820729_INSPECTIONS_20171231

NORTH CAROLINA
r
Department of Environmental Qua

Type of Visit: F,) Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: / p: 3 G
Departure Time: 1
County: ,, �'/
Region:y l
Farm Name: %/�f
� y-6-rr-,�
Owner Email:
Wet Poultry
Capacity
Owner Name: � /' � y t S 1.t,,; rL �Phone:
Mailing Address:
Physical Address:
Facility Contact: _ •A „ ; y Z U`r r3 Title: Phone:
Onsite Representative: Integrator:
Certified Operator:/ 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 ratan -made?
❑ Yes M_No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
Design Carrent
[] No
Design
Currenf
Design Eurrent
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattie Capacity Pop.
Wean to Finish
NA
La cr
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dairy Cow
Wean to Feeder
❑ NE
Non -La yer
❑ Yes
r.No
Dairy Calf
eerier to Finish
[>G•
a
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Poat
"`Ca aci
P,aP
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -I a 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 ratan -made?
❑ Yes M_No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[] No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
r.No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/?015 Continued

Facili Number: - jDate of Inspection: 3�GY
{ Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fj4 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); f'
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 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
PqNo
❑ 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
[gNo
❑ 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 53 -No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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): rpm c•a�� a ry
13. Soil 7 ype(s): 11 t'a. ,_ , tf it +� I r�
14. Do the receiving crops differ from those designated in the CAWMP? [:)Yes [A -No DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®.No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes (� No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g No ❑ NA ❑ NE
the appropriate box.
[:❑ WUP []Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes �.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [�LNo
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [34 -No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
! 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f&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 f!jNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:)Yes [gNo [] NA ❑ NE
Other Issues
28. Did the facility fail to property 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
0 Yes [RNo ❑ NA ❑ NE
❑ Yes FA No [] NA ❑ NE
[:]Yes MNo ❑ NA ❑ NE
❑ Yes EjjNo ❑ NA ❑ NE
❑ Yes fa No
[] Yes Jallo
Yes E3 No
❑NA ❑NE
❑ NA ❑ NE
E] NA [D NE
Phone: '91-12-50-01_51
Date:
21412015

Type of Visit: ZJCompliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (:Uoutine Q Complaint O Follow-up O Referral a Emergency O Other Q Denied Access
Date of Visit: 113- 7;4[71 Arrival Time: !0' Departure Time: : SD County: Regio .�
Farm Name: eCe I t� 12 Owner Email:
Owner Name: _kL0"t `'E1Px Suwt-.Z Phone:
Mailing Address:
Physical Address:
Facility Contact: �-�K'«{ 'w Jl��lr� "t 1� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: b �J
Certification Number: m( 1t53
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 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 [2 -Ko ❑ NA ❑ NE
❑ Yes
[] No
�,..
s Design
Current f
Design Current
Design Current
Swin e '. Capacity
Pop. Wet Poultry '
tCap$city Pop.
Cattle Capacity Pop.
_ =
Wean to Finish
!a cr
Dairy Cow
=
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish 4F5 dYS7,'
Dairy Heifer
-
Farrow to Wean�DesignCurrent=
D Cow
Farrow to Feeder
_ D , P,oultry=. `
Ca acs u P>o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
I
IN INon-Layers
I
Beef Feeder
Boars
jPullets
Beef Brood Cow
n' amu
QtIer}:: fix,
Turke s
Turke Poults
.,
Other
OtheINN
r
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 [2 -Ko ❑ NA ❑ NE
❑ Yes
[] No
[ NA
❑ NE
❑ Yes
❑ No
[!fNA
❑ NE
❑ Yes ❑ No
❑ Yes [llNo
❑ Yes [fNo
ffrNA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page J of 3 21112015 Continued

go Q 19 4
Facility umber: - Date of Insection:
Waste Collection & Treatment
4. i storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EB -57 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2 -NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�!r_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
[J"No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
❑10
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q o
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Application
❑ NA
❑ NE
_Waste
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;4 to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D ❑ Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): s � L -)c .4'1' _. .
13. Soil Type(s): W a- - IVQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ENo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes [R'Ffo ❑ 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?
D Yes 2No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;3:!4o
❑ NA
❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ Yes
❑10
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
[r] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility tail 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
dNo
❑ NA
❑ NE
Page 2 of 3 1/4/2015 Continued

