310594_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qua

y
Type of Visit: UCom PH
Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r i
Date of Visit: , Arrival Time: Departure Time:.J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -If 9'\ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ? f ( Z�c 7l
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pap.
1
Wet Poultry
1 Layer
Design
Capacity
I
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Z
Dr. Point ,
Layers
Design
C►_a aci
Current
P.o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
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?
❑ Yes
No
❑ NA
D NE
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ 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
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'No,
No .
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: T 1 - S-7 Y-7 I Date of Inspection: 2•I /7
Waste Collection & Treatment
4. IsAtorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 2 `�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes ]o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ]Vo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes io ❑ 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? f
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E 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 0 No
❑ NA
❑ NE
t5. 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 k__J lvo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
ReAuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE .
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements
❑Ot�Ye_s[]
21. Does record keeping need improvement? If yes, check t appropriate box below.
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 ff NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: '3) jDate of Inspection: IL
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I �J N "❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes El -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [J 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 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?
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[:)Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes Ero
❑ Yes ]?No
❑ NA ❑ NE
❑NA []NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: 2 i
Page 3 of 3 21412015

s
Certified Operator:
Back-up Operator:
Location of Farm:
Type of Visit: Or pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ZS Departure Time: SS County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� '� '�tj St"��-"'-'t--� Integrator:
Certification Number: ? Z 7
Latitude:
Phone:
Certification Number:
Longitude:
Design Current Design
S11 wine Capacity i'op. Wet Poultry Capacity
Wean to Finish La er
Current
Pop.
Design Current
Cattle C*apacity Pop.
DairyCow
Wean to Feeder
Non -Layer
DairyEEI Calf
ceder to Finish
�2 g
4 7Z
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Des!gn
D.r. P,oultry Ca aci
Layers
Current
P.o ,
I
D Cow
Non -Dairy
Beef Stocker
Gilts
I
INon-Layers
I
Beef Feeder
Boars
I
jPullets
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 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 T ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o NA ❑ NE
❑ Yes }o NA ❑ NE
u
Page I of 3 21412015 Continued

Facih Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2-go ❑ 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Po ❑ 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 ❑ NA ❑ NE
waste management or closure plan? TTT
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 ❑' T5o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V N ❑ 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 [r]'l o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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?
❑ Yes Q No
❑ Yes 6No
❑ Yes ]�No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
640",
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Zo20.
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis E Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
N❑
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❑
NA
❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: - Date of inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes " [/J 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 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
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 reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ETNo E_] NA ❑ NE
❑ Yes ..jNo ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes dNo D NA ❑ NE
[—]Yes 6No ❑ NA ❑ NE
[—]Yes a No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other .comments: .
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PIk-_tI10/)c_Ie,,.r�Q
t1l V/C_j 0--,4 Phone: Ala 7 7 ` 730y
Date:
21412014

NCDABCS Agronomic Division Phone: [phone]
Website: www,ncagr.govlagronomil
Report No,
FY16-SL036835
����:uiauee�b
Client:
Summerlin Farms
Advisor:
Predictive
872 N NC 11-903
i 4
Kenansville, NC 28349
Extraction
Soil Report
NOV
Sampled
Sampled County: Duplin
Sampled: 06/11/2016 Received: 06121/2016 Completed: 06/29/2016
Farm: 31-594
Links to Helpful Information
Sample ID: F1
Recommendations: Lime
Nutrients (lblacre)
More
Crop (tonslacre)
N P205
0
g S
Mn
Zn
Cu B
Information
Lime History:
1-Bermuda hay/past., M 0.0
180-220 0
Q
0 0
pH$
0
0 0
Note: 12 Note:
2 -Small Grain (SG) 0.0
80-100 0
0
0 0
pH$
0
0 0
Note: 3 Note:
Test Results [units - W1V in g/cm3; CEC and Na in meg1100 cm3; NO3-N in mgldm):
Soil Class:
Mineral
HM% WtV
CEC . BS% Ac pH P-1 K-1
Ca% Mg%
S-1 Mn-I
Mn-All Mn-AI2
Zn-I
Zn-AI
Cu-I Na ESP
SS-1 NO3-N
0.41 1.22
10.5 96 0.4 7.2 438 270
62 21
64 121
71 64
477
477
318 0.5
5
Sample ID: F2
Recommendations: Lime
Nutrients (Iblacre)
More
Crop (tonslacre)
N P206
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1-Bermuda hay/past., M 0.0
180-220 0
0
0 0
pH$
0
0 0
Note: 12 Note:
2 -Small Grain (SG) 0.0
80-100 0
0
0 0
pH$
0
0 0
Note: 3 Note:
Test Results [units - W!V in glcrrr; CEC and Na in meg110O cm3; NO3-N in mgldm3]:
Soil Class:
Mineral
HM% WIV
CEC BS% Ac pH P-1 K-I
Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn-Al
Cu-I Na ESP
SS -I NO3-N
0.46 1.25
8.9 91 0.8 6.6 351 138
68 15
81 104
70 63
435
435
366 0.3
3
Sample ID: F3
Recommendations: Lime
-
Nutrients (Iblacre)
More
Crop (tons/acre)
N P20s
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1- Fescue/OGrassl7m, M 0.0
120-200 0
0
0 0
pH$
0
0 0
Note: 12 Note:
2-
Test Results [units - W1V in g1cm3; CEC and Na in meg1100 cm3; NO3-N in mgldnr):
Soil Class:
Mineral
HM% W1V
CEC BS% Ac pH P-1 K-1
Ca% Mg%
S-1 Mn-I
Mn-All Mn-AI2
Zn-I
Zn-AI
Cu-1 Na ESP
SS -I NO3-N
0.27 1.19
10.0 97 '0.3 7.2 315 233
72 13
62 110
66
329
329
169 0.5
5
North Carolina
�k
Tdbaao Trust farad Commisslm
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

