn
Owner Name: 6zSNGL_ �- 3C- VW�S Phone:/_ 916-98s-o�L/a3
Mailing Address: 19�Ui �A f' La tom`- �(4LC0CCC ' c— W[O(0
Physical Address:
Facility Contact: 1 Title:
Onsite Representative: 14 m-ScuF(- 1 U.)"r>A IF_/V KIA/S
Certified Operator: 14 Q.T G c�- W . S EYVI /41
Back-up Operator:
Location of Farm:
Phone No:
Integrator: r?
erat�Certification Number:
Back-up Certification Number:
Latitude: = 0 = g 0 « Longitude: = ° = 6 =
Design Current
Swine Capacity Population
Wet Poultry
Design
Capacity
C►anent
Population
Design
Cattle Capacity
C*urrent
Population
❑ Wean to Finish
10 Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non
❑ Farrow to Feeder
El Layers
❑ Non-Layers
El Pullets
❑ Turke s
❑ TurkeyPoults
❑ Other
-Dairy
El Farrow to Finish
❑ Beef Stocker
El Beef Feeder
❑Beef Brood Co
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El Yes ` No ❑ NA ❑ NE
Page 1 of 3 12178104 Continued

Facility Dumber: t — 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �o]�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �%(Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes \\�No ❑ NA El NE
through a waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 ANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �C,(ZCP�
13. Soil type(s) C-YjcD-,q_�cac Au-qZ o, r_tc
Ili
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Cg�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yeso
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
jNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer triquestion #}: Explain atiyYES'answers and/or any.kecomdtendations,�sr any:other coi»inents n
Use drawings of facility to. better explain situations. (use additional pages as uecessa.ry)
-'•'
w-A
Waho 1. q
Reviewer/Inspector Name �Q L C S ._ Phone: �j�d9�'��
Reviewer/Inspector Signature: Date: (�
e
Page 2 of 3 12128104 Continued

;Facility Number: -3 �] Date of Inspection U
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 ANo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Desig
n 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANO ElNA ❑ NE
ElWaste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ElWaste Transfers ❑/inual Certification
El Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections [D Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
b(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;o No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JA 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
_,..�(
�J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ao] a
0
Page 3 of 3 12128104

.: Division of Water Quality
Facility Number 3 3� O D�visian of Soil and Water Conservafion
l
e
�.
then Ag
Type of Visit (Icompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ,g2Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: J Q Departure Time: County: t 1N Region:
Farm Name: 1-A&(Z5CHEt— J�NKIIVS T`(�(�fY1 Owner Email:
Owner Name: R L. �� • Phone: 9 )0 02�S" (_a�
Mailing Address: C999 JAmEs
Physical Address:
Facility Contact: L I� Title:
Onsite Representative: }ctsc,y��` �G—NK1NS
Certified Operator: ERSCNEL- W . sENSC[X/S
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: i-4 9 , j
Back-up Certification Number:
Latitude: = c = I = ff Longitude: = ° = 6 =
is
Design
Swine Capacity
Curren# m Design_ ;C
Population Wet Poaltry ;Capacity
_. .
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑Non -Layer
Feeder to Finish e�
-,VjU"
El Farrow to Wean
1
Dry Poult `
!Y
" ❑ Farrow to Feeder
_a »;
❑ Farrow to Finish
❑ Layers
.' ❑ Gilts
❑ Non -Layers
❑ Boars
❑ Pullets
Other.
.. ❑ Turkeys
❑ Turkey Poults
J ❑ Other
❑ Other
Discharp-es & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow_
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection i 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: n p
Designed Freeboard (in): � -f . 5
Observed Freeboard (in): L, 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes ,] No El NA ❑ NE
maintenance/improvement? {
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1� 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 WindDrift❑
Application Outside of Area
12,
Croptype(s) <SC �JCE(Z-�P� FfSCttiE
13.
Soil type(s) G Oc us Goeo A (A TO
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No
❑ NA
❑ NE
17.
Does the facility tack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #); Explain any YES answers and/or any recommendations orany"others omments :„
Use drawings of facility to better explain situations.'(use additional•pages as neccessary);
9.Y
Reviewer/Inspector Name F VM NDA AtffC- S Phone: 910
Reviewer/Inspector Signature: awx9� Date: �d�� f1a9
12128104 Continued