[Facility *lumber:F13Z, Date of Ins ection:
❑ Yes
[3-N r
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[i Yes
E No
❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E7 -No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
❑ Yes
C21110
❑ NA
List structure(s) and date of first survey indicating non-compliance:
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Ea Vo
❑ 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
[3-N r
❑ 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
[�o
❑ 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
C21110
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
_ 2-1 o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q -11o_
0 NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ o
❑ NA
❑ NE
aG b41 12-- ' si s
SL�.e°���� 1�t Zol g
CA( C? fo-,3 O�
Reviewer/Inspector Name: tl� INU Phone: qJj_
Reviewer/Inspector Signature: An_W -__1 UVlft Date:
Page 3 of 3 2/4/2015

I ype o1 V IsIC We'
I, Ommpnance Inspecuou V VperalLUU 1[eVleW V 31FUULUre r ValUallUL1 LJ 1 M111 U11 iISSOLaLIce
Reason for Visit: -Cl Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: D M& Arrival Time: Departure Time: County: Region:
Farm Name: �., iC F- 6-v` Owner Email:
Owner Name: T 4�� gW t"" BK�'1i1, �Z Phone:
�-
Mailing Address:
Physical Address:
Facility Contact: {:-�' t -L 6 )1 ff rOLV Jr Title:
Onsite Representative:
Certified Operator: U
Back-up Operator:
Phone::
Integrator: o -`J
Certification Number: /_ V1513
Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrentDesigIII
❑ NE
n
Cnrrent
Design Current
Swine Capacity. Pop.
Wet Pointry
Capacity
Pop.
Eattle Capacity Pop.
Wean to Finish
Layer
Non -La er
I
Daky Cow
Dairy Calf
Dai Heifer
Wean to Feeder
Feeder to Finish Sig
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
Dr. P..ouit .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Points
Other
Other
Discharzes 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?
Page l of 3
❑ Yes [] ' ❑ NA ❑ NE
[:)Yes ❑ No
[:]Yes ❑No
❑ Yes 0 No
❑ Yes &No
[:]Yes E] No
ErNA ❑ NE
[2'1�A ❑ NE
[�'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
2/4/2014 Condnued

FaciliNumber: jDate of Inspection:
Waite_ Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
s is
❑ NA
❑ NE
1 a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
®,IA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier: �3
Spillway?:
Designed Freeboard (in):
T
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U jKo
❑ 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
E&To
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[Z 1- o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FYNo
❑ 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
VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EI/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 > 101/6 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):
}}626
13. Soil Type(s): /V-42
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EP -No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[p�lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[21&o
❑ NA
❑ NE
20. Does the facility fail to have atl components of the CAWMP readily available? If yes, check
❑ Yes
[rlo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [6No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z' o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]YesNo
0 N ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Nuthber: - 12210 Date of Iris ection: D *L-6716 1
24. Dill the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C9- o ❑ NA ❑ NE
25. Is the facility out of gompliance with permit conditions related to sludge? If yes, check ❑ Yes l3lfo ❑ NA ❑ NE
the appropriate boxes) 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 [);.,W ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q.W6 ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
rZKo
❑ 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
g3o o
❑ 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
L30No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
[�rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[7No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
[allo
[] NA
❑ NE
qu- 1 r
Ca4t ro� 0VV _ I S- is
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: IJ3-3-33
Date: LOVA
v�
2/412014

Type of Visit: (D'CompHance inspection. 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 12 o' utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access J
O r -
Date of Visit: Arrival Time: Departure Time: f� J/ ��5 p� County: . Region:/
co
Farm Name: Owner Email:
Owner Name: &)scXVt'.yt Phone:
Mailing Address:
Physical Address:
Facility Contact: ��►�I t �jli i ji a vti 5ritle:
Onsite Representative: l
Certified Operator:
sq
Phone:
Integrator: (WS
Certification Number: - 012 -VO']
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
[:]No
Design
Curreat
Design
Current
❑ NA
Swine Capacity- -Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
aig Cow
Wean to Feeder
aig Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
2a Cow
Farrow to Feeder
D , Po_W
Ca achy
Po
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
Other
Turkey Poults
Other
Other
Discharges 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?
Page 1 of 3
❑ Yes [g- -6— ❑ NA ❑ NE
[:]Yes []No [ErI A ❑ NE
❑ Yes ❑ No � ❑ NE
❑ Yes
[:]No
�iA
❑ NE
❑ Yes
Cg<o
❑ NA
❑ NE
❑ Yes
[I No
❑ NA
❑ NE
2/4/7014 Continued

