820716_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

V
Type of Visit: QComp ' nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
1-0 Date of Visit: Arrival Time: p Departure Time: County: 8--- Reglan: r
Farm Name: r,t2f Owner Email:
Owner Name: V D/-" Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: QlyJ7 Yr' _ Phone:
Onsite Representative: Se—� . %
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: /op 31?b 6
Certification Number:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Pogltry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
❑NE
Dai Cow
Wean to Feeder
Bmayet
I I
Dai Calf
Feeder to Finish
_
Daig Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul .
dm
Ca act
P,o
Non -Dairy
Farrow to Finish
Layers
lBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Diseharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 [31�o ❑ NA FINE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
Fe No
❑ NA
❑ NE
❑Yes
El"No
❑NA
❑NE
Page J of 3 2/4/2015 Continued

jFaciUty Number: - fr jDate of inspection; lg9&
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /2 --
Observed Freeboard (in): _3D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [31' 4o ❑ 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
[3No [DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
[ To ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
E3<o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[3 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
(: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 ❑ Evidence of Drift ❑ Application Outsidee of Approved Area
Wind
/Window-�-
12. Crop Type(s): /!t /' Z
l
J
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑'des ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:3 Yes [�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes [/] No ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ET -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes []'No ❑ NA 0 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 �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['!
❑ NA [—]NE
❑ Weather Code
❑ Sludge Survey
o
DNA D NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Ins ection: 49 %--
} 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA ❑ NE
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
r;Tl�0
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
['Yes
❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�o
❑ NA ONE
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
[31Vo
❑ 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
ET -No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? 1f yes, check the appropriate box below_
❑ Yes
C5 -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
To
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Ej No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[!fNo
❑ NA ❑ NE
Comments'(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.-
Use'drawfngs of facility to better ezplain situations (rise additional pages as necessary).
y�llf�GK/fnp}e IFa/ r %ylSC
W UP /`r9 u red Ta '4e2_4 D f/v r.�( J870�e �/'7��,5
3 % —PV%gr—' 0 L( Y%� G�.����v-� L� tzz-a' cl
(,Aj of c`e ccruS`r� �%r/�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: jU�0�S'i
Date:
Page 3 of 3 214/2015

p,} i'visinnt� "Water Resources --
Faciltty Number ®- �J� Divisian�,of Soil and ateLGonservation rte;
OQ Other Agency
Type of Visit: EMompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
reason for Visit: outine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: r —/ Arrival Time: p; Departure Time: County: Region: J --D
Farm Name:Owner Email:
Owner Name: TJ— I,,,- Phone:
Mailing Address:
Physical Address:
Facility Contact: 6rrYr /f,3/'Z- Title:
Onsite Representative:
Certified Operator: Z�' CZAI.��j1'1V..-
Back-up Operator:
Phone:
001
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
design
�9
Carrenk
�� '"�•r is rG�
E", k Design Current
a, Design Current
Swine -
Capacity
WettPoultry
Capacity
pap.
Csttie;:.Capacity Pop.
a .::
Wean to Finish
Layer
Dai Cow
Wean to Feeder
(000
Non -Layer
Dai Calf
Feeder to Finish
` G
ia
Dairy Heifer
Farrow to Wean'
ME
IF
Design.
Current
Dry Cow
Farrow to Feeder
D , Poulti,''
Ca act {:
llo .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
H
Turkeys
i
Other
Turke Poults
Uther
Other
M,:.
Discharees. and Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If ves, 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?
0 Yes 2 -No ❑ NA ❑ NE
Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
C]NA ❑NE
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: _ % W jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
RYes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L&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):� f its
14, Do the receiving crops differ from those designated in the CAWMP? 0 Yes B 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 [:INA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [:]Other -
21. Does record keeping need improvement? If yes, check the appropriate box below. EffYes ANo ❑ NA ❑ NE
waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L�g_No ❑ NA 0 NE
Page 2 of 3 214,12015 Continued

Facility Number: _ 7 f Date of inspection: ,�/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes '0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [6 -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 M 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 q 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
�o
❑ 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.
[aYes
❑ No
❑ NA
❑ NE
n Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
[] Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Callo
❑ NA
❑ NE
Comments {rete to quesUoa xPY' Y;i , any.other enlmments:' r
;ti
r h[a"--m an answers and oran a thoaa .,recommea � ons or as of � '��'
Use„drswmes,of facility additional naffes as necessarvV _ .
F.�in ►'mss �r��.,�� ;� 7�,c �`� �"�� F' -a'.`.` �' "� (, ; .-�:� av��-C�.:�—
�a"�ccp "71r� GUa� �za'D� �Z�u� d�z�7L�/� GmL
3t, �r dt rte- I[e-_ VJOI�- AIMS 0(69
Reviewer/Inspector Name: J ­/r4 -'-G
Reviewer/Inspector Signature:
Page 3of3
Phone: �/O --723--0
Date:`����
21411015

114'
Type of Visit: © Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 911 routine Q Complaint O Follow-up O Referral Q Emereencv Q Other O Denied Access
Date of Visit: — /6 Arrival Time:j ('� Departure Time: ! County: Region: PW
17
Farm Name:
Owner Name: 0
Mailing Address:
Physical Address:
Facility Contact: t MO8-.'r Title:
Onsite Representative: 5�
Certified Operator: Q(� n A
—�
Back-up Operator:
Location of Farm: Latitude:
Owner Email:
Phone:
?e. Phone:
Integrator: Z
Certification Number:
Certification Number:
Longitude:
- _Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder 6V
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
@urrent
D Cow
Farrow to Feeder
D , P,ault .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
' _
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 allo [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No
❑ Yes No
❑Yes PL6J No
[] NA ❑ NE
[]NA ❑N
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection: /Q
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 R No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway'?:
0 NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):
0 No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'S No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Q No
❑ NA ❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 4:71 No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
E] NA
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 C2 No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [R 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
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �y/�-j �Gff/1�dy,6r—mss
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo [:]NA 0 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 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check❑Yes
� No
E] NA
❑ NE
the appropriate box.
❑ WUP F-1 Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
E] NA ❑NE
0 N 0 N
Page 2 of 3 2/4/2015 Continued