- M
Facility Number: Date of Inspection 91
Required Records & Documents
19. Did the facility fail to have 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
No
❑ NA ❑ NE
the appropriate box. ❑ Vap ❑ Checklists ❑ Design 3 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes]
No
❑ NA ❑ NE
[] Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Ainual Certification
EIRainfall ❑ Stocking [] Crop Yield 0 120 Minute Inspections [] Monthly and 1"
Rain Inspections E]
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?
Cl Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
A 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
Xj No
❑ NA
❑ NE
F
wow 6zap
12128104

AV
W Division of Water Quality
Facility -Number $ S-1 9 0 Division of Soil and Water Conservation
Q Other Agency,
Type of Visit` i9) Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Vislt 12) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: U1121M I Arrival Time: ® Departure �Tiime: � County: � �'f � Region:
Farm Name: y A E f sc H C L _SG/V K!y S FAR N� of Owner Email: r�
Owner Name: H eesyv G `L VV , � F-N 4c jm S Phone: 91 0995" 04pJ
Mailing Address: I J A o es Z8 W lqulgC-C /V c a 89&
Physical Address:
Facility Contact: Title: Phone No:
�
Onsite Representative: i-i���Cf��t- �F/NL Integrator:
w hN DFl .NENr-1AS n
Certified Operator: ��Q �; W� lcjAj s . , Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Location of Farm: . Latitude: ❑ o = 4 = « Longitude: = ° = , ❑
Design Current' Design Current Design,.Curren
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity PopulahOR'
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
}GO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -Layer
f:
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
.I
Number of Structures
�:x
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ) No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility Number:3 j — 3 - Date of Inspection obi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )4NoElNA ElNE
a. If yes, is waste level into the structural freeboard? ElYes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C ON 12
Spillway?: �y
Designed Freeboard (in):
Observed Freeboard (in): _ y fio
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes] No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes }V1 No
7
El NA
El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �qNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. 1
Use drawings of facility to better explain situations. (use additional pages as necessary): I
S1C1 L &^QLf-S ZA! AZOUC- 3c3oo . bc-,, Ncrj- V�u mp oAv
o xV E S u�v T 1 L R S u C_T 5 C9 rr F� �If U? +4 E� SOIL SAP� S t4 a c w
Reviewer/Inspector Name DA I �/ S Phone: 16
M A N
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

r Facility Number: �) —`j Date of Inspection O
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 El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
[] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (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
0, No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number j 3
40 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit 670 pliance Inspection () Operation Review Q Structure Evaluation Q Technical Assistance
Reason far Visit ORoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: It t3 � Arrival Time: p `"1 J Departure Time: County: "tlyJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: � EN 7Ccd J
Certified Operator:
Back-up Operator:
Location of Farm:
'Swine
Y: ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 6 = i Longitude: = ° ❑ s
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry.Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design CurrenU
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:-_
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
] No
ElNA
ElNE
❑ Yes
El NA
El NE
El Yes
,L�,I/No
L✓J No
❑ NA
FINE
12128104 Continued

Facility Number: 3I —3 11 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA Gam ? ( L%i G'000 `L
Spillway?:
Designed Freeboard (in): j g r J J T, 5
Observed Freeboard (in): (/ 9 e3%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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? El Yes EJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [I'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 E'J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VIo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Lr I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop rWindow El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ec") r L G) S(.0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[I NA El NE
C]No El NA El NE
dNo ❑ NA ❑ NE
E No ❑ NA ❑ NE
L No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
.a.y,) GAjW"TZ j0tj D fli�X . AL
{aF fLJ0 Ge SVR-JEY art- LAC, ►O *L SWD -u ZALi;_Z64
Reviewer/Inspector Name �— o �.j A (, u Phone:
Reviewer/Inspector Signature: Date: ! t 13 0
pnoa 7 n(2 17/7RA)d rnnlirruod

Facility Number: — 3'jq Date of inspection t o
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ wup ❑ Checklists ❑ Design [I Maps El Other
❑ Yes ENo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D o
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
E Yes
El No
ElNA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
EllN
Yes
f_'J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
la No
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
[❑,/NA
O NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ET"No
ElNA
[INE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El2 Yes
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?
El Yes
��,,�
E?<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
ErNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
A,
Page 3 of 3 12128104

IType of Visit 6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %o J7 a S Arrival Time: J J 00 Departure Time: County: r)UPL'1'tO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 14 E I'LS C.1-I ( L. J74e N ►_:npjS _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 ❑ I Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑
Wean to Feeder
©
Feeder to Finish
1 2320
a D
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dahy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ICJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
El NA
El NE
El Yes
WNo
❑ NA
❑ NE
12/2"4 Continued