Faciii Number: Date of Inspection_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes S_11�00 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes [DKo ❑ 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
Eq -Mo
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
tv
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ill"
❑ NA
❑ NE
$_ Do any of the structures lack adequate markers as required by the permit?
[3 Yes
[4 "o
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
0 Yes
Yo
❑ NA
❑ NE
maintenance or improvement?
❑
❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 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): c I c S
13. Soil Typc(s): l
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VJKo'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[nNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
l ZKo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[5 -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�fo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
tv
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
d NA NE
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?
❑ YesFa'No
❑ NA
[] NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspectiom
24. Did the facility fa i to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 11 o_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-<o�❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q'No ❑ NA
❑ NE
Other Issues
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Io 0 NA
❑ NE
and report mortality rates that were higher than normal?
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
[:],I�o
❑ NA
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.
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
io
❑ NA
❑ NE
permit? (i -e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
[:],I�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
� o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[No
❑ NA
❑ NE
Comments (refer to question #I): Explain any YES answers.and/or any additional recommendations or any other comments. „010
Use drawings of facility to better explain situations (use additional pages as necessary)= _ ,
-
`� for
Cl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: K&
2/4/2014

r4-5' t31 -fes 14 &3
Type of Visit: (jCom •ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County
Farm Name: �`�/CrC [ y`�'�- Owner Email:
r
Owner Name: 0 Phone:
Mailing Address:
Physical Address:
Region:' I 0
Facility Contact: _g±v(•(4 1kf_ L IOC -1A Title: Phone:
Onsite Representative: t Integrator: 11
Certified Operator: Certification Number: �s 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Design Cui rent
®' Vo
Design
Current
Design Current
Swine
Capacity ,Pop.
Wet Poultry
Capacity
Pope
Cattle Capacity op.
Wean to Finish
[!+NA
La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Da' Cow
Wean to Feeder
❑ NE
I Non -Layer
I
Dairy Calf
Feeder to Finish
g p
[:]Yes
[]No
[] NA
Dairy Heifer
Farrow to Wean
❑ Yes
[a No
Design.
Current
jDry Cow
Farrow to Feeder
El—No
D . P..ou! .
Ca paci
Po' .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pallets
Beef Brood Cow
Turkeys
Otber
Turkey Poults
Outer
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[—]Yes
®' Vo
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other: `
a. Was the conveyance man-made? ��
❑ Yes
❑ No
[!+NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
[J -RA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
[]No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El—No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

[FacilityNumber: - Date of Inspection:
rWaste Collection & Treatment
17. Does the facility lack adequate acreage for land application?
❑ Yes
[No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [3 -NA"❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E5 No
Spillway?:
❑ NE
the appropriate box.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E],?r6___❑ 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
0 -Ko ❑ 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
To ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑moo ❑ 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
Ej No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ['Flo ❑ 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): W l b (Do -
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 E:fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E!f No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
on
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E5 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA [-]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes reNoo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
l 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej+1d"_❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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)
3 l . 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
[ 10
❑ NA
❑ NE
❑ Yes
- 10
❑ NA
❑ NE
❑ Yes
[:]4
❑ NA
❑ NE
❑ Yes l�Ko ❑ NA ❑ NE
[:]Yes [2- ❑ NA [] NE
❑ Yes En"No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
C No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
Comments (refer to gneshon #: Explain any YES answers and/or : any additional recommendations or.anyLother, comments.
q c ... F..
Use drawings of facility to beEter explain situations fuse' additionai�oaQe§ as necessary). 4-
G (cG 6""
A ✓"A
Reviewer/Inspector Name:
L
Reviewer/Inspector Signature:
Page 3 of 3
C6 r;,�o--t_3
Phone: 1(0` `13 3 33
Date:
2/4/2014