Facili Number:
Date of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? Cj Yes 0 No D NA D NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check E] Yes EE� No 0 NA E3NE
the appropriate box(es) below.
Failure to complete annual sludge survey (] Failw-e to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance'
26. Did the facility fail provide documentation of an actively certified operator in charge? ®. Yes [:]No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes 0 No NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [-] Yes Eg 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
0 Yes
® No
[3 NA
D NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facilityl If yes, check the appropriate box below.
[a Yes
D No
Q NA
0 NE
application field ❑ Lagoon/Storage Pond 71 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[H Yes
E3No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
0 Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[5„Yes
[:) No
[—] NA
❑ NE
f, r-arWl j;,&, 4 9-;h �bnad G(�o5 ►'L uc�ra-Q �tf i 1%e i9/►� v i�r ���9t
ave-/- X1-0 7 Ta v.r.,-�x�,a Qs ux ;-5� G-a�..��
C 1 /4 ! Go ref 'X/0�V/zr,r C!� ��
OP�frutv►. riz S :^ur�� N>f,�:r Cir iir� d��x� �`rlo�s.
,, }fl ��Ct�/17�,rt-�.r:���vf��l.P�r ±V�i Ger`7 ►f'��'r� Dpt�s/i'.� G'�ia� � :!'%u/Y``���
N r/
�p! en t,(fr � � ]��Glr.:� .`�-- Com- .�75
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone: }7D-qjr t?7 015-
Date:
Page 3 of 3 214M 15

i"vi`sion of Water Resources
Facility Number ®-/(, Division of Soil and Water Conservation
Q Other Agency
Type of Visit: aroutine
nce Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: p-/ Arrival Time: ! p Departure Time: County: P__ Region: F) w
Farm Name: � ic--ae"y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ej-"' "- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 9�o 6j
Certification Number:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D 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 D�No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes ❑ No
[:]Yes J, No
❑ Yes [ o
❑ NA ❑ NE
E] NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 2/4/2014 Continued
Design 'Current
DesignCurrent
1-
Design Current
Swine
Capacity- :Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
can to Finish
Layer
Dairy Cow
can to Feeder
ger
Dai Calf
Feeder to Finish
s
Dairy Heifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
,D . P,oul
Ca acP,o
Non -Da'
Farrow to Finish
Layers
=
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
�F
Beef Brood Cow
`ter t -
Turke s
^:
Other
_
Turkey Poults
Other
-
Other
-
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D 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 D�No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes ❑ No
[:]Yes J, No
❑ Yes [ o
❑ NA ❑ NE
E] NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 2/4/2014 Continued

Facili Number: - / Date of Inspection:
O -45--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ZYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
UqNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
. Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f -
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ 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
JK 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
Wo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pats of the waste management system other than the waste structures require
0 Yes
9q'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes O_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑�Evidencce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)- _ Qr rt / W4. � Y
f
13. Soil Type(s): 21a -.'t
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 2No DNA ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �KNo ❑ NA ❑ NE
❑ Yes J21No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 25.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ZLNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

Facility Number: - Date of Inspection: ZZ -1,9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FO
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [A_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 to provide documentation of an actively certified operator in charge? Yes ❑ 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
-Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ]a No ❑ NA ❑ NE
2�yes �❑ NA F]NE
❑ Yes [2�No
❑ Yes No
❑ Yes No
❑NA E] NE
❑NA 0 N
❑ NA ❑ NE
Comments (refer to question # • Explain any YES answers andlor any additional recommendations or any o r�comWineOr
Use drawingsvf facility W e er explain situations (ase additional pales as necessary).
/W.-. Up�c���� / �C� � �o � 1S IVO L0��'� a� K C�1�/r✓r 7 Cz'��►
pu haute .3v�� s y
7-0
�
J � r301
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:f/Y��3�33��
Date:
V4/2014

i ype or visit; *,o-tcumpnance inspection V uperanon tceview U structure Evacuation U t ecnmcat Assistance
Reason for Visit: t- Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: / / Arrival Time: Departure Time: ; 3!7 County Region:
Region:
Farm Name: .3U+1d— /--5'tdm Owner Email:
Owner Name: p, 5– �v �rr Phone:
Mailing Address:
Physical Address:
Facility Contact: ��rY/ Mtr)p/--r_ Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
e . Phone:
Integrator: Alew,17 W�'�
Certification Number: q*1rb%0
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
Current esi n
amg
Current
❑ NE
❑ Yes
Capacity Pop.Wet Poultacio.Pap.
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Finish La er
Dai Cow
Feeder
Finish
O Non La er
_
Dai Calf
Dai Heifer
0,Boarsi
o Wean''
.Design
Current
D Cow
o Feeder
�out Ca aci
l;o
Non-Dairyo
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
}
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/412011 Continued

Facility Number: - Date of Inspection: ILI
j Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [S 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes R 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 Z[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): jfo!-h
13. Soil Type(s): j PL S
14. Do the receiving crops differ front 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 allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
[:]Yes EK -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.
❑W T ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes C. 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 A No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�,No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Eacili Number: - f Date of Inspection- V41/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ 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
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
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 ElLagoon/Storage Pond El Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA 0 NE
❑ Yes No ❑ NA ❑ NE
Yes [:]No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
jo No
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 77,P
Date:
2/412011

1-4
7/(..
IType of Visit: U Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:# 3 c7 Departure Time: l,l : County: sia.fs.r
Farm Name: s Owner Email:
Owner Name: i� D 1::-- 15uJ- —,-, Phone:
Mailing Address:
Physical Address:
Facility Contact: . Title: &e'.
Integrator:
Certification Number: / L5 _�6 r
Phone:
Region:
Onsite Representative: S �
Certified Operator: a, 7;u�r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page I of 3
❑ Yes MANo ElNA ElNE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA EINE
❑ Yes ❑ No
❑ Yes rMNo
❑ Yes [KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued
Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
tattle Capacity Pop.
PD—es
Wean to Finish
Layer
Dai Cow
can to Feeder
7,
Non -La er
DaiaCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry P,ouli .
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke PouIts
Other
Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page I of 3
❑ Yes MANo ElNA ElNE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA EINE
❑ Yes ❑ No
❑ Yes rMNo
❑ Yes [KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

. Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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:
❑ Yes
® No
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
ONO
❑ NA
Observed Freeboard (in): -
Required Records & Documents
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.)
❑ Yes
R[ No
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?
® No
❑ NA
1f any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CKNo
❑ 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 N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
/Window
12. Crop Type(s): CD rpt hAar -f-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fZ 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 tack adequate acreage for land application'?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONO
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Sallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 12ainfalI Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I& No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili • Number: gw= _ 21C, I Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WjNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g No ❑ NA ❑ NE
the appropriate box(es) below.
M 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 -comps iance:
26. Did the facility fail to 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)
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes E, No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes
,FMApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WM P? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
rU-)
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
❑ No
❑ NA
[_]NE
No
❑ NA
[] NE
No
❑ NA
❑ NE
21 No
❑ NA
❑ NE
Phone: `, :g YE '-^.336c)
Date: �f �a�- 13
2/4/2011

irisionof Water Quality
Facility Number ®- %/� U division of Soil and Water Conservation,
Q Other Agency
Type of Visit: ompliauce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
rrival Time: pc7
Departure Time:�f `
County; Reglan:
Farm Name: _
ey-.r"&'5 j
Owner Email:
Cattic Capacity Pop.
`.
Owner Name:
F „ "'-
Phone:
Mailing Address:
Physical Address:
Facility Contact; rT-J MT-�D 'r--_ Title:
Onsite Representative:
Certified Operator:�u/
e-. Phone:
Integrator: MLA &.o12111
Certification Number: ! _
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 2 No ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes 5jNo
E] Yes ELNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued
Destgn�,Curreat �
n
'�1=Desegn � Current
x �JDesign Curren#
Swine
CapacF Pop.
,
Wet Pauttry=,. ap c ty op
Cattic Capacity Pop.
`.
eA
Wean to Finish
C a er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
`DesignCurrent
Cow
Farrow to Feeder
Ca acitv.,Pa _
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
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 2 No ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes 5jNo
E] Yes ELNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: Uate of inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J&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): 3Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ 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 [g 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
�g No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
$4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
❑ Yes
Eg No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_
❑ Yes
Lg No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
0 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): `n 100,
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
LRNo
❑ 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
(R 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
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0No
❑ 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.
[3 Yes
FNo
E] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stockin!: ❑ 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
r—_1 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg_No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ts Yes [] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Won -compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance: j D
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 review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
❑ Yes C�L`No ❑ NA ❑ NE
jg�xesto ❑ NA ❑ NE
❑ Yes No
❑ Yes] No
[—]Yes [2LNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / _11�41Z.
214/2011

im
Int
of Visit: OTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
m for Visit: GPeoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ��p� Departure Time: '7 County:Region:
Farm Name-terGzl�/ir� Owner Email:
Owner Name: r Phone:
Mailing Address:
Physical Address:
Facility Contact: a-�.� %%%�' Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:'�� f;
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[—]Yes ❑No
[:]Yes f2l No
[:]Yes El No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued
D.e gn Current
1
DK Current a
Design Current
Swine
CapecityPop�
Wet Poultry
Capactty� ` 'Pop3
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La yer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Des�gnCrrent
Dry Cow
Farrow to Feeder
D , P,autt .
Ca aciPa
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'} •� _
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[—]Yes ❑No
[:]Yes f2l No
[:]Yes El No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

Facility Number: -21 Date of Inspection: TA �!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus.heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes allo
❑ 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 54 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
/
12. Crop Type(s): GJ � r, / W`/`/ 74�/ S�-' yfr—tars ���rt
13. Soil Type(s):x
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 ES No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No [] NA ❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes © No ❑ NA ❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 12 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �f] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZ No ❑ NA ❑ NE
1
A 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2[No❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
IgNon-compliant sludge levels in any lagoon
List structurc(s) and date of first survey indicating non-compliance: / 7— G20 ! t]
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 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 Dail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA [] NE
0 Yes ®No ❑ NA ❑ NE
❑ Yes I" No E] NA ' ❑ NE
Iz—Yes go ❑ NA ❑ NE
❑ Yes
[B No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Yes
i(
❑ NA
❑ NE
jtj, d'/S• �ar�- t-��f�_y �L�u� �sa� �#�f �•�'G�d:� r��sl� IP_ I27��
�-
Grarl���'�Nr- _47 7Z�
�a f %
Y( L-lov _
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
Phone:d •�T7
Date:
2/4!2011

Type of Visit Q5-Co-mpliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ouUne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:r' Arrival Time: ,��5 Departure Time: County-, Region: a
Farm Name: — ,0�Y' �Q�'Ls Owner Email:
Owner Name: l/O �� Phone:
Mailing Address:
Physical Address:
Facility Contact: ��� $ter Title: Aw"w r ✓ Phone No:
Onsite Representative: ��.r Il�lrc_ Integrator:
Certified Operator: UO:• Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =, = « Longitude: = ° ED I = u
Design Current
Design C•urrcnt
Design Current
Swine Capacity Popufation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
-Laver
❑ NA
❑ Dairy Calf
❑ Feeder to Finish
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
9 No
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes H No [INA ❑NE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2LNo
[INA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: Date of Inspection U
Waste Collection & Treatment
13.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
BNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NE
15.
Spillway?:
® Yes
❑ No
Designed Freeboard (in): /
❑ NE
16.
Observed Freeboard (in):
❑ Yes
ag No
❑ NA
❑ NE
5. Arc there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ER No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ELNo ❑ NA ❑ NE
through a waste management or closure plan?
❑ NA
❑ NE,
1f 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
ERNo ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No ❑ 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
14. 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
54 No ❑ NA ❑ NF
- ❑ 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) �Lt�l�r�� O--rL lj&1e!u&7_--
13.
Soil type(s) -^-
14.
Do the receiving; crops differ from those designated in the CAWMP?
❑ Yes
N 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
ag 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
3No
❑ NA
❑ NE,
l ��5wc v e w�� �C *' o � /JVU_ 1 t� � 1 6 x'-�.� 7`o U h?, S v, -e To
<5 ISO u� "I'�i c �fl: •4t �►�a� ; - N of d.s Tb b r; f>-� i7r. Sir
v� ; �. f ps i o pi -- ust7��1 i � a_
Reviewer/Inspector Name 7:2:v Phone: 9y4> 'Y33 ".3�
Reviewer/Inspector Signature: Date: /0 ;96 i9 / D
Page 2 of 3 12/28104 Continued