FaciliV Number: �j — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes LQ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA GOO � r LAG aD`Z
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in): '3 �— 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes WNo ❑ 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? ElYes El"
No ElNA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes Q No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Fe S Ly C C G-) 8 (4 ffLA CG) S[ O
13. Soil type(s) is 0 ra eu).Sfs'>YLO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
[<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P1<10
❑ NA
❑ NE
uPaATE jZAJ1!4-J�NLL. AWrD 1`' RAZAJ -Vu9-PGc_T-�56t1J {o(Lr..I 06'TAyn! �'T-Oc i 0&
iiVC-rUR (Y& i'aS EN n'b 'JI Ca Z,
)A 2 rvl_
Reviewer/InspectorName Q�j,�j �y,f[,tL : .`: Phone: ( 910) -7r, y 7.,?C,s"
Reviewer/Inspector Signature: dP - Date: /0 S-
12/28/04 Continued

FaciliV Number: 31— Date of Inspection
'te uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ N • ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Zyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil alysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ElStocking ElCrop Yield ❑ 120 Minute Inspections Monthly and 1 "
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
D<o
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I J/ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
NN
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
,B
L�'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
UN-0
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;' .
❑ 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
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
ElIa Yes
,�,
►vo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P 4
❑ NA
❑ NE
Addiiional Comments and/or Drawings: `P
e
12128104

Type of Visit Q Co liance 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: 1 i6h3joy ITune:
Q Not erational Q Below Threshold
Permitted dcerr&ed © Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: 6 a S C'VI LL Ji-Ij 5 f�YLM County b V Q &
Owner Name: ^ , _ , , , _ M _. Phone No:.
Mailing Address:
Facility Contact: ___. Title: Phone No:, ,
Ousite Representative: _,,,af 9 WAN �A Integrator: �5A fiAzil.i
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude •
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Dischar ,es & Stream I:n sets //
1. Is any discharge observed from any part of the operation? [I Yes [rNo
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 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes;;X0
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — I Z __
Freeboard (inches): 33
12112103 Continued

Facility Number: 3 1 — �j
Date of Inspection 14
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
. seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceJimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type BaVrA
❑ Yes 12(No
❑ Yes [a/so
❑ Yes [1To
❑ Yes 2<0
❑ Yes ❑'No
❑ Yes Q No
ElYes io
13. Do the receiving crops differ with those designated in the Certified Anima] Waste Management Plan (CAWMP)? ❑ Yes VfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 6] No
b) Does the facility need a wettable acre determination? ❑ Yes X
c) This facffity is Pe tided for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? dYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [INo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes EZ No
liquid level of lagoon or storage pond with no agitation? f
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 7[^1 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Vivo
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 No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
13L6LMV1DA Fzr-CX > w T.Lt, NEED sores I SI��-�GCsS�fG *jC-X'1" 5� vJG- s�
H-Drtg": Pwyv",
C"TSrJUr, vteq C"fit" .
Reviewer/Inspector Name
ReviewerAkq*ctor Signature:
1c`I111.
17/f7HlZ
r'nafiarvaj

Facility Number: 3 — Date of Inspection G !
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
eNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
Q
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑'Ro
❑ 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
LI No
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
//
(ie/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�Q,,'N�o
L
28. Does facility require a follow-up visit by same agency?
❑ Yes
'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
7No
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
To
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does retard keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112M

e m lVW01I erWater
A.Q Diof" ari4=Water Conservat�oa
Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j2o-Routine O Complaint O Follow up O Emergency Notification O Other 13 Denied Access
3! Date or visit: 0 Time: 7-S�
Facthty Number ,3
O Not O erational Q Below Threshold
0 Permitted C3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: __..... ..
Farm Name: ........... [ lI e�I.S.� 1e.......51 ''?. !_'^ �..... .....•r'r'L............................ County:....P.no /.!.la ........................
OwnerName: ..............fl rL,........................................ Phone No:.................................... _........_....... .. . _.
Facility Contact:
Title:
MailingAddress:..................................:.....................................---•..........................................
Onsite Representative:.RelYG !Ie f �C�., �'1'c, .' S
Certified Operator:
Location of Farm:
Phone No:
............................ .......... ... ..................................... .. ........................
Integrator:... r.'....5............................................
Operator Certification Number:
,Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 fit Longitude a 4 69
Design : Current .'-
: ;: - Design
Current Desgxi+ =. Ctirreat
._
.Swine
= Ca aci Population
Poultry = -
::..Ca aci
_- .
Pi ulation Cattle . ; : ca aci -_: Po elation
Wean to Feeder
10 Layer
❑ Dairy
-ErFeeder
to Finish Z '3 Zo
I[] Non -Layer I
1 10 Non -Dairy
❑ Farrow to Wean
-
Farrow to Feeder
❑ Other
_.
_
❑ Farrow to Finish
Total Design Capacity
-
-0
Gilts
❑ Boars
TOW SSLW
Number of Lagoons I0 Subsurface Drains Present [] Lagoon Area . ❑ Spray Field Area
Holding Poi* / Solid Traps ; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes .,,ffNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ONo
c. If discharge is observed. what is the estimated flow in gal/min? )11 a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ................ ... ................. ............................................................................................. ...........................
c^n ...
Freeboard (inches): 2.9 28
5100 Continued on back