Type of Visit: i

T
Facility Number: 113ate of Inspection: /
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cq No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[-]Yes
T No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: -_� �-1")
Spillway?: N4 -
Designed Freeboard (in): 725 1
Observed Freeboard (in): I3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 50 No ❑ NA ❑ NE
waste management or closure pian?
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 (A No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes }moi 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): 5�MtVwaN VNPA4 t S .- C", C>>
13. Soil Type(s): W C�-- po , i"') U 14- r1\)o 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
Renuired 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 M 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 5� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes $ No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 4./
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey OFailure 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 14 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
.1--
2141201I

,a
type of Visit: ii.Compliance Inspection 0 Operation Review Q Structure Evaluation 0 "technical Assistance
Reason for Visit; 0�1 Routine a Complaint O Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:.S. County: Region: Deb
Farm Name, C t=lfTf,I?. rAl147 Owner Email:
Owner Name: )(ifs*? sn{r'p— [;*-i, ;�C_ Phone:
Mailing Address:
Physical Address: jqQR [Q'lPY W, R7j t
If
Facility Contact: PCftM1 11 1r Title: Phone:
Onsite Representative: h K DAn k M10 iam r Integrator: H_ 13 -
Certified Operator: (j woff,Pn Certification Number: ( S`
Back-up Operator: Certification Number:
Location of Farm;
Latitude:
Longitude;
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
® No
E3NA
❑ NE
A"
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
We Poultry .
Capacity
Pop.
Cattle Capaci on.
Wean to finish
❑ NE
I 11-ayer
Dai Cow
Wean to Feeder
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
I iNon-Layer
I
[] NA
Calf
Feeder to Finish
5
10 No
[] NA
❑ NE
Dai Heifer
Farrow to Wean
H No
[] NA
Design
Current
Dry Cow
Farrow to Feeder
Dr,V P,oultrY .
Ca acih°
Po
Nan -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Turke Points
kthr
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
® No
E3NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
10 No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
H No
[] NA
❑ NE
of the State other than from a discharge?
Page I 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 ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 15a 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 i] 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
p 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 5� No ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
❑ Yes N No ❑ NA ONE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [ No
❑ Yes ® No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Foam has 9a,� info MVCfi a, wry fi,
f�Ornl i7as 1 rnD�ab1e_ i�o� Fish 3 �o a I �� 'loew yah 1, Thi 6r s �a etall~arie) +il 0011,
P � � c� �aL
d 0 - rsJ S'Wje_ s wI�P1� y rl a o14 ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q1t) 33-33U01V'M"1''
Date: /
2/4/2011

Facility Number: $ a -7a=
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 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: v�
Spillway'?: 1
Designed Freeboard (in): i - i g f
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property 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 N 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 El No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'?.If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops dlller from those designated 1n the UAWMY'f
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
U Yes
N No
U NA
U Nt
❑ Yes
N[ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes f53 No ❑ NA ❑ NE
❑ Yes W No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes ® No
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑other:
21. Does record keeping; need improvement? If yes, check the appropriate box below. ❑ Yes CR 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
O NA ❑ NE
Page 2 of 3 21412011 Continued

'Facility' No. �_ c���Farm Name _Date l
Permit COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop. Design Current FB
_Iff e Drops
La oon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt_ Zone ft
Ratio Sludge to Treatment Volume
PtVef— )0�- F,4+
Calibration Date 11'3111111 2 T11f 111 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width D
.1 r.
111 I
INNi
•
•. ..
Eta i► i f ! Iso-,
3 �
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 15116 loDate last WUP at farm App, Hardware
FRO or Farm Records,y.,s- r i
Lagoon # vev, ry " -�"r_ -j,t j 41 l l
Top Dike
Stop Pump `1`�'r T 10,0:"Mee
Start Pump {Jl
Conversion- Cu -1 3000- 108 Mac; Zn -I 3000= 213 Ib/ac
Soil Test Date
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed a -a.
Weekly Freeboard ✓ Mortality Records
Lime Applied
1 in Inspections_
Cu -1
120 min Insp. .�
__-,-Zn-I
Needs P
Weather Codes ✓
CropYield ield
Transfer Sheets
.1 r.
111 I
INNi
•
•. ..
Eta i► i f ! Iso-,
3 �
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 15116 loDate last WUP at farm App, Hardware
FRO or Farm Records,y.,s- r i
Lagoon # vev, ry " -�"r_ -j,t j 41 l l
Top Dike
Stop Pump `1`�'r T 10,0:"Mee
Start Pump {Jl
Conversion- Cu -1 3000- 108 Mac; Zn -I 3000= 213 Ib/ac