Facility Number: — Daae of Inspection �a
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ N F
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [XNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
W[No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
04 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
971- 7kjr__ Fcf ru-e_ Y(�.
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[]Yes
allo
❑ NA
EINE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
S 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
BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
C,Yes
❑ No
❑ NA
❑ NE
_ ,.
Additional Comments and/or Drawings: ,,. ,... .
CV7i`t n&e i -a ll,� Fri e i-ef'DrZ-- Tr
Ve
YVA�i G,�e 0- ��` �,� e� older
V, LAA FC
L5 Ga& m �•� °r �k e� �-,-�. rr�5���� d-���v 7
971- 7kjr__ Fcf ru-e_ Y(�.
r c� by for
r✓� �-�� 4/amu_. Q/'� � aCr��� i.S �O ,ter �%� �� j�GW
b F) Y_J 7-0 prr-
U
Page 3 of 3 12/28/04

/Z-0'7- Z007 R42—
Type of Visit �mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e "one 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date ofVisiU %2--07`D Arrival'Time: l0%O0 Departure Time: %fp County: Region:
Farm Nance: �4TIGY farscS Owner Email:
Owner Name: Toe, Bcxfle. V Phone:
Mailing Address-
Phvsical Address
Facility Contact: �'� �DOre Title:
-7e--c-4 � �Gt� � Phone \o•
Onsite Representative: ar-d <-✓ Az&,U*-e-- Integrator: �y
Certified Operator: U
^-�0e— �++�# ���✓ Operator Certification Number: AdA — 99'9'06
906
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑° ED, ❑U Longitude: =°
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
S7G D 1 10 Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & `trearn Impacts
L 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
❑ Dair3i Cow
❑ Dairy Calf
❑ Dairy Heifer
[I Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: a]
b. Did the discharge reach waters of the State? (If ves, 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 LRNo ❑ NA ❑ NE
❑ Yes ❑ No GRINA ❑ NE
❑ Yes
❑ No
[ 'P/A
❑ NE
E3 NA
El NE
❑ Yes
No
El Yes
�❑,
L_-f-N��o
El NA
El NE
C1 yes
2 o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: g2 — %/(o Date of Inspection / T 07-o9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E[ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L'7 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 -No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on-site which are not properly addressed and/or managed F1E 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
El,
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 [3No ❑ 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 LTJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement? ,
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) J �
ea Al 4 Co N
13. Soil type(s) C�' rJ5
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[`No ❑ NA ❑ NE
L No ❑ NA EINE
[]�No ❑ NA ❑ NE
ffNo ❑ NA ❑ NE
eNNo El NA [:1 NE
i. }lx-..:"ai eQ "..�' at'�'. 1
Comments (refer to question #)-...Explain an YES answers and/or any recommendations or any�other comments:
a•4iS=r x `''" �.,'_ ' ! .tips`
Use drawings of facility to better explain situations. (use additional pages as necessary} ;
A6
Reviewer/inspector Name
Phone: 91O, 5�33.330�
Reviewer/Inspector Signature:.(,
Date: %,Z. -Q ]
12128/04 Continued

q7- - 7/(P at -v7 -o 7
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [__1 Checklists ❑Design ❑Maps ❑ Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
Cl Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Bl�o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O'<o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[,..3.�<o
El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<O
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L7 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ 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?
El Yes
L7 No
O"
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
�
31. Did the facility fail to notify the regional office of emergency situations as required by
Yes
ElL3
,�
"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
El,
��
Lr No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Delo
❑ NA ❑ NE
AdiictionaliCom mens°aad/orrD�wngs:
AL
12128/04

r
type of Visit &'frompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (311outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: !Z �0�~a �' Arrival Time: Departure Time: /Z.� $ County: Region:
Farm Name: + I z Owner Email:
Owner Name: O ear Phone:
Mailing Address:
Physical Address:
Facility Contact: G m—C-4- mi", rte, —Title: Phone No:
Onsite Representative: tos—e"e—I+(AMInr Integrator: ?>r&UA.0
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other. -
❑ Other
Back-up Certification Number:
:J
Latitude: == old Longitude: 0 oF-1 I Q"
Design Correct
Wet Poultry,:- Capacity Population
❑ La yer
❑ Non -Layer
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turke Points
❑ Other Number of Structures:
Cattle
] Dairy Cow
] Dairy Calf
] Dairy Heifer
] Dry Cow
] Non -Dairy
] Beef Stocker
] Beef Feeder
] Beef Brood C
Discharges & Stream Impacts
I . Is any discharge observed from any pan 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'?
R. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
'age I of 3
❑ Yes B No ❑ NA ❑ NE
❑ Yes
❑ NorqA
❑ NE
❑ Yes
❑ No
STA
❑ NE
R`IA
❑ NE
❑ Yes
❑ No
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
®'o
❑ NA
❑ NE
12/28104 Continued