NCDABCS Agronomic Division Phone: [phone] Websits: www.ncagr.gov/agronomit
Report No. FY16-SLO36835
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 Ib11000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil 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 Ib11000 sq ft) at oni
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
Iblacre unless otherwise specified). Recommendations for N (and sometimes for B) are based on researchifield 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
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1
Mn-AI2
Mn-availability index for crop 2
Mn-i
manganese index
d
Farmers.and other commercial producers should pay special attention to micronutrient levels. if $, pH$, $pH, C or Z
M-o
min anese nsoil class
notations appear on the soil report, refer to Note: Secondag Nutrients and Micronutrients 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.
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.ticagr,gov/agronomi/obpart4.hnd 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
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
zinc availability index
Zn-I
zinc index
remaining 16 [P-1, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-1, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routinel
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncagr.yov/agionomiltiMt.htm

-� 1 101 511'
Type of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: © Departure Time: Q County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: j) N. 5'1 e%-o ^ _ Integrator:
Certified Operator: Certification Number: rA 7)
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C*urgent
Wet Poultry Capacity Pop. @attle
La er Dairy Cow
Design Current
Capacity Pop.
W an to Feeder
Non -Layer
Dairy Calf
feeder to Finish Z 9
Dairy Heifer
Farrow to Wean
Design Current
D , Pooult , Ca acit P,o
ILayers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts '
1. Is any discharge observed from any part of the operation?
❑ Yes
EJONo
❑ 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
[go o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
��o❑
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Elgity Number: - Date of Inspection:
r
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EHgo ❑ 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?
(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 ENo
❑ Yes [�No
❑ NA ❑ NE
❑ 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
[J'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[f 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
[!rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E7(No
❑ NA
❑ NE
maintenance or im rovement�
� p
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�f`No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 El"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�rNo ❑ 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
ff No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rTNo
❑ 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. In"Yes ❑ No ❑ NA ❑ NE
❑ Waste Application [fWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility N wber: 113ate of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C�`No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[!j'No
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
fNo
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
7-No
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
ff No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]�No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[D"'No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
MINA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ 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).
O s �
,Ij
.- .� r
S' tTt e c
16,3 4-,33,3 , s�
2 j� 1 � � Z � ,_ .; to i.✓'` s � ,�•t/k f f j ...t.c�
C f", e 'e- o a P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
h t. r j P0,41� Phone: 110 7 7� 730y
7,1e_ J Date: V7Z I S
21412015

Operation
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Othe/r] �0 Denied Access
Date of Visit: q' Arrival Time: I Q915 AM Departure Time: j 3 County: Ukp� Region:
Farm Name: �; ►,rw+� ��„�„�wtiB,r- •� y� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: -Toil
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: qq 1Q''11 Ro
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-La. yer IDairy
EE]
MQ7eTign Current
1) P,oult , Ca aci to ..
Layers
Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Datry Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes W] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
OlNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
�TNo
❑ NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Z�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

\'. Facil' Number: -5CH Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes k5No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ _ L I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 VrNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P—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]
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E!fNo
❑ 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
7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
7] 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
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�j' No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VI No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zf No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

I�
ci1i umber: - q Date of inspection: '3 -
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ZfNo
❑ 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
E5 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C6 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Z] 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
V1 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
V] 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
ff No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ 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 explainsituations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: a�j, _Ii L aaso
q Date: -3 b- I Lf
21412014

a
Date of Visit: Arrival Time: Departure Time: M County: �Q Region:
Farm Name: �I+^ �yt. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: —174) X1�`1r'yr�/\ s8 Integrator:
Certified Operator: y l r a b .W �� ' _ Certification Number: C1 (8!")
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design"rayer
to Finish
sign Current
attle Capacity PopWean
Dai Cow
Wean to Feeder
airy Calf
Feeder to Finish
D . P,oult r
Layers
Design Current
Ca aci P,o P.
airy Heifer
Farrow to Wean
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
IN
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?
[:]Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[]Yes
7No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

•
Facifi Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 12rNo ❑ 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): 3b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ETNo
❑ 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 KI 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 ZI No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes VfNo
❑ 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 Zj No
❑ NA
❑ NE
maintenance or improvement?
Waste AaUiication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 7No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes FfNo
❑ 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 RTNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g No ❑ NA ❑ NE
acres determination? F�
17. Does the facility lack adequate acreage for land application?
❑ Yes
P?rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PTNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
7No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PTNo
❑ 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 ;6No
❑ 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 RTNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeflity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!rNo 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�frN o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
J!7Vo ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
g!j No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
Rl"No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo ❑ 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
D Yes
46No ❑ 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
Z'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
VI No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VTNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.71
Use drawings of facility to better explain situations (use additional pages as necessary).
+k ?'cans
ate%
Small
� 1 .
`tom
Reviewer/Inspector Name: ` Sw AA n Uts
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 01D_3 b ):DA
Date:
21412011

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: O County: 1hi Region:
Farm Name: 31 M M cx, MMF_(Z-L 1 JAI 640 6k Owner Email:
Owner Name: � Ili � STD � 5 � �,�,�R� r,� Phone: %0 � o�9 (p —1t`/ ZU L/
Mailing Address: N /y C i�1i�U c.� , °i� l�lw c� �U3 } y& )V,QN S UILLG4
Physical Address:
Facility Contact:
Title:
JW
Onsite Representative: )o�n I N S L,.ytt Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish j
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult , Ca aci_ P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
tither
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

LEacility Nuihber: - I Date of Ins ection: eY
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 6No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 646QDN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g �[
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �XI No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) '7�
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes0',
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) A
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 1 XI No ❑ NA ❑ NE
maintenance or improvement? '7�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check'
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
Q WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis ❑ )�&e T s ers 0 Weather Code
❑ Rainfall [] Stocking ❑ C/op Yield [] 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Nimber: ---� 1 - 5 ri c-/ I JDate of Inspection: DMIJU
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 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? ❑ Yes t 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 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).
; q
g9 • 0445 007 12E� �1 � �4) C.A��1 L� - Gc� l�1 wSs' EL Ae.T I u E
wA
00111 1.1
qlw j 9
CPL,jg" XY,1 ��,� ► a
_ mAe S(kak_ l s 7-Us Gz uc cL�oa fs
Reviewer/Inspector Name: HmagnA6,41A16S Phone: ' 10 -_+ &-43 P
Reviewer/Inspector Signature: Date: 910M a
Page 3 of 3 V412011