g - /Z - 00 /0
�Facilily ytlrnber 82 % Z 9 Q Dir'sion of -Sail and Water Conservation
Q Uther Agency
Type of Visit
Compliance 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 ❑ Denied Access
Date of Visit: I B-Jo'JO Arrival Time: 9.'3SAK Departure Time: County: Region: H2O
Farm Name:,o 41 e- Fa ►_'"-" _ Owner Email:
Owner Name: l..-3 Q -V -.—C j 9c,, -' Ft i,, Phone:
Mailing Address:
Physical Address:
Facility Contact: Qo Nn►�c t,..I i d, .tb. S Title: tc�4111" A4"--' Phone No:
Onsite Representative:1�/ Integrator:
Certified Operator: onrrvr C wilf,ew S Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: =0
=' 0" Longitude: = o i
Design Current
r,!Xine Capacity Population
to Finish
to Feeder
Design C•urrenl
ins v . .
Wet Ponitrv-Capacity-Populanan
❑ La er
❑Non -i a er
Design C•nrrea#
Cattle Capacity Population
❑ Dai Cow
❑ Dai Calf
r to Finish 7 O $
El Yes
❑Dai Heifer
to Wean
�^
Dry Poultry s }4W
❑ D Cow
w to Feeder+:
w❑
Non -Dairy
w to Finish
La ers❑
❑ Beef Stocker
❑ No
Nvn-La ers❑
Beef Feeder
❑ NA
❑ Pullets
Beef Brood Ca
No ❑ NA
❑ Turke s❑
❑Turke Points
❑Other INumber
of Structures
Discharges & 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 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?
Dyes RrNo ❑NA [3 NF
❑ Yes
❑ No
1=BIZ'- 1 NA❑
NE
El Yes
[:1 No
El NE
LTtyA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continned

Facility Number: 02-7
Date of Inspection S-ZO-/D
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?
❑ Yes
❑ Yes
No
L2No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: tr %.3
❑NA [I NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `1�Z ,_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UMo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑Neao ❑ NA ❑ NE
& 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 El[] NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ 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) Be. -►.4,•cd c._ 6&, ! 1 � 4� �+���^� (/Q• S • J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
LI Noo [JNA ❑ NE
❑ NA ❑ NE
ET'N'o El NA El NE
S o [3 NA El NE
0 N El NE
.r rfer to:; uest
Comments (rete 9 ion'#). Explain any YES answers'and/or any recommendations beam uther,comments
Use drawing''of facility to better explain situations. (use additional pages as necessary) `
Reviewer/lnspector Name 'e Vel Phone: 9/0 , e133 , 3 Soo
Reviewer/inspector Signature: Date: /O — ZO/0
12128104 Continued

9 -/O -/o
Facility Number: $2 —72-9 Date of Inspection APf-/o -�
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 ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA LINE
❑ 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
❑ Yes No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UKQ
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CB<o
[:1 NA
El NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
70,
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L o
❑ NA
❑ NE
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)
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M40
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Gk o ❑'NA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
EJ 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?
1:1 Yes
�,
L44o ❑ 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?
❑ Yes7No
E]NA
[:1 NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Commenatid/orDra�ngsx��'
Page 3 of 3 12128/04
Page 3 of 3 12128/04