df-- A
Facility Number: 8' —W& Date of Inspection R'O
Soil type(s) 4Z, n _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2j'El NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[I Yes
,1,'No
L"! No El NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
E]NE
Spillway?:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? [3 Yes
2 o
Designed Freeboard (in):
❑ NE
17.
Observed Freeboard (in):
❑ Yes
[Ko
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9'NNo ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
0,<o
6. Are there structures on-site which are not properly addressed and/or managed
ElP 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
9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2No ❑ 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 [:INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�,�/
[E 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 Area
12. Crop type(s) F� SGtt 'q.Sju jt__) C_CrN -
13.
Soil type(s) 4Z, n _
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,.,/
BIN
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9<oElNA
E]NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? [3 Yes
2 o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[Ko
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0,<o
❑ NA
❑ NE
Comments refer [o question # � Eg lain .a—nn"S a05wers an1dlo�r a�neco tendataons or an other co men
Ilse drawings of fs ty to bettter� plain situations. (use addt nal pagesoasln essary):
A'
•
Reviewer/inspector Named
4.v[S _ -` Phone: y/Q ,.3.3.3330
ReviewerAnspector Signature: -
Date: /2 -67-2 0610
Page 2 of 3 12128/04 Continued

Facility Number: 5 — Date of Inspection
Required Reeords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design E] Maps El Other
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
M<o
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EK
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
and report the mortality rates that were higher than normal?
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections❑ Weeatthher
Cade
30. At the time of the inspection did the facility pose an odor or air quality concern?
[I Yes
,�,�
L] ivo
❑ NA
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L� Noo
*� A
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fNNO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
Bio
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
E3 NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
E] Yes
D,
I3'ivo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErN.
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QKo
❑ 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?
[I Yes
,�,�
L] ivo
❑ 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
2io
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�
❑
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[IB Yes
No
❑ NA
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EIN<
❑ NA
❑ NE
i ,u .'r.f,.•vA'fil e4:da,-Mur ,;�I7Y 'y .^ # Y *'�iz'i4 'S kh' � '
Adrlit onal Comments an&or Drawings` t
Page 3 of 3 12128104
Page 3 of 3 12128104

fivision of Water Quality O�
[Facility Number Q Division orsoil and Water Conservation l5
Q Other Agency
Type of Visit MQpmpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit )4 Routine O Complaint Q Follow up O Referral O Emergency �Q Other ❑ Denied Access
Date of Visit: JU 01�1 Arriral Time,: ' �_D�eparture Time: � County;
Farm Name: C'�i t�tA9 fYL� Owner Email:
Owner Name:L— L -1`L �� Phone: _
Mailing Address:
Physical Address:
Facility Contact: � X 1 � � Title: Z S Phone -No:
Onsite Representative:ff Integrator: r - r t
544
Certified Operator: �L Operator Certification Number: 1 O `
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: EJ o=] f =1. Longitude: =0=4 =
o❑4= p
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
mtzo� Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_e5 & 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 -matte?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Caif
❑ Daifx Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
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 I'No ❑ NA ❑ NE
❑ Yes
❑ No
r_ NA
❑ NE
❑ Yes
❑ No
'qNA
❑ NE
❑ Yes
❑ No
WA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128/04 Continued

Facility Number`taDate of Inspection l a�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *No ❑ NA EINE
a. if yes, is waste level into the structural freeboard? [:]Yes ❑ No �NA ❑ NE
S eture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in)--
Observed
in)_Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo [INA ElNE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Wo ❑ NA ❑ NE
maintenance or improvement?
Waste ADMication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Cl 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
P tYp T�wn:s
�--(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P4No
❑ NA
❑ NE
15. Does the receiving crop and/of land application site need improvement?
❑ Yes
P;:]Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JN0
ElNA
[:1NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Kio
❑ 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):
Reviewer/Inspector Name j Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number- ' — Date of Inspection iL Cl
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 /llRNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tvNo
❑ No
9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�34o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
~ �&o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
❑ NA
ElNE
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
[__1 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
�&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
caubfr-mVdS
60-riry, ; n nim m Sla fe
•
12/28/04

Facility No. r^ , Time In Time Out Date
Q
Farm Name _ 1`i�Y Integrator } f'k rl
Owner Site Rep IN�
Operator No.
Back-up No.
COC Circle: Gener or NPDES
U ck
Desion Current
Design Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed, Finish
Gilts 1 Boars
Farrow -Wean
Others
S BOARD: Design
.2iuuyc aui Jay ��A
Crop Yield
-s-
U,-, t2 0 C
Observed
Calibratior,,!GPMCI_&� t ��
Waste Transfers -
Rain Gauge Rain Breaker
Soil Test L on / PLAT Wettable Acres
Weekly Freeboard V Daily Rainfall 1 -in Inspections
Spray/Freeboard Drop � n { o,C `e -50 l 4G 4�
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
._7
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
3 a
3115- -- 7
�LP
�-
-71 -3

19LDivision of Water Quality
Facility Number 0 Division of Soil and 1Vater Conservation
0 Other Agency
Type of Visit Q Compliance Inspection 0 operation Review r5 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency V Other ❑ Denied Access
Date of Visit: TJ (, 01 Arrival Time: Departure Time: �Z 5 County. Region:y*_10
Ir
Farm Name: IV W rwtr }S Owner Entail:
Owner Name: _._ 7sle, t'�IT Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title: �-� Phone No: n
Integrator:_—
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o = • =" Longitude: [= ° =' = w
Swine
Wean to Finish
-Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑
Non -Layer
Dry Poultry
❑ La ers
[] Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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
❑ Daia Heifeo
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 1-i'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?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes
❑ No
� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ No ANA
❑ NE
❑ Yes
❑ Yes
®No
[:INA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
12/28/44 Continued

Facili"umber: —'71,p Date of Inspection [?
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
❑ Yes C�No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in): t�
Soil type(s)
Observed Freeboard (in): 7-1
A6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑Yes
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA ANE
through a waste management or closure plan?
15-
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes
❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
17.
Waste Application
❑ Yes
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA] NE
maintenance/improvement?
18.
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.)
❑ NA
❑ 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
17- Crop hype($)
13.
Soil type(s)
A6
14.
Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ No
❑ NA
VINE
15-
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
IfINE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
PNE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
19 NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
C@ 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):
A6
wer/Inspector Name
E
Phone:
wer/Inspector Signature:
Dale:
12/28104 ' Continued