Facility NAnther: —t[ - 5 cif-/ I IDate of Inspection: 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 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes No
❑ Yes gNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes t� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail -to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. '-
Use drawings of facility to better explain situations (use additional pages as necessary).
a�. N44S N67 �Z.�C-EIuF� aGA(a _Ot -� -C �3tw1slL-AC'.TIuE
wA
09111 1. i
H9
CAL,le" A:�,W )uAe C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q 10 &'-� -�al
Date: Diow/ a
214a011

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I fIBT J Arrival Time: /O Departure Time: County: i N Region:
Farm Name: �� rnm mm�P�-IN A1M Owner Email:
Owner Name: C-� N ` Exl J, S4 A4MF17—L1)V Phone: R16 '9qLO`11-IbLl
Mailing Address: + of a /V NC- 14 W!A 1 1 '} fA"j�S6S ? �'�S U 1uUlc �CF J W J
Physical Address:
Facility Contact: , ! Title:
Onsite Representative:��t%�S��y
Certified Operator: �) LL1S ODD �I�ul Sow
Back-up Operator:
Location of Farm:
Phone No:
Integrator: p
Operatoo? tertifcation Number: I M.-T�
Back-up Certification Number:
Latitude: [= c [= ` ❑ `I Longitude: = ° = g ❑ «
Design •urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry C*apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder I
IE] Non -Layer I
❑ Dairy Calf
Feeder to Finish I
Dairy Heifer
LJ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
ElBeef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
1171 Turkey Poults
❑f
Other
Number o Struc#III re!III :
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RID40 ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: 1 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess 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: L4i_4 M_ H
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
E] NA
[I NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat,
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 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo
❑ NA
❑ NE
'Comments (refer to question #} Explain any YES answers and/or any recommendations or any other comments k F =°
-Use drawings of facility to Better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility.Number: 5rj+-� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes -�q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA El NE
the appropriate box. 0 WUp 0 Checklists 0 Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IiSI No El NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis El V/aste Transfers
////���"`` ❑���� Alnual Certification
[] Rainfall ❑ Stocking ❑/rop Yield 0 120 Minute Inspections [] Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ YesN0 No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
)klNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
v ':
)01010
�12/ro
6OC4 R1�N�'P6N Ou:� �� �-
Page 3 of 3 12128104

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: �/d Arrival Time: Departure Time: County: �r��L�il/ Region:
Farm Name: t�s I m &A MC2t_IN CAenA Owner Email:
Owner Name: [RlJ EES TG-E/�JV� J -1 S(..ANPAEQ-tltAt �f phone n110- o��^�}o-t*ytCy
Mailing Address: 10)0 N ) —' '1�1w \\ (A L`lw i�N4MS UILLf= , ! V c �� 3L► 9
Physical Address:
Facility Contact: �,.i� Title:
Onsite Representative� 1
� c `
Certified Operator: �t g dD� - ]✓�! NEOM
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operato- r Certification Number: _L
Back-up Certification Number:
Latitude: = c = d Longitude: ❑ ° ❑ i
ign CurrenSwine Fc.,
apacity Population
Wet Poultry
Capacity Population
Cattle C•apac! Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
jo Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ La ers
ElBeef Stocker
rEj Gifts
❑Non -La ers
❑ Beef Feeder
Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
x No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[--]Yes
❑ No
❑ NA
❑ NE
[:]Yes
[]No
[]NA
❑ NE
❑ Yes kNo
o ❑ NA El NE
El Yes ❑ NA ❑ NE
12128104 Continued

>;acility Number:�j1 — _ Date of Inspection %
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: (-AC- CK)A(
Spillway?:
Designed Freeboard (in): �. 5
Observed Freeboard (in): Ids
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentathreat, notify DWQ
El7. 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
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. ❑ Ycs p�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [IEvidenceof Wind Drift El Application Outside of Area
12. Crop type(s) 'i]
13.
Soil type(s) VfLL \-11,1\ M6
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
�No❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
.N No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
..N No [-INA❑
NE
18.
is there a lack of properly operating waste application equipment?
El Yes
XNo ❑ NA
❑ NE
'..:
Comments (refer to question #): Explain"any YES answers and/6r any recommendaetions or any other comments..
K � T
Use drawings of facility to better explain situations (use addrhoual pages as necessary)4� fm'
db10 C AUL� NCt 2EC.� 1 U -- t� 1 M (31 C aC7 UF-
t„­� - A .
,Ql/6,lo C x9t1
Iox))o9 1.0
Reviewer/Inspector Name �Jj(fJ� G� /�S' . j Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYesXNo
❑ NA ❑ NE
the appropriate box.
3 WUP [] Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )KNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis Epeaste Transfers ❑_ x/nual Certification
❑ Rainfall ❑ Stocking ❑ QL'op Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes VNo
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes )9fNo
❑ NA
❑ NE
❑ Yes �iNo
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No )�q NA ❑ NE
❑ Yes No
❑ Yes No
El NA El NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Cl Yes
No
❑ NA
❑ NE
❑ Yes
tjNo
❑ NA
❑ NE
12128104