Facility Number: 3- 3 4 Date of Inspection 2 D
5. Ale there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (11rNo
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 maintenance/improvement? ❑ Yes o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes J2No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes,�EfNo
11. Is there evidence of over application? ❑ Excessive Ponddiing ❑ PAN ❑ Hydraulic Overload ❑ Yes )SNo
12. Crop type ,..] A �1 i� Gj , % rr ,4A A, /&Ze , Ps-& UQ Cen ze , 19rq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'PKNo .
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? '112'yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes
Required Records & Documents /
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes,,E!'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 o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes/eNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes GY&o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 21NO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes'ff&0
23, Did Reviewer/Inspcctor fail to discuss review/inspection with on -site representative? ❑ Yes ,ErNo
24. Does facility require a follow-up visit by same agency? ❑ Yes P�40
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P'No
.: yiglaliigns'er d�f e�e�ci�s ivre P9 �1 �fi:��s�t, Y oj� wii� t�eciye too dui thr
colTes deiki al OD tf Mils Visit«
Co '(refer to4question #) j4Iam.any YES answers and/or any -recommendations pr any otl>ier camine�s. ¢ tr
Use dcaivnngs oftici ;tfl,better;e�t� pWn si4*#oA (use additEonal Pages as necessary).
)5. �T.-1F,-,o beo-rkWO(A v �tlorlL 7d 1en.,0✓e o. lc✓ 94rgS5C5 ir1 Z.eher
49 Vol !� . /-��p1r j;.r,e �n z®�,e S-�'•rp�e lesGae ,� 2one,5
CgAc,- 4tL4-1 n�ed aboV-e,44e TaG, t,"�r� z{-o sj A records ife well kFI4.
_ - a
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Pi 5/pp

Facility dumber: Date of inspection JJp7 'z 75 11
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes.'ONo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes eEiNo
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? ❑ Yesjf!�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 /EfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
Additional omments andforDrawings:
5100

eDivision of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
(Type of Visit GrCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit V Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date or Visit:
.3 t
Permitted 0 Certified Conditionally Certified (] Registered
Farm Name: .............�Il---
............................................ .............. :f .�t.r.............
Owner Name:.......... &-K. <c.4ei �"I;rLS
8 of) Time: 1355 Printed on: 7/21/2000
o Not O erational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County: J) U ��............ .. .........................................................
Phone No:
FacilityContact: .............................................................................. Title....................................................
MailingAddress: ............................................................................
Onsite Representative: ,,.,,,,, G��... S �e h�L 'r.S
' Y ...............L........
Certified Operator;,,,,,,,,,,,,,,,,
Location or Farm:
Phone No:
Integrator: _4V,-.ri-5 .........................................
............................... Operator Certification Number:......................
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude
' ��
�.4
Longitude ' 6 64
Design
Current
Design
Current
Design * Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I FE:1
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Z ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance: man-made'?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharve is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier: ... .........)..................... .......... ......
Feeehoard (inches): afej 3S
5/00
❑ Yes $No
❑ Yes No
❑ Yes No
hl,q
❑ Yes �fNo
❑ Yes �EfNo
❑ Yes �!fNo
❑ Yes XNo
Structure 6
Continued on back