V ­8T-mS il-23 -2,009
O'Division of Water Quality
Facility Number B2 7 Z O Division of Soil and Water Conservation
Other Agency
Type of Visit�Commp�pliance
Inspection
Q Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
CT Routine 0 Complaint
O Follow up O Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: fir 30 County: Region:
Farm Name: 1__V ✓ Owner Email:
Owner Name: Alaw Al �""" ✓cam Phone:
Mailing Address:
Physical Address:
Facility Contact: &A/^Jf .4 iJ" �l �-- _ Title• `_"�`� Phone No
Onsite Representative: F—Dij N i t— Integrator:rL--
Certified Operator:' ^iN + t i, si I �� .•-mss Operator Certification Number:
Back-up Operator: f9rvzld i,faYrC�J Back-up Certification Number:
Location of Farm: Latitude: =0
=g =u Longitude: = e [=' E-1 tg
Design Current
Design Current
BO<A
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
BNA
❑ Da Cow
❑ Yes
❑ Wean to Feeder
❑ Non -Layer
El NE
❑ Dai Calf
,[3
No
® Feeder to Finish 9565— g3
❑ NE
❑ Da' Heifer
❑ Farrow to Wean
D.ry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑Turke s
Qther
❑ Turkey Poults
Number of Structures:
❑ Other
❑ 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 [TNo ❑ NA ❑ NE
❑ Yes
❑ No
BO<A
❑ NE
❑ Yes
❑ No
LINA
❑ NE
❑ Yes
❑ No
BNA
❑ NE
❑ Yes
No
[:1 NA
El NE
Yes
ElLT
,[3
No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ly 2- — 7.29
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
❑ Yes GKo
❑ Yes Ld 0
Structure 5
[INA ❑ NE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
v
Observed Freeboard (in): 72,0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LS No EKA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��//
6. Are there structures on-site which are not properly addressed and/or managed El Yes L Ff 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 3 N' o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [R<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) D/
9. Does any part of the waste management system other than the waste structures require [I Yes D No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L3No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13�•.�w �:� i/hd-� 5 �� // G.�e'..� Cv: S .
13. Soil type(s) 11A A N
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,El,"NNo El NA [INE
[3
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes BNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [3 �o_ ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes EIV -o ❑ NA ❑ NE
Comments (refer to question #}: Explainairy YES answers,ind/or any. recommendattons or any other comments.
Use drawgs pns:f facility to Better explain situatio(use additional page'
hns ns necessary,).
Reviewer/Inspector Name / i G a y "iQ'e ✓ l5 Phone: 9/a . s133 • 334 U
Reviewer/Inspector Signature:
Date:
- i0 �J
12/28/04 Continued

Facility Number: J3 7ati Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (3�o ❑ 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. ❑ VTUp 0 Checklists ❑ Design El Maps [:1 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B No
❑ NA
❑ NE
29.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
E3<o
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections E]
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Er No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:]NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,E3,'//o
ESNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ej<o
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3<o
[:INA'
❑ 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
//
B 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
B<o
❑ 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
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UrNo
❑ NA
❑ NE
12128104

Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 01 outing O Complaint 0 Follow up O Referral Q Emergency 0 Other ❑ Denied Access
® //'Q Departure Time: //.��r County: J�H"►�O� Region:
Bate of Visit: 9 �7� Arrival Time:
Farm Name: Co+}[ PC- Fa\r-w` Owner Email:
Owner ;Mame: W cLirtrt a SLj i NP__ F& v w+ s 1 T44 C.. • Phone:
Mailing Address:
Physical Address:
Facility Contact: �U`�� �QY+r.11 [.k Title: _ I ec.tn • SPm� • Phone No:
Onsite Representative: integrator: C ""A04 t— �7aY r S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =I
0 u Longitude: = ° = I ❑ u
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ Layer
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ an to Feeder
-Layer
❑ Dai Calf
Feeder to Finish (o © t
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
Ej'5'A
❑ Non -Dairy
❑ Farrow to Finish
❑ La urs
❑ Beef Stocker
❑ Gilts
❑Non -La urs
❑ Beef Feeder
❑ Boars❑
Pullets
❑Beef Brood Co
El Turkeys
❑ Yes
Q_wt Me F=
❑ TurkeyF'oults
❑ NE
=00ther
FS 91iFmim—
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ea<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
Ej'5'A
❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
. ❑ Yes
[:]No
[- TTA
❑ 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
EhIA_
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B -go
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0' iTo
[:INA
❑ NE
other than from a discharge?
12/28/04
Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El Yes B o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes B< ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B<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) �erw► .....>
13. Soil type(s) LJO•$ �JO Nc;g
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [3 Yes
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
E3 -'No
I --]NA ElN E
3
�NoNo ❑ NA ❑ NE
2<o El NA ElNE
❑, o [:INA ❑ NE
Comments (refer to question #). Explain any YES -answers and/or any recomm[en- a#rons or any other cOmtnents�
-
Use drawings of facility to better explain situations: {use additional pages as necessary)
Reviewerlinspector Name FRi GSC j�e_�IQ, Y Phone: 91a, X33.3 3
Reviewer/Inspector Signature: Date: 9-17-7-00?
72128104 Continued
Facility Number: Date of Inspection
Waste Collection & Treatment
,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CEJ Ngo
El NA
[INE
a. If yes, is waste level into the structural freeboard?
[:]Yes
,
LTJ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ -7 Z p1.,..t-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed andlor managed
1:1 yes
�,�,,�
Lr <
❑ 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
environmentall,thrreeat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E7 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El Yes B o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes B< ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B<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) �erw► .....>
13. Soil type(s) LJO•$ �JO Nc;g
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [3 Yes
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
E3 -'No
I --]NA ElN E
3
�NoNo ❑ NA ❑ NE
2<o El NA ElNE
❑, o [:INA ❑ NE
Comments (refer to question #). Explain any YES -answers and/or any recomm[en- a#rons or any other cOmtnents�
-
Use drawings of facility to better explain situations: {use additional pages as necessary)
Reviewerlinspector Name FRi GSC j�e_�IQ, Y Phone: 91a, X33.3 3
Reviewer/Inspector Signature: Date: 9-17-7-00?
72128104 Continued

I ` ,
]Facility Number: J92 -7Zg 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 ❑ Checklists ❑ Design El Maps El Other
❑ Yes
CK
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [7< ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
[INE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
r8
lI oo
I[INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,C—
o
[�T
[INA
NE
26. Did the facility fail to have an actively certified operator in charge?
1:1 yes
©No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
u No
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B<o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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
E o
❑ 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
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E 5o
❑ NA
❑ NE
A?d tonal COIIklllegtS sud/66r. DrBWlIIgS :-
12128/04
12128/04

13-rM -s $12 9108 rr -
�visioa of Water Quality
flacui Number dz mm 7ZDivisionofSoilaadWaterConseryataort
- Q Other Agency
Type of Visit 0<ompliance
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 ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: /O.'�/ �, County:, _.� SCAT Region:
Farm Name: Cam l l Co --[1 r -r - e -. Owner Email: T
Owner Name: w i t CaKyb i k Phone:
Mailing Address:
Physical Address:
Facility Contact: 'te r }' x E�ca V w ice` e— Title: /GGA: .SAS -C- . Phone No:
Onsite Representative: Integrator: C_'li O r i c- A r r r
Certified Operator: l 4.�r, �1rcN Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: latitude: =]' [--]' 0 Longitude: E] ° E�] ' = u
Design Current
Swine Capty Population
❑ Wean to Finish
❑ Wean to Feeder
Design Current
Wet Poultry Capacity Fopu larth'on
❑ Layer
❑ Non -Layer
Design Garrent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
Feeder to Finish S /[? Z
-
❑ Dairy Heifer
❑ Farrow to Wean
Q. Poultry
❑ Dry Cow
❑ Farrow to Feeder
a. Was the conveyance man-made?
❑ Non-DaiTy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
[:1 Beef Feeder
❑ Boars
❑ Pullets
Beef Brood Cow
ElTurkeys
Other
❑ Other
❑ Turkey l?oults
❑ Other
Number of Structures:
❑ No
D<A
❑ NE
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[SVo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[]No
C3,qA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
❑ No
❑<A
❑ 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
D<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B- Flo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[]N—o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: j -7- 7Z9
Date of Inspection 3-Q
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?:
Designed Freeboard (in):
Observed Freeboard (in). %3 Z ( i
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Bl�o ❑ NA ❑ NE
❑ Yes B 4o ❑ NA EINE
Structure 5 Structure 6
❑ Yes 3No ❑ NA ❑ NE
❑ Yes 3-5-o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2110 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑-o
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9-<o
❑ NA
❑ NE
maintenance or improvement?
Waste Arttflication
10_ Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�,
Ir
❑ NA
❑ NE
maintenancelimprovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L"1 No
[INA
❑ 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 1 lav
12. Crop type(s) c+Zs�w¢K i S%4�4 r�r �4<S.� b.� ef1'61f:S4_4 4 5-'01-0
13. Soil1yW(s) /40,+_
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?
❑ Yes ❑'lqo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Q.No
❑ NA
EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
D -N -o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑-o
❑ NA
❑ NE
3� z q W "^sem G-,.��.— � �4d by r'-11 zdoS
� /Z - 30 - CIV
Reviewer/Inspector Name 1 �e;S` .V �' =1 Phone: 'l`/0, 5433, 3330
Reviewer/Inspector Signature: Z_-111_.- Date: 7 j3 - 7-00
Page 2 of 3 11128/04 Continued