Type of Visit 0Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit k Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �%�% Region:
Farm Name: .�1 f`c1 MLA Sty M mER-u . / rA SZIY7 Owner Email:
Owner Name: E2
Q n-/v EA �S T�1FrEA/ , tl Su(Y1 (l'1 C-tZ !_ 1 Jl/ f� Ph91a-a96P_/'_/&9
Phone:
Mailing Address: 1 O� g /Y /r C r!w L1 '` V"�. f QQ J
Physical Address:
Facility Contact: Title:
Onsite Representative: �O ir-ND ->A-) lNSgnl
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6 ❑ O Longitude: 0 ° = 6 0
Design Current Design Current Design Current
Swine Capacity Population WeE Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
Layer
❑ Dairy Calf
Feeder to Finish
y
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Co
❑ Farrow to Feeder
El Farrow to Finish
Gilts
Non -La ers
PO Boars ❑ Pullets
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
I
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
tkNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

�FacilityLNumber: 1 — 5 Date of Inspection ywn7w
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAC'ido1V
Spillway?:
Designed Freeboard (in): �. 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 4No
❑ 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 A No
ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El of Wind Drift Application Outside
of Area
A014 r,- 5 rpr
(� r + XAL-,,
12. Croptype(s) 1'~��- 6CN-Q'i0 r C_5[L.tr_(C� I(J9 C
5<3 -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[:]Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
w'04.
J09 C)IC C.Aij� xaT oar iri" T1 U E
Reviewer/Inspector Name r AXIS Phone: `SIG �'496 `.)a
Reviiewer/]uspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes �] No [INA ❑ NE
the appropirate box. [] WUP 0 Checklists Design 0 Maps ❑Other '
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ )taste Transfers ❑>inual Certification
0 Rainfall 0 Stocking ❑ I/rop Yield 0 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J6 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 4 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KNA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
K] No
❑ NA
❑ NE
General Permit? (ic/ 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
6 No
❑ NA
❑ NE
Additional Comments and/or -Drawings•
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 Arrival Time: 1 00 Departure Time: County: t4 V Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C]��._ SU'_'s1N SCWY
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: 0 ° [� g =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
1 1 y
S
❑ 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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy_Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyj
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 (0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(�'No
El NA
[I NE
❑ Yes
14 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A 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: 646002V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 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 4 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 21 No
17. Does the facility lack adequate acreage for land application? ❑ Yes 9No
18. is there a lack of properly operating waste application equipment? ❑ Yes 19 No
[I NA ❑NE
El NA El NE
[I NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
96, GET L-AGC50N bF-SlCN F*Oa1 501L 4"IalE 4-LAPLIN OL&N ' -# KEEP L-2iffecog-bS
f 633
6T .4U6� �41VNugL �pcKIN6 JLECoa1� 9rtc�p w/ R.ECOR
�wHo R��Mc cAc r l3l�A T �on� -IF bATE fN FO.nn RN0 T
Ecz
cA
AuA1�R� �o� c.A S'T
LIRR07/a/V' CP(_1 Zjq-TC -TN1s �E41ZIt KEEpw/
85. DA.-IQwt(.L cc>c t7.Eco-b SL-uI)4E 54ftuE� cAQ-AvAva"r F3C cac497cL co,(l)'uCI
Reviewer/InspectorName inrE �U1n/ 241.11D Phone:
Reviewer/Inspector Signature: Date: c9 j 5/0
12128104 Continued

Facility Number: 3 1 -may Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [4 Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IX Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall IKStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N 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?
12 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
E� NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R 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
rV1 No,
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(�(No
❑ NA'
• ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[X10
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional Comments and/or Drawings:
U T-I t._- -rF-S'T TOKEN C CT AN 61 C, fl S 14N,471oN po4L^ FB R- A
•
Cevz IIFIC_% C�IC_
Lj3Fc_NG-et�, i d ikv_X /N A C-1441V P aFoc.JNGR-SH 1�+
1<t✓D�C� PosTCD 0Ar ,4uu� �p n�rw�S
rAX Ac.L 21��uE57E� ��CC'�i�S -fp
R-r7-N
q 1 (5 - 35p- aooy
az- A 1 L To
Nc.hen p- -ew4
A-T'rfv' Amam>P (Z;me 3
/0'4 CA(LbIxA RI UE_ T--X7
12128104

Facility Number
Division of Water Quality
O Division of Soil and Water Conservation
O Other Akgency
Type of Visit <0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: = Departure Time: ' County: Region: -
Farm Name: kt2Owner Email:
Owner Name: ^ o !J 1 [f , ��/lf%��jf1Z� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: dr.�?�Y1�i �lf�w77Fi�G�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = 4 = i! Longitude: = ° ❑ A = «
Y Design Current ` Design Current Design Current
Swin"e Capacity Population Wet Poultry -'Ca aci Population Cattle
p ty p Capacity Population
"
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
Farrow to Wean
D Pool
DryPoultry
tiT
El Farrow to Feeder
ElFarrow to Finish
❑ La ers
❑ Gilts
❑
Non -Layers
❑ Boars
❑
Pullets
I t
J
4+,
--_ - - - - ❑ Turke s
Other ❑Turkey Poultsa y�
❑ Other Number;
r Hof Structures
- ❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;�No
❑ NA
❑ NE
❑ Yes
XNo.
❑ NA
❑ NE
12128104 Continued

SN,
Fhcwty Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1011
Spillway?: Ak
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes Y-11,
o
❑ Yes No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes /0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes X No
❑ NA
❑ NE8.
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
ElNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 1�1No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )�' No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN • ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X No
❑NA
[INE
18. Is there a lack of properly operating waste application equipment?
❑ YcsNo
❑ 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):
Reviewer/Inspector NameI
PhoneK9AP
Reviewer/Inspector Signature:
Date: ✓�
Page 2 of-3 12/78/04 Continued

+ Facility Number: — Date of Inspection O
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes zp�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X
No ❑ NA ❑ NE
Elthe appropriate box. WUpEl❑ Design ❑Maps ❑Other
Checklists 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No El NA ❑ NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Trans rs ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;�'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑'NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:1 No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;2(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
f
31.
Did the facility fail to notify the regional office of emergency situations as required by
Cl Yes
J No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