R
Facility Number: _Z — 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 ❑ NANE
the appropimte box. ElWUp ElChecklists ❑ Design [IMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA Q NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ No
❑ NA
W NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
X NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�j 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
W1 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
P2 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
Fj NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
&NE
Comments and/or Drawings:
12/28/04

Type of Visit,5ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 to Arrival Time: ® Departure Time: ' • County: h Region: 7 ' —0
Farm Name: J&u-��A �w m S,_•,,, ,• Owner Email:
Owner Name: Zy�f a4LV Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Rep resentative:):h(,C� t l�
Certified Operator: SDE'
Back-up Operator:
Title:T(? CAG Phone No:
Vlntegrator•
e r Operator Certification Number: V `0 1
Back-up Certification Number:
Location of Farm: Latitude: =0 =A
= Longitude: =0=11 = u
Design Current Design -10_11rrent Design Current
Swine Capacity Population Wet Poultry Capacity lation Cattle CapacityPopulation
EBaars
to Finish ❑ La er ❑ Dai Cow
114
to Feeder O /Sf3S ' ❑Non -La er ❑ Dai Calfr to Finish ❑ Dai Heifer
to Wean � oult`s ❑ D Cow
# :' tw to Feeder Non -Dai to Finish ❑ La ers ❑Beef Stocker
❑ Non -La ers p Pullets ❑ Beef Feeder
x ❑ Beef Brood Co❑ Turke s❑ Turke Po ❑ Other Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes)6No ❑ NA ❑ NE
❑ Yes ❑ No
NA
❑ NE
❑ Yes ❑ No
fANA
❑ NE
❑ Yes ❑ No 19,NA
❑ NE
❑ Yes -&No
❑ NA
❑ NE
❑ Yes )jNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ♦tp Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No *0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
t"
Observed Freeboard (in): awl
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) 10
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 'YNo ❑ 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? ❑ Ycs�'IvNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'IVo ❑ 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 c� Xyes to [:1NA [-INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes)�.No ❑ 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.)
❑ FAN ❑ 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
Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YeSANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettablc acre determination ?
❑ Yes
A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage 1'or land application?
ElYes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
,QNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments..N RA,
Use drawings of facility to better explain situations. (use additional pages as necessary):_ t:
Reviewer/[nspectorName�v1� k)� �o1V Phone:qlo3�j3��3�
Reviewer/inspector Signature:LQ Date: J oCW (0
Page 2 of 3 12128104 Continued

Facility Number: Date of inspection �1 ti2.LlLJ
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WI]P El Checklists El Design ❑Maps ❑Other
❑ Yes � No ❑ NA ❑ NE
❑ Yes )aNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, checkthe appropriate box below.
❑ Yes )RNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Annual. Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?%.,Yes
❑ No ❑ NA
❑ NE
23.
1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0339A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ NoNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes N A
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �MNo ❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [:]No _J%;�A
❑ 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
4 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
�%o
❑ NA [:1NE
33.
Does facility require a follow-up visit by same agency?
AYes
❑ No
❑ NA ❑ NE
Additional Comments and/or Drawings:
d �u_ad b4t n 176uu,2.e -,J- ar,, r w,
o4rmutRc 1._;`,��,��.,
-�o vex ; � .� C�.tn -- t.,$ [ �'r `�'� � ,r -e � � �� •��„� ,
Page 3 of 3 12/28/04

Facility No. O'O� _ ('� Time In 1U55 Time Out Date
Farm Name G u,' W_r ids Integrator _y+C-
Owner - 3 �� _ Site Rep
Operator &IML No.
Back-up No. _
COC >/ Circle:eneral or NPDES
Desi n Current Design Current
7 Co ca Farrow - Feed
Wean - Finish Farrow - Finish
Feed - Finish Gilts 1 Boars
Farrow - Wean Others
FREEBOARD: De ' n
Sludge Survey v f,
Crop Yield
Observed
elm
Calibration/GPM 1
Waste Transfers
Rain Gauge RainBreaker
Soil .Test '�' / PLAT 1j1
Weekly f=reeboard ✓ Daily Rainfall
Spray/Freeboard Drop 1 r Ik
Weather Codes 120 min
Waste Analysis:
Date Nitrogen (N)
U (1l0
!' l
` iI-,
r ,
N
Wettable Acres
1 -in Inspections
�
Date Nitrogen (N)
Pull/Field Soil
Crop Pan
Window
(t,- o
V ., - J
Q
�2
LAD-Oao,�

(Type of Visit .Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O. Routine Q Complaint 136follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Fz= Countye
Farm Name:tilQ]U�-✓ _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [= n 0 . [� it Longitude: = n =I = N
Design r CurrenX� WDeRf"gipA Current mc....'iMp..
urrent
Swine Capacity Population r. Wet Poc ty Population Cattle ulation
❑ Wean to Finish` ❑ La er ❑ Dai Cow
❑ Wean to Feeder P, ❑ Non -Layer ❑ Dai Calf
❑ Feeder to Finish
Dairy Heifer
El Farrow to Wean ty trv- } ❑ D Cow
zI) Poult
❑ Farrow to Feeder c $':~' "`
El Non -Dairy
❑ Farrow to Finish ❑ Layers
, ❑ Beef Stocker
10 Gilts ❑Non -La Non -Layers
t
❑ Beef Feeder
F:' ❑ Pullets
❑ Boars ❑ Beef Brood Cowl
❑ Turkeys _
Other rE ❑ Turkey Poults
❑OtherElOther Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
[INA
IME
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
OiYNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
N 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
IE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
*E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
-1b NE
other than from a discharge?
Page I of 3
11/18104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )qNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NPIP NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
cl lr
Observed Freeboard (in): �p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes biNo ❑ 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 ANo ❑ 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 ❑ NANE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 10E
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA"'VNE
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
P NE
Comments (refer to question #): Explain any YES answers and/of�any recommendations'or any other -,'comments
.Use drawings of faciliWfo better explain situations. (use.addttional pages as necessary):_ . .
s.".,
Reviewer/inspector Name
Reviewer/Inspector Signature:
(,4Vt_ /V J Phone
- — Date:
AE
M
Page 2 of"3 12128/04 Continued