Facilit� Number: 3 ) — _?7AT Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
❑ Yes
JO 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 maintenance/improvement?
OYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
E f No
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 L3�►�'� Stti,ti� (�r4in j FC-5_CUC 66n4,,el4r-a0Co Ve✓- .v4 CAn
( ►'a e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
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'?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
fiffNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
f9'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
DNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
WYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J�j No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
ElYes
j)_'j-No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
RfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
t!fNo
; o yiolatioris:ot, deficiencies were it44, du -ring ihis;visit: You will receive iio further ;
C0rres�6fideirce.ab_'fthis visit..-.•.•.•.-.•.-.•.-.-.....•.-.-.-.•.•.•.-.-.•.-.-.•.-.•.-.•.-.•.•.-.-.-.-.
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):
r
11. QVtrC nVh,6( Pti )1 �l of _2 �1Lr�S ak, 2 6 d S+nuilgrkin.
f S. ,l�ar�rk 4Q rernna r
ovc o►, �-r-%V,4c, gr^f c,S -le�err+.LdA �ie IA eih.pf J
bt PI)e esC4A b i1_5� C,"A S44i ir, .fiC 1,AJJ- }
1r'J. WrS-�e gti,a yySis need -ill 6eVeh4i�;{n1tis1r✓ Gi�G) sus Cat1 b�
Used �o� �f►�)1Gq�?oY, i ocG rr,,v t�r)1,�h �dduy3` c�F�;�t e avt ltn4Y�U. Ee�6�tr�
r-, cords ne M qe b P k�F 'rn!
IReviewer/Inspector Name e � , LV A'-'/j � S I
Reviewer/Inspector Signature: Date: (� 5100

Facility Number:31 —3j7q
Cate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
§j`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
JRj 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
�O 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
E No
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?
Yes
❑ No
Additional Comments: an .or. rawin s -,
3/23/99

1
❑ Division of Soil and Water Conservation - Operation Review
❑ Division of Soil and Water Conservation-- Compliance Inspection =
Division of Water Quality - Compliance Inspection
Other Agency - Operation Review,. ry
JQRoutine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number ,5
Date of Inspection
r _. Time of Inspection 24 hr. (hh:mm)
j�.Permitted [ Ci'erti#i{ed ❑Conditionally Certified ❑Registered ❑ Not O erational Date Last Operated:
Farm Name: ........ i*INSC.U"�-�...... . ltl c.' 'W-s ...... ....... Couzit} ...... t t . �h..................................... ......................
OwnerName .................... G.6-A.....--...........ie1Y11ki('5..............................-...... Phone No:...�lh�...-...................................
Facility Contact:.............................................................................. Title:.......
Phone No:
MailingAddress: ....... (acl.Z....... ........5'z ........................................................... ....... �}-C .............................. .n— -4t.6?.......
Onsite Representative: 4� QJrsl� . .............. Integrator:......... ��. �........ ..............................................
Certified Operator : ................................ ........... ........ ............................................................. Operator Certification Number:..........................................
Location of Farm:
..................on......(.x? �....���....r�.......5..CL....I.B�....0:5....:rrxL¢s.....�:a�-'#�....g........... 5 .......J 7....................................................7.
..........................................................................................................................................................................•--....-........................---....................I...I.......................
Latitude Longitude • �° ���
Design Current Design
Current
Design Current
Swine
Capacity Population Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
JE1 Layer I
I
❑ Dairy
I
I
® Feeder to Finish
Z
❑Non -Layer
❑ Non -Dairy
:�j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
_V
❑ Farrow to Finish
E' r
-
Total Design Capacity
Z3z0
❑ Gilts
❑ Boars
= Total SSLW
4Nnmber of Lagoons-. []Subsurface Drains Present ❑Lagoon Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field Area I.-.
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure
Identifier: 1
Freeboard (inches): 2,
.......................
❑ Yes
53 No
❑ Yes
Et No
❑ Yes
Wo
❑ Yes 0 No
❑ Yes UNo
❑ Yes Z?No
❑ Yes P No
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Z-
................ .................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes CTNo
Continued on back