1%
Facility Number
'
Division of Water Quality -
O Divisionof Soil and Water Conservation
0 Other Agency N . ;:
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / a Arrival Time: � + Departure Time: �� County:
Farm Name: -1- Zn► �,k/Zry ,4 a Owner Email:
Owner Name:/ri ,�`Zr✓ Phone:
Mailing Address:
Physical Address:
Region • WIA 0
Facility Contact: Title: } Phone No:
Onsite Representative: S M 1/ �K.�m ER 11r Integrator: �i/�PPrf�-- UeL
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o � Longitude: 0 ° 0 6
�P
;r
x Design Current Design Current DesrgnCurrent
z a 4
Swine. Capacity. Population Wet -Poultry :Capacity Population:' Cattle 7 = Ca aci Po ulahon
u
to Finish
❑ Layer
_Wean
Wean to Feeder
❑ Non -Layer
Feeder to Finish
Farrow to Wean
k D Poultry,
Dry
u arrow to ee er
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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?
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures '- L
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 to Na ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes )6No ❑NA ❑NE
❑ Yes to No ❑ NA ❑ NE
11/28/04 Continued

Fgcihty Number:, — (L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: tva
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA El 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 ❑ YesXNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ANo ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes1A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) , /'�fil�'M V,, 0.4 f �rP�47 1 , v - �C� QS dzF� 1
13. Soil type(s) A10B. 04
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes10,{No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J[J No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/� No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): 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):,
2 25 G�yu �✓F�o der Zak 6
Reviewer/Inspector Name d Phone: o- - Llo
Reviewer/Inspector Signature: Date: J r
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 9No
❑ 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 /0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
'0
❑ Yes /P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes ❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes �] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 91Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit r110outine O Complaint O Fallow up O Referral O Emergency (:)Other ❑ Denied Access
Date of Visit:[�� Arrival Time: Departure Time: County: G Region: I
Farm Name: L Owner Email:
Owner Name: - y„����,� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 1=1 o EDI F] I, Longitude: 0 0= t=
td
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Ij ❑ Non -La er - - - --- - -
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
❑
Daia Cow
❑
Dairy Calf
❑
DaijX Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
l
❑
Beef Feeder
❑
Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V1 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?: d
Designed Freeboard (in): L9
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ 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
fONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
V No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
V 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
o No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
oNo
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
16 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
i
z144 4V�*& /
Reviewer/Inspector Name 7 ""} 4 '� Phone:
Reviewer/Inspector Signature: Date: 3
1212814 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists / ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �Q No El NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers// ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:]No
❑ NA
)ZNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
INo
❑ 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
y
[I NA
[I 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
y
ElNA
ElNE
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?
El/ Yes
No
❑ NA
❑ NE
Additional Comments and/or Dra`vings:
�(�coao5 /✓�.�-r lNo D�o�,e�y,
12128104

Type of Visit ,UCompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit r Routine Q Complaint Q Follow up Q Emergency Notification Q Other 0 Denied Access
Facility Number Date of Visit: Oia+ Time:
0 Not O erational 0 Below Threshold
XPermitteOX( Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold•
Farm Name: �....r..!1 �:j1!!+�.... �Y?ll��?. CSR-i� ....... County:.......D.A....L.11LIA.............. .........................
OwnerName: ------------------ ------------ -------------------------------------- Phone No: ------------------------------------------- -----------------------------------------
Mail[ing Address:
Facilitv Contact: Title Phone No:
Onsite Representative-....�(� �/l ... �2U mb ..... Integrator:. ......,.
Certified Operator: ........... ................................... ...................._...................� .._...._... Operator Certification
Location of Farm:
[]Swine ❑ Foultry ❑ Cattle []Horse Latitude • 4 69 Longitude • 4 64
y Design " -Curreint R f Design Current, w - Design Current
f :..Ca acr -elation ,-Poultry f. `.Ca` -ci -Po `iilat,dnr Cattlet Ca`aci =Po` ttla on
dlpo
• .
_£°F _. E .
Layer; 0 Dairy
Y Non -Layer ❑ Non -Dairy
PO
4Y❑
-
$ Other �s
Total Des>Ign CapacttyF
{'Total SSLW`-.
Number of Iagooiis
p
Wean to Feeder
eeder to Finish
Z �Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
-
Boars
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon ❑ Spray Field [3 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 gaUn-dn?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identil"ier
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0 No
❑ Yes
❑ Yes
PTO
Structure 6
Freeboard (inches):
12/12/03 Continued

Facility Number: — Date of Inspection
• 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes /No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes a<
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �<O/
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type psi
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes NO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes L—Z
b) Does the facility need a wettable acre determination? El Yes
c) This facility is pended for a wettable acre determination? ❑ Yes PN�
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes /No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Vo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1►d'tvo
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 o
Air Quality representative immediately.
.��. _a.���.a
COnlrllCIItS �' iltis
�I'efer t0 (IUeStIOII ) ][plAlll Any all5Wer5 Angtor any-recomnitendatzOns-4r Ally Other comments. I.t
- _ _r. .r _- - --.�
;Use dcawings'af sty to bettereaip�n�sd�latlons {use;addibdriat pates as rlecessary.) �, ❑Field Cop ❑Final Notes �`
�3,� c-JASTC, An1�1.� 5 NL�S�z�G �2 td�t� 03 12 24 03
•
-AC,aa�i LCUGL (,OW DUF Ca S7LUDGE, RFN00A , f7"A— &CWT-US DRAY,
pJER$C�b 4�R+3&STE1�
_r.,j� Sw�rPE.
T
ReviewerAnspector Name _ -} Q
_ z _ �.e.. .��.
re
Reviewer/Inspector Signature: Date: o
12112103 1 Continued