Facility NumberDate of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ VA_Tp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
❑ No
❑ NA
ANE
❑ Yes
❑ No
❑ NA
0 NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCAWMP? ❑ Yes ❑ No [INA �0E
29.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Yes
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
%No
❑ NA ❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA PV E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA )@ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA 53 -)NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA A�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA jjb E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCAWMP? ❑ Yes ❑ No [INA �0E
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
JVE
and report the mortality rates that were higher than normal?
r
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
*E,
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
PPKE
General Permit? (ie/ discharge, freeboard problems, over application)
ZAE
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
.6NE
Additional Comments and/or Drawings:.#
e� & n n C[Carwj ,rt
�P
�'.n _'n 54, f d �4 to
d
Page 3 of 3 12/28104

rZ14003
$ Division of Water Quality
Faciltt}�;Number 8 2- 1(0 Division of Soil and Water Conservation
Q. Other Agency.' �'Y+
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: s OD Departure Time: County: �rt+.i.�DSa� Region: rZO
Farm Name: v v --r- V Owner Email:
Owner Name: 3 r, 1E g,u 4�2�T p Phone: I �l0 - ,S�o 4/ yo -4 (2
Mailing Address: 3 3 �� v'C- gr16 �o[ . �i � K�'ox N t� 283 Z g
Physical Address:
Facility Contact: -�ot 9 ex- Title: Phone No:
Onsite Representative: -Soe-Z-0-fie_' ree t r -e Integrator: �s F
Certified Operator: Vj eAe4 _ �crr v� Operator Certification Number: (0( 8.3 y
Back-up Operator: oe Back-up Certification Number: _ 4::� v,4t tvsfSoo,.
Location of Farm: Latitude: O =, = Longitude: ❑ ° [� l ❑ ,.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
PElOLa er
_`!00 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. 'Alas the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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. Docs discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
6RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
11/18104 Continued

.t
Facility Number: 82— : 11i Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes (4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes I.No P,NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
``I
Spillway?: NO
Designed Freeboard (in): W. I
Observed Freeboard (in): -Z5-
S5.
5,Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JR No [INA ❑ 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 LaNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes JKNo ❑ 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 LRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes BNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes CgNo ❑ 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
cyto t35' 53 SS 143
12. Crop type(s) Fesw� 5
13. Soil type(s) �u: +�S O • 40 1.0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes KNo ❑ NA EINE
17. Does the facility lack adequate acreage for land application?
❑ Yes RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo ❑ NA ❑ NE
Comments (refer to question #} Explain any�YEs answeiis;and/or any rernmmendations or apy other comments.
* ; :
� ,� kis
Use drawings of facility to better explains tuatid- -;(nse additional pages. as nec esary):
0.,f4
! S. AA, g,,t t e r %;, tt be i ►a sr-�� 1 � +^� V� e.rq L�O � i r r F q a`�
t—r� � � rt �S �.w�J
r
t�t�:.� � lQ • h t'�-�eSc_J � t-� et�5 � k}� �` Ili wti � r`iv'e WAV '�
ei��o—S v� ��SL.1�
„ ,M-._
Reviewer/Inspector Name , ;,; r;. a Phone:
0/10 'M —MPY-4
Reviewer/Inspector Signature: Date: Z
12128104 Continued

Facility Number: $2 — l b Date of Inspection Z
Rem[ _uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2!kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropirate box. ❑ WUi"' ❑ Checklists/ ❑ Desigf( ❑ Mapj/ ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes URNo ❑ NA ❑ NE
❑ Waste Application/ ❑ Weekly Freeboarlf ❑ Waste Analysis✓❑ Soil Analysi*,*� ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall✓❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspection/ ❑ Monthly and I" Rain [nspections/ ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
EK NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
EINE
25. Did the facility tail to conduct a sludge survey as required by the perrnit?
❑ Yes
JE9,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
A''"" o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P;�tqo
❑ 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
9No
❑ NA
❑ N E
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
[gNo
❑ 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
L.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ANo.
❑ NA
❑ NE
Additioriai Comments and/or Drawings'
vIUSkeA--lAj,;s : zhk/05- 2.2- Ll/lb/01f
11 / 1.5 101 1. 5� z/z-v16Y -2.0
91tz104 2.2.
- !11/01 Z-
12/28/04

Facility Number Date of Visit: 7 p Time:
rO Not Operational O Below Threshold
U(Permitted ErCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: F4 t oeArVA County:......... ! !.. _� ....... .. _W ..._._ .»
Owner Name: Phone No:
Mailing Address: .....�r33.1.._...... - Fu
Facility Contact: - ✓ v� ..__Title:.�...._ .. Phone No: ---_,__ -----
Onsite Representative D tiC
p _...... Integrator-
Certified
ntegrator
_...._
CertiFied Operator:.......... Operator Certification Number:
s............ __ - . _.
Location of Farm: /
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • ` "
Design Current =Design Current^ {
Swine Ca Po Mahon.: w' 'ou h3':. CapiPo uladon . .Catle. µ
Ca PoonlahD
n . .
SIVean to Feeder 5r7&o 0
Feeder to Finish
Farrow to Wean
EJ Farrow to Feeder
El Farrow to Finish
Gilts
Boars
m Ldyer❑ Datry
Non -Layer :; E] Non -Dairy
Other -
Total, Desfin Capacity
°Total SSLW
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 04<6
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D.AIo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G -No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
structure I Structure 2
Identifier: ..............�.....
.... ... -..... - ....
—
Freeboard (inches): i.o6•r�
12112/03
Structure 3 Structure 4 Structure 5
❑ Yes ❑.i'do
Structure 6
Condnv _ z