a� cility,Number: 3} — 3�5 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? �&xcessive Ponding ❑ PAN
12. Crop type
❑ Yes
No
k]e Yes
❑ No
Yes
❑ No
❑ Yes
JoNo
❑ Yes
ONo
[DYes
❑ No
J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes 01 No
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
OYes �No
❑ Yes ED No
❑ Yes Q 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 2 No
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 JZ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 19 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes IgNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes rR No
24. Does facility require a follow-up visit by same agency? 52 Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
VWat idiis'eC & dendE mere pgted diw.i. u. t.b.11s, visit' • Y:oir Witt •kec6*0 tnq further.. .
cories oxide i .. sibi i this visit: :: .
Comments (refer to queshan #): tExplatn any YES answers and/or a_ny recommendations orr..any other comments: =- r
Ilse drawingsof faciii to better�ez tarn siti ahan use addjhotial pages as necess a ..
_ Y H
�- 3srL at=�s on i�asr. 2- -.t oL))6 "-WAd `
S. Cow s&t o A) be &` te) 00k A dcds .�O �,-�rf _-y--;or—
op Z + 3 Rtfioq c,6�, -vet3. No, 0iIc1-4Vj,_ f f.Ja�-S a' `
-+y 1a 1 o t L U-t) -sari W V p s k w lb
[3. �rsctrc, tv. `�-eld S s did. Ov�eJe� i{..s �'`,��c� W;kt.. +rye.
ke 4S,W hzrrAIL) / 5 VVVkk t `�`r(,i,� [`ro an
l`t. Co�rcyt pj�A1 5�a�1� he (aioeterns 4r �C%r'Ve aJ ioa�a�w. `liti�
aacmaA �eYco1� rs
Reviewer/Inspector Name
Review•erAnspector Signature:
Date: I
3/2 3/99

I -Facility Number: �t �� 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 �j 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 ONo
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 #rNo
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 No
31. Dn 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? ❑ Yes O No
Additional
Comments: and/or
Dswings
=P^ JJ�
r,
Mal -ko
ASusk
1,Sk ask j5;z
--'ha4a 6 -Wte,— try 3 m4
d
3/23/99

Longitude �• �` 0"
` - Desiign ,"Current
i " Poultry Vuliaritv_°Pnnulaition , . Cattle-
ti
❑ Division of Soil and Water Conservation ❑ Other Agency � s
Division of Water Quality ��� �'
JokRoutine O Com taint O Follow-u of DW ins action O Follow-up of DSWC review O Other
Date of inspection —7
Facility Number 3{
Time of Inspection 13' lb 24 hr. (hh:mm)
13Registered pCertifiied� t© Applied for Permit 0 Permitted 0 Not O erational Date Last Operated:
FarmName............. ......... A a_i a, ...---- ic►..r..................................... County: ....... hUAaa...................................... .......................
OwnerName: ........................... .............................. I................. Phone No:......� .1Q�... 5 :. !%.......................................
Facility Contact: .................................•---.....-----...... ---- Title: ............. Phone No:
Mailing Address:........... 4.51....... lgr!s.kS......... 4 ................... ,��.i� 11 r.......................... 24 Sara........
Onsite Representative: ................ Cttisti'l...-. �u7au�,.,S.................... ..... Integrator:......... ................
Certified Operator................................................................................................................ Operator Certification Number..........................................
Location of Farm:
Latitude ' 0"
Design Ca
Siiifiiiw Caoacitv:, Pant
2; ❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
23.0
7-32"
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
. ................
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes I$ No
2. 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 Surface Water? (If yes, notify DWQ) ❑ Yes (� No
e. If discharge is observed, what is the estimated flow in gaUmin? N
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 M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [3 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes MNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [A No
7/25/97

1 i
li'acili y Number: - 3�
8. Are there lagoons or storage ponds on site which need to he properly closed? ❑ Yes )ANo
Structures (Laeoons.flolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 �
Freeboard(ft):....--.......4...y............. ....•....--- `.1........................--•--..............................................._.................................... ........................... -.......
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
f
15. Crop type T'V:U.f..............�tCm+.l&.................sm .�.�......f�1LAN ......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss reviewfinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vialations•or dd ciencies:werentited-during this:visit. You4ill rece'ive-n6°f1irther-.'
. eorres'p&Aeike about this:visit::
❑ Yes
® No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
M No
❑ Yes
No
M Yes
❑ No
❑ Yes
No
❑ Yes
® No
❑ Yes
No
(� Yes
❑ No
❑ Yes
1P No
❑ Yes
is No
❑ Yes
P No
ts- 664-Inue- CAVYk% 4 It"YWC �%cve, avJ !o%j c�YtIV'. vc=Cue .A �A
io e 5�r� e� W e ens �t SI`�- yc�l�{ 1Ve .rr.rvt� t 5 VA 1 `l° .
Go rrti T t��� �U �e t(►��e u) o►.- 4— s4VA�yI t eCOX, � Ba C��
A o-1ft?��(- Z WWI _ SrW JI �1 � 14 'f C C , emu? 1 5 5avl o ` P,G�e (�i 0 A
� ��
k C V'O-\J0 i-004s _�th it-$- pcult S1tA �e M W 4
�r�1,{fir Gr\P� O" tt Of b k) (k1 7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: 71V11__111__1 AY, Date:

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Comnlaint O Follow-un of DWI) insuection O Follow-urs of DSWC review O Other
Facility Number
Date of Inspection 3 7
I '�
Time of Inspection D: o0 24 hr. (hh:mm)
© Registered M Certified [3 Applied for Permit © Permitted JE3 Not Operational I Date Last Operated:
Farm lamp lk.SCfit CGjktli.XCounty: n1"� ..'.h............................................................I
Owner Name:...... L(. r...................... ......... Phone No:
Facility Contact: ..... t....... 4h4r..S......................... Title :.............. .kl.... ,. f ... Phone No:..9LGt� �S:Z'�p3.........
liailittgAddress:...... ...z...... 9�i t...rzwi .�..'. �K...................................... I............. ..... n I,SG.�....t. G........................................... .Z% .6I+.........
Onsite Representative .......... �ttafS_Wll....... 1 :n .... ........................... Integrator:....... .G.t:tr�p)Ts............... .
Certified Operator, .................. --..---......... Operator Certification Number,.........................-...
.........................................................................
Location of Farm:
aY- ....... .. ..►per' +.....{;roe* ..... ;K.-4A..A..Tur.-a... .t:.......-en -ta.... *dy.. .,..�r �. �1t .....an..fD.....513..I S.ZA....
. �
:$.1.1a....t\.... -�...�.o. -. ....{. ..-.5--- crt....- nrn...i44.an.. ....SR.-1.g2 ....-i w�e�......
1Jm...i- ........o+�. .....5
t M - Fczr► A- i 5 &PCx 'v _
UAL LU C I 1 I E- I I --
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
iU11gRUue I �J onrtoviwast 9id�'(�.rgU4i'�
Design Current Design. -
Poultry Capacity Population Cattle Capacity Population . -
❑ Layer ❑ Dairy
❑ Non -Layer I j JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I Holding Ponds ® ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes allo
2. Is any discharge observed from any part of the operation? ❑ Yes W No
Discharge originated at: ❑ Lagoon [I Spray Field El Other
a. If discharge is observed. was the conveyance man-made'
b. If discharge is observed, did it reach Surface Water" (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
& Is facility not in compliance with any applicable setback criteria in effect at the time of design?
T Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
i�] No
❑ Yes
$ No
❑ Yes
(3 No
❑ Yes
f,No
❑ Yes
Q9 No
QO Yes
❑ No
❑ Yes
6D No
❑ Yes
® No
Continued on back

Facility Number: 31
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes R) No
Structures (Lagoons,Ilolding fonds, Flush Pits,_etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IN No
Structure 1 Structure 2 Structure :3 Structure 4 Structure 5 Structure 6
Identifier:
Z
Freeboard (ft): .........2................. .............
........................ ................................... ...... ......... ... .................. .................................... ........ ............................
10. Is seepage observed from any of the structures? ❑ Yes 09 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 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
® No
Waste Application
14. is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State4. notify DWQ)
15. Crop type ........... SG3t...... ...................... ................. ..... caksi.J...... t"bnUi......------- ............................ ............................
........ ............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
P4 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
Q_No
18. Does the receiving crop need improvement?
Yes
[A 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
4 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PS No
22, Does record keeping need improvement?
($ Yes
❑ 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
EA No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes
[9No
.25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
OQ No
®• No.violations or deficiencies. were -noted during this:visit.- .You.will receive no ftirther _
correspotideht a about this.visit..,
Comments (refer.to question #):, Explain any YES answers and/or any recanitcrtendattons or any,other comments:
Use drawings of facility to'better explain situations. {use additignal pages as;necessar)) s€
_....
s pow 04%s.5 s �I log 'I%J
iz.. 8ire&, sl�oylJ bt re rejtd oti 6oP, 101160r+S. nru, wm�x of bit, UAgoor,z s6vid
•
So- *�owet6, COnnet i� �a'QC, 6AJtt - ta5cavti� ,,,,,�r] irr%a`tlo�v IMPS Sl�ta��t}
�csrj.Otj Coa�� berrj& ovo �d 6 im raven
6e k. ' 44 #nYa�►
2x. so-,l 4-ts�-lievIJ 4s,, S. � ya�a+�I i tco�S 51wuld rb, ���rvF�— tfnrvr�b
�
dCS'Pt
"Mll -di fV%4er, 'a3com i rC��G.riCn Lieu TjtkY+blLS q�1� /�p11� �p�iy�2y�G(/ G(L�r COI`
i i ]
��ay. 5{nOv�t1 ine Dry Sit.
7/25/97
�.._ -. Rhy►
Reviewer/Inspector Name o. ,.. i
Yi0.h �. _
Reviewer/Inspector Signature: ,[&A _ _ _ ,� �,��_ Date;

f Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
i DATE: , 1995
Time:
Farm Name/Owner: ne 'S
�
Mailing Address: T
f
County:
Integrator Phone: r
On Site Representative: Phone:
Physical Address/Location: a Co
.Z r /-+ .
Type of Operation: Swine �� Poultry Cattle
Design Capacity: O Number of Animals on Site:
• DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:''" Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year //24 hour storm event
(approximately 1 Foot + 7 inches) (Xe� or No Actual Freeboard: T Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or�oJWas any erosion observed?Yes oro
Is adequate land available for spray? Yes or o Is the cover crop adequate? Yes or o
1-1
Crop(s) being utilized: e e' Gt e
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?e or No
100 Feet from Wells? or No
ion
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Uly
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or6) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage N th cover crop ? Yes or No
Addido al Comments:
t
rs
v rGa e tr f+
4 7C Fri
Inspector Name i ature
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
Site Requires Immediate Attention:
Facility No. ,7-, 79
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 , 1995
Time: • y�
Farm Name/Owner: H� �h C.� j t� Te/V -Irr/1%s
Mailing Address: _1'1614sQ7e- A/
County: 1
Integrator:
/ Phone: ` 1!9 — S�z — 6151I
On Site Representative: _i�OIJ &l&/er Phone:
Physical Address/Location: _-7 -.W4 e�
Type of Operation: Swine v"" Poultry Cattle
Design Capacity: o2&W „ Number of Animals on Site: 3X 8?0 21,Ya
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:.3`f 14' _" Longitude: —7T° _eg Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (esIor No Actual Freeboard: 9 ^Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? Yes orS
Is adequate land available for spray? Yes or No Is the cover crop adequate? ( or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?®e or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of ,USGS Blue Line Stream? Yes ore
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or io
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ors) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (Es10r No
Additional Comments:
•. L o ti
Inspector Name
Signature
cc: Facility Assessment Unit Use -Attachments if Needed.

f.
Site Requires Immediate Attention
Cal Facility Number:
SITE VISITATION RECORD
DATE: _ i __—, 1995
Owner: 14 e,r 5-A a-k VA'i Farm Name:
County: a4h.;� „
Agent Visiting Site: No,,f4p _ _ - Phone: VOO 2.96—,.i.Z0
Operator: Phone:
On Site Representative: Phone:
Physical Address: 0 a C EQ
Mailing Address:
Type of Operation: Swine 'X Poultry Cattle
Design Capacity: _ _ O Number of Animals on Site: RR 0
Latitude: " Longitude: 0 "
Type of Inspection: Ground Aerial
0 Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: _I Feet 7- Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Continents: (3i n -A- 3 A La-
• /3'&* /Ynn2�
Fax to (9I9) 715-3559 ignature of Agent

OPERATIONS BRANCH - WO Fax : 919-'15-604L JUI20 ' 95 12 : 56 P. 04/09
--
. Facility Nur bent- ( r
SITE VISITA`I'ICN RECORD
. r
•
•
Aunt Visiting Site: Phone-
[117�i3[pF: Fhoa:e: On Site Representative: phone:
Physical Address- U.? q
Mailing Address: -- __— - -
Type of operation. swine I'oui[rY Cattle
Design Capacity: Number of Animals can ,Site:
Latitude: To Longitude:__ ----
Type of Inspection: G�owid
Circle. Yes or i,�o
Does the Animal Was[e Lagoon have. sufficient freeboard of 1 Facer f 25 year ?4 hour strain event
{approximately I Foot m i inch~:!;) Yes or lNo Acta,,d Freeboard: ..'- Feet , inches
For facilities with rno;e tbxi one [a,,Oon. please address the Qrher lagoons' freeboard under the
cpA[7mrr lsis section.
Was any seepage observed from the lagoon(s)7 Yes or No Was there eroszcn of the darn?: Yes or No
Is adequate lznd availabie for land applicatina? Yes or NYa 1s uh- toyer crop ad,-,quate? Yes rr �-Q
Additional Comfiitnts: ?0-
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