Facility Number:31 —
Date of Inspection Q
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If y s, check the appropriate box below.
❑ Waste Application [IFreeboard 131wraste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [�No
VNo ❑ No
❑ Yes (�
❑ Yes No
❑ Yes
❑ Yes FNo
❑ Yes
❑ Yes
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit .0 Compliance Inspection 0 Operation Review Q Lagoon Evaluation I
Reason for Visit o Routine 0 Complaint O Fallow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not O erational 0 Below Threshold
Permitted 0 Certified [3 Conditionally Certified r[3 Registered Date Last Operated for Above Threshold -
Farm
Farm Name: �� �/ �G!/17 rY7 �21 Zn1 f /�I,Q�] County: PLIN
Owner Name: T SUn'1/ih F�PLZN Phone No:
Mailing Address:
Facility Contact: Title: -Phone- No:
f
Onsite Representative: Integrator: i!¢ azz
Certified Operator:
Location of Farm:
Operator Certification Number:
PfSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° u Longitude ' 4
Wean to Feeder
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish
Gilts
Boars
Subsurface Drains Present
No Liquid Waste Manaeen
Discharges & Stream 1_ mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav 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)
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ;A
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes XNo
Structure 6
Continued

1
Facility Number: Date of Inspection D2
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
O No
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
Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
f
12. Crop type L4
LL
13. Do the receiving crops differ with those designated in the Certified Animal Waste Man gement Plan (CAWMP)?
❑ Yes
No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
A No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Required Records & Documents
IVNo
IT Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
IPINo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[/No
t9. 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
No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
X
24. Does facility require a follow-up visit by same agency?
ElYes
� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;31No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
. s
Commetts.(refer tii,question ExplamFany YES'answers and/or any recommendah(nsor any other cammetats.l, : ,:
Use drawrngs of facility to better egplatnsituahons: fusee additional pages as necessary)
_. Field Copy ❑ Final Notes
�p Nip
Reviewer/Inspector Name j
Reviewer/Inspector Signature: Date:
05103101 C"f Continued

Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
tion Comments an or wings., ..
46)
❑ Yes /No
❑ Yes XNO
❑ Yes �No
❑ Yes �No
❑ Yes No
ElYes 'XNo
❑ Yes ❑ No
5100
J

wDivon of Water°Qity
Q Dion of Soil and Water Conservation
Q Other Agency m
(Type of Visit R Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: rime: 0= Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted [p Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name:......!^?`...t^t^Q.......................... County:....?�\!-.....................................................
OwnerName ................................................... Phone No:......................................................................................
FacilityContaid:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.....................................................................................................................
Onsite Representative: L-...,.?'................................................................... .
Certified Operator:
Location of Farm:
Integrator.• Y-v
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 44 Longitude • ' «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish JA JEI Non -Layer I ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
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? J
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
Strue;turc I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............................................................
............ ................................... .................................... .............................
Frechoard (inches): to
5100
❑ Yes❑ No
❑ Yes gNo
❑ Yes Pf'No
❑ Yes IX No
Structure 6
Continued on back

iFpcility'Number:' — 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 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 kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12, Crop type �v—c _c\� rsvc�� P _ TC Gti-�-2�_ Sc# CM_I k_ -i
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?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N,6-yiulati6ris ;or dgf ciencies -were noted :during �his;visit: • Y;oir wiii fe;pfAye iio further. - ; ;
rorrespo ' de... about. this visit ' .. .... ................
Comments (rg0frto question #): _Expl*-any-YIES.answers and/or "any recommendations o
Use drtiiwings of facility to better explain situations (use additiotial:pages as necessary)
[:]Yes N'No
❑ Yes JqNo
Oyes ❑ No
❑ Yes VNo
❑ Yes No
❑ Yes Wo
❑ Yes A 'No
❑ Yes 9T1110
❑ Yes O�No
❑ Yes �oo
❑ Yes ANo
❑ Yes [;<No
❑ Yes fi�No
❑ Yes ]4 No
❑ Yes WNo
❑ Yes KNo
❑ Yes ONo
❑ Yes No
❑ Yes 9No
❑ Yes KNo
�,.,,a,� QV �7'� �-.! d� 5�-vyC•� c� t� csS r5�-��� . �C� r-.��..-�, t'`�.�e�
,�e..���c� ��� �� �� � ���- � �� �a►.-,fie.. ie>��, � 1�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q ^ 5100

,J Facffit r Number: ok I Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes jf] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes <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 ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes - K No
do Comments- an or rawings:
0
V'�� e e low e
5100

ivision of Water Quality
Division of Soil and Water Conservation
O'Other. Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit k Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Dale o�visit: i�ne: 13 : L� Printed can: 7/21/2000
Facility Number 3 1 5
[CrNot Operational O Below Threshold
[Permitted [3Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold
/� j
Farm Name: .........%.�.M�r.`..................(5RI%-elf.'14..................... County:.......... ...1... .y� 1....Yi............. ....0 ...........
,] f c
OwnerName:............ ... .........f.Y� r.... Phone No: .......................................................................................
_mac
Facility Contact: ....... .. % ...............................
........ .. ..... .... Title: P".. Y............................ Phone No:
Mailing Address: ............. `................
.............
.
I '�............. ..l.....L......,.
�.�....... ..........................
ve:.............................. nte�................-..
Onsite Representatiu1................. grator:.............. ...................................
Certified Operator: ...............................................................
Location of Farm:
Operator Certification Number ......................
4
MSwine []Poultry ❑ Cattle []Horse Latitude �• �� ��� Longitude �• ��«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer JEE31 Dairy
Feeder to Finish ►7- 1❑ Non -Layer ❑ Non -Dairy
❑ lFarrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-)n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste :Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance mast -made?
❑ Yes
❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑Yes
❑ No
c. li'discharge is observed. whist is the estimated flow in gal/min?
/Y
fi
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
ElYes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:...........S;2.... ..-..............................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number:' — Date of Inspection Q Printed on: 7/21/2000
5t Are there any immediate threats to the integrity of any of the structures ob4d? ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes WNo
(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 Vo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VIN-0
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes io
12. Crop type l
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)'Mis 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?
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd-yiolatidtis'oi- deficiencies were noted d&iriii this visit: - Y:oir WHI-t'eceiye tno further: -,
correspondence.allotit this 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):
VIn"
�- V,-o,s cob 6e,,A ewn,[ BerW ovk st<J-e.
❑ Ye o
❑ Yes
❑ Yes N
❑ Yes
❑ Yes R�No
❑ Yes 'O�No
❑ Yes No
❑ Yes 54
No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes §kNo
❑ Yes �kNo
❑ Yes RNo
❑ Yes [�_No
lava
6t . yq r
UV s � okk
�� {
Reviewer/Inspector Name y-
Reviewer/lnspector Signature: te: o/pa