1. J
Facility Number: $Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW IP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annum 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
B No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[T No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as requited by the permit?
❑ Yes
❑ go-
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ago-
go
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El, Yes
� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Rl o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETfTo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'97o
❑ 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?
ElC� Yes
, ,��
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
[:INA
❑ NE
Additional Comments and/or Drawings:
12/28/04

I
B.7741S 2-05--2010
Type of Visit_Commpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit 'U Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f Z 9 - I d Arrival Time: Departure Time: / SS County: Sam_y Region: if—WO
Farm Name: r4 �''' Owner Email:
Owner Name: GLV tr �� SLi11 N ¢ �ay'"" ANG • Phone:
Mailing Address:
Physical Address:
Facility Contact DNNJ tr i.�l i t G S Title: Fxrv., ikAgy, . Phone No:
Onsite Representative: Tzo m "I e— W i I; i a s,-, S Integrator: Cc kc V- e__ r6"` "'"
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =I 0 " Longitude: =0=&
o=& 0
is
DesignCurrent
Design Current
Design Current
Swine Capacity Ropulation
Wet Poultry
CapacRUN lftion
wattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
a. Was the conveyance man-made?
E] Dairy Calf
® Feeder to Finish
E NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Stocker
❑ NE
El Non-LaMetsers
El Beef Feeder
PGilts
OBoars
❑Pullets
❑ Beef Brood Cowl I
El
111111 , I
❑ Turkeys
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Other I'll
❑ Turkey Poults
ElNA
Number of S®r ctures-
❑ Other
❑ Other
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
E, o
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
do
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
E NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N'o
ElNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
E, o
❑ NA
❑ NE
other than from a discharge?
11/18104
Continued

Facility Number: S2 —72—q
/—Z9-10
Date of Inspection 10.
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?
❑ Yes No
❑ Yes l.J No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
0 N ONE
El NA El NE
Structure 6
Identifier:
Spillway?: _ rG
Designed Freeboard (in):
Observed Freeboard (in): 59
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on-site which are not properly addressed and/or managed El Yes B o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7- Do any of the structures need maintenance or improvement? ❑ Yes DNreo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 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 L(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10- Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement? //
11- Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 2 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) Ee n4 6k J,,, I! .�Ju�t �l Cv rein/ 60, 5 J
13. Soil type(s) wctF, IYo 4 o 9
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
Comtnents (refer to question#) Explain any YES answers'and/oika y recomr m"endat>ibns o any�lother comm nd 2
Use drawings of facility to better explain situations. (use a¢dittonal pages as necessary)` ' + :' -
0 N
El NE
,ErNFoo
L_ o
❑ NA
❑ NE
No
❑ NA
❑ NE
ET'No
❑ NA
❑ NE
io
❑ NA
❑ NE
Comtnents (refer to question#) Explain any YES answers'and/oika y recomr m"endat>ibns o any�lother comm nd 2
Use drawings of facility to better explain situations. (use a¢dittonal pages as necessary)` ' + :' -
�
Reviewerllnspector Name f