Facility Number: ,? —
Date of inspection S7 7 /is
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8_ Does any part of the waste management system other than waste structures require maintenancelimproventent?
4. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/•tmprovement?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type •+*n4. I rSt
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 01 0
❑ Yes [,Allo
❑ Yes LSO
❑ Yes [lio
❑ Yes �o
❑ Yes &NO
❑ Yes MINO
❑ Yes [R'K0
❑ Yes [�10
❑ Yes [R'flo
❑ Yes BIN
❑ Yes ENo
❑ Yes 931<0
❑ Yes jg'No
❑ Yes QTNo
❑ Yes [110
❑ Yes BNO
�y���.'�i� � f/�T �y�. '1 .l�y�1�M fl�Y��p��/� .,. a�
an_ l e -r' s and1b 1 *py�recoY�il.YYiwons NVr otner.M/YVJa�.LLl1
.^F! -=•--T r�.._-_.. ia..x... � ♦ .r : _ - - � � � .
[lse drawuigs of fac�ty to better exg#a s�matwas. {use at tianal pages as nary) teld Copy Final Notes
�. - n = � _.;.'-.i- 4 s-�-. .z-ra..• .... '.-�:'? -_ ": - w-z�--r-._3 —' ,�. "r=��___�'i?--. .,. - - �-:.. _ _ �a-"-•-- :E �-'� _ -- - - - — Ar
Reviewer/Inspector Name
Reviewer/lnspector Signature:F Date: 17,119 �L
12112/03 I_ 6___1 Continued

Facility Number: Date of Inspection= -J
Required Records & Document,,
21. Fail to have Certificate of Coverage & General Permit or outer Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . 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 Forth ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Rf4o
❑ Yes E914o
❑ Yes EM
❑ Yes S -No
❑ Yes Ml' qo
❑ Yes Rgo
❑ Yes E9140
❑ Yes B140
❑ Yes M No
❑ Yes alio
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
lffNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit_
dditional Comm _
" Ga ntcord5 ��lo t�61�-,c
rt Gt.,.% LCC..' e h (oc-'t-i014 tea K1wI
12112103

AFA90 Division of Soil and Water Conservation ❑ Other Agency
4wc_%Yarm`°
Division of Water Quality
........... ........... ......__.._..-.........----._....
A Routine Q Complaint 4 Follow-up of D%VQ inspection Q Follow-up of.11S. 4`C review O Other
i
Date of Immspection ��
Facility Number
Time of Inspection 1 � 24 hr. (hh:rnm)
© Registered 0 Certified © Applied for Permit 13 Permitted JE3 Not O cra€ional Daat�e^ Last Operated:....- ....................
Farm Name: s�->�.z ......................................... .......... .. County:..............s../?..............................
......................•...............��/....-...........
Owner Name:..
ff.'.0"C :................................................................ Phone No:. .l. . G...~.�47�
...........
Facility Contact: .......... Jis- ,t2.. .... Title Phone No:
Mailing X331.,N....'...
Ala' ' Address ............ .... _ .... ......... ....
Onsite itepresentative:/�i�Tf ... Integrator:.......
------------------------ -- ...,.....-.......-
_.,...................._..
Certified Operator;.,............. i y���rj..���, pe�rjator Certification Number,.----._�r-...._ ..
Location of Farm; .. r4/ AA0,AL_// .Lw
Latitude • 4 " Longitude ' 4 OS'
° s,x::
Design` Currept : p Design :Current . Uk" emgnt,�XurrentZ�
Swtna-
'Capacity}Populattoii_ Poultry Capacity Topiilation Cattle„ `L�#Capacity Population
Wean to Feeder
O yrp �` ❑Layer ❑Dairy.
Feeder to Finish
1E] Non -Layer " ❑Non -Dairy • °
" ❑ Farrow to Wean
°.. .. 4 ^R--
...❑Farrow to Feeder
❑Other x:
i rua r...r .max sw... .. ,,•,kx.b....='a
r ' " " x -
Farrow to Finish
;Total Design Capacity
~n'
❑ Gilts
_.
❑Boars=-Totat:SSL!4Y.
Number of<I:agootns /Holding Ponds •' ❑Subsurface Drains Present ❑ 1-2goonre8 ❑ Spray Field Area 2
"�[z� H?"^"r A - 3P�•Mp,fTr F: - ,
Liquid .... . ..... .. .. '
9°¢'i9 j
❑ No Waste Manage meat Sys tem
wr: o
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
2- Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon [] Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes RTNo
b, if discharge is obsen--ed, did it reach Surfacc Water? (If yes. notify DWQ) ❑ Yes Jallo
c_ if discharge is observed, what is the estimated flow in gaUmin? /v
A. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes f t No
3. Is there evidence of past discharge from any parNof the operation'? ❑ Yes E9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Pd No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes )KNo
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes FNo
7/25/97 Continued on bank

Facility Number:,$2 -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure t Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): ... L,3...).........................................................................................................
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes A No
❑ Yes ❑ No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop tyAer✓/ :.....lit ...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss 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.violations.or defteietiteies.were-noted_during this:visit.AVU.wiil receive:no:fiirther_
: Oeresp6ndehce about this:visit..........
❑ Yes 9 No
❑ Yes H No
Yes ❑ No
Yes ❑ No
❑ Yes No
❑ Yes XNo
❑ Yes KNo
❑ Yes WNo
❑ Yes No
❑ Yes ANo
❑ Yes A No
❑ Yes N'No
❑ Yes No
❑ Yes No
❑ Yes No
(refer tokqueshon #} Etrplain airy YES answers andJor any'rerornmendattons of any other camtnentsk yah
Use'drn�
trtg� otfacthty to better exptain�srtuativns��uce addttianal pages as necessyj' a
c% F�r�x'SF,� - �� MUM ..x r
7/25/97
_
Reviewer/Inspector lame AA;«
29
Reviewer/Inspector Signature:(24 Date: fZ 2 7