Facility Number: �j l — rLA Date of Inspection o Printed on: 7/21/2000
e)dor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge M/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 /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 4No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R Fo
32. Do the flush tanks lack a submerged fill pipe or a permancnt/temporary cover? ❑ Yes KNo
Additional Comments and/or Drawings:
i
Yea G yv ve,
r
1 tA��
ors
V-A
5/00

13 Division of Soil and -Water Conseryation Operation Review
0 Division of Soil andWater Conservation =,Compliance Inspectioin
ivrs>ton of Wafer Quality Comphance'Inspection x
= ._ :- - -
_- _- � Other Agency--_Opera4ort Review -
_- . _
NRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number � ! 5'i
Date of Inspection
Time of Inspection FF�M24 hr. (hh:mm}
0 Permitted *Certified 0 Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
County: ...... `!.. .
Farm Name: .......J.r..M.M.....!�Ml€-L.� "%
................... (-+
OwnerName: .................... Phone No: ...................................................................................
Facility Contact:.................................................................Title:....................... ........ Phone No. ...................................................
..............................................
Mailing Address: .......... ..........................
OnsiteRepresentative :.......�.Mµsr,-.-,jam(y�!`F -Z— Integrator AQ42%LL
..... ` .....................I.. .......G...................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
...................................................................................................................................................................................................................................................
Latitude a �° �•� Longitude • �° ���
Design Current ..,Design _ Current. Design Current
Swine -- Ca Capacity Po ulation' Poultry; Capacity .Population Catitle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
I Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
�Natctber Lagoons
❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
_.
Holding.Pon ; Salid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes U(No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes JZNo
c. If discharge is observed, what is the estimated flow in gallmin?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 5TNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes "El No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches). ..........
:�l........ I. ...... ..........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JZ No
seepage, etc-)
3/23/99 Continued on back

Facility y. umber: hate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes UNo
(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 0No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement? ❑ Yes J'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [-]Yes 7No
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes 2r�o
11- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ONO
12. Crop type Cam, 3Sa4u.VQX / a— - C'Le.1C4 *�''z S W £.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes �2No
b) Does the facility need a wettable acre determination? ❑ Yes j5rNo
c) This facility is pended for a wettable acre determination? m Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes VNo
16. Is there a lack of adequate waste application equipment? ❑ Yes Ef No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ZNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ZNo
(iel WUP, checklists, design, maps, etc.) -
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
V�(qo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[;(No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
Rio violaiioris:oi- deficiencies were noted during this'visit' - Y'oit wi Lteceiye Rio further
corresponc)terl . abvu1 this visit .... .... .. ... . ` .. .... .
'Comiinenis (referto.;quesdnn #) �_-Explaid an YES answers:a dlar au � rec ce y y ommendateons or��any otEier comments
Use drawings of facility to better explain situations {use additional pages as necessary) - -
M�r� su,a �.3>✓ c'tet ��07 ,IE6t�--r. AcL�+�>=v
1�pc 4, -rq S0%tA L I.iBJE .S4-F�': e�t9ri'T dIJr-van.-X 7; z 4 'Ra flrz,'l7 0Z_
PAc k�G�
s. A^,c- uo�.s P-A,,F.ks. -wiU L-Lo PXR-.�t Nr4DI rSG- .
C-r )9]
ReviewerfInspector Name ] r ( :�;.,•r'r �ql ? `] ic`� :
Reviewer/Inspector Signature: G1S��.5, �, ,�— Date: -7 I-Z. f �9
3123199

Facility umber: 31 -- s9 Date of Inspection 7 2.-�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,Z 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 ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ;KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
-_ - _ tiona -Comments . an or rawtngs•
if
IM
3/23/99

❑ Division of Soil and Water Conservation [3Other Agency
0 Division of Water Quality
4WRoutine O Complaint O Follow-u o_(DWQ ins ection Q Follow-up of DSWC review O Other
Date of inspection
Facility Number
Time of Inspection L 30 24 hr. (hh:mm)
(3 Registered 0 Certified © Applied for Permit [3 Permitted JE3 Not Opera Date Last Operated :......................
Farm Name: 3to l :S yynpyVAi:rn County: . �` .
Owner Name:...... - ....... j�nrl...........Phone No:..LA4 Z1L.;M44&q...---...........
Facility Contact:....................................................••••-•..... ... Title. •Phone No
Mailing Address: ........ m..... N ... :g:...... 4W....U.L.103....................... .... .t J.�..... N.C... .. .....................
Onsite Representative:..........
..............sdtnl'tti4hr.1111...................................... Integrator . ........... ..............
-Certified Operator ........... .:,?ft. r ......1�.:.................. ��rrm m�X: t t- ......................... Operator Certification Number s..----. ��3a.9...........-----....
Location of Farm:
Latitude.�1• ©6 Imo" Longitude 1't ' ©4 ®"
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 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
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes 121 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
q No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
Co No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
1P No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
qNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KI No
7/25/97

ac R Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes '0 No
Structures (LaQoons,HoldinE Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 7" No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard ft ................. ....................................................................................................................................................................................
( )'...........7:..
10.
Is seepage observed from any of the structures?
❑ Yes
[3 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 maintenancelimprovement?
❑ 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
1A No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
53 No
(If in excess of WMP, or runoff entering of the State, notify DWQ)
15.
`waters
Crop a ................... G;1.......... .....................................................................
pY]t,l�li........1LM.�•1.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
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 review/inspection 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.vidlations oc dM iciencies.we.m noted, during this:visit.- You :will rre'ceive•no-furi er :-
correspbbdehce dtioid this`visit: : .
Cb✓tt G� HJ tua SefG� �r� OVt✓ VA-1 j i h
0
❑ Yes ® No
Yes ❑ No
❑ Yes [9No
❑ Yes [S No
❑ Yes � No
[] Yes ® No
❑ Yes No
❑ Yes [� No
❑ Yes No
7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature: r 4 X _ _ Date:

� `� ❑Division pf Saii and Water Conservation 0 Other Agency ��� �: ,� �� f �•
"'� �y' ®'Division of Water Quality
. t
O Routine O Comnlaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number q
El Registered M Certified © Applied for Permit 13 Permitted
Date of Inspection
Time of Inspection 1 y.1 - 2_1� 1 24 hr. (hh:mm)
113 Not O erational Date Last Operated: ..... .
Farm Name:. .... Countv:.... u.►.�.............................
..u:.r�e ., rya. i.4. k ........ .......................... �.% ..... .i...Lo
r
Owner Name . ......... I ...... t.u, ............. ................. Phone No: �.F.(}.. .....Z...A.�...'. �. .6.. .
Facility Contact: .............................................................................. Title Phone No:
Mailing Address:.... ` . .�...... hl. ...�..�..�, .. i..l�..........q..�1��.......................... ... ,A ,.4 S.u..t...�� k %�.� ............ ... ZS..a..� j
r....
f
Onsite Representative:.,;3-�..r►-•s. ............... Integrators.... , ..i. ........................................
Certifted Operator: ......................................... ..... Operator Certification Number:..,4734..
Location of Farm:
Alt......... 4f..... -..........a...... j u t. ll. ......o- .. i .�cr a �. �.. nn...L.1 R� ....u. �.r...#`t.,-............ y y
...........��.,ra....�..t�.�..t...... w ...... ......K..i....... 0 .
Latitude •=' =11 Longitude 0• =' "
n
Destgtt x CurrenE
y 4 DesignCurrent n =Destgn# Curre�►t�
xuSwme R
,... .,
,Capacity Popt>la�tton
;Poultry,Capactty PoptilsEton Cattle Capacity Popul:itton
x-: _ _.:
❑ Wean to Feeder
.
❑Layer ❑ Dairy
Feeder to Finish
i10
Non -Layer I I Non -Dairy.
❑ Farrow to Wean
`
Farrow to Feeder
t ❑Farrow to Finish
M..Qk I TOta� D£ i n C �IaCEt�
i SS
t�
r
❑GiltsBoars
Number of Lagoons 1 Holding Ponds Subsurface Drains Present ❑ Lagoon Area PR Spray Field Area
.. . ..... r
-� �-"��w ��s '�' ❑ No Liquid Waste Management System
�� �.?��a=� � �" �. � �_
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ® 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 than -made? ❑ Yes 4R) No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
M No
c. If discharge is observed, what is the estimated flow in gal/min?
f3
•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
eNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
JXNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
RlYes
❑ No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
Xj No
7/25197
Continued on back

FadVitv Number: 31 — 5�
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
®.No
Structures (Lagoons.ltolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
kNo
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 2_.
.............................................................................................................................................
.......... I ......... ............... ...................................
Freeboard(ft):........................................................................................................................... ........................... ....
.............................................................
10. Is seepage observed from any of the structures?
❑ Yes
5j'No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
JXYes
❑ No
12. Do any of the structures need maintenance/improvement?
9Yes
❑ 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 RNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes EQNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. crop type ........... .W N.�.-... rxs s ........................ %?:S .C..V-.&.......... S .i!_ t!ar►.r�n.11y .Q4-Y,.r� r ! ......err i. !
`cuq
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes UrNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
NrNo
18.
Does the receiving crop need improvement?
ayes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
KNo
20.
Does facility require a follow-up visit by same agency?
$Yes
❑ No
21.
,Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
IR No
22.
Does record keeping need improvement?
CUYes
❑ 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
1ZNo
24.
Were any additional problems noted.which cause noncompliance of the Certified AWMP?
❑ Yes
9 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
ENo
13, No.violations:or deficiencies. were; voted -during this:visit.- You:viriil receive-noltirtlier
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Reviewer/)(nspector Name +',: a� 9 Uzi; � 0
NWd /. -ram.
Reviewer/Inspector Signature: Date: soy

•
0
Site Requires Immediate Attention:
' Facility No. 31 . 5 q4+`�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SM VISITATION RECORD
DATE: ail - , 1995
Time: 13 5'10
Farm Name/Owner: .1 i+�.
Mailing Address: 9 g _ Vip r } NC. -11— `t o 3
County: ��$ 1: ✓
Integrator. _ Phone: o g 6 �14b
On Site Representative: Phone:
Physical Address/Location: y i 6 3
Type of Operation: Swine Poultry Cattle
Design Capacity: c7 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4 S i ' S 3 " Longitude: 11 ° 1 44 _" 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) es r No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? - Yes or No
Is adequate land available for spray? or No Is the cover crop adequate? 1�or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (Mor No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Leine? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate was management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed_

•
..•
Site Requires Immediate Attention: h (--'I
Facility No. 3 1 S9q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
- DATE: ' , 1995
Time: �[�?
Farm Na
Mailing .
County:
Integratc
On Site hcy,cav-Mauve.
Physical Address/Location:
rz—I 1-0 c7 , U •�
Type of Operation: Swine t Poultry Cattle
Design Capacity: �_ `� C� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: `� S-`� ' y .[Sx% Longitude: :74 ' V_` '--1 J q- 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) OorNo Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or IQ Was any erosion observed? Yes oro
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C g G-�4� f NL, �� f
Does the facility meet SCS minimum setback criteria?, 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet o€USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or e 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)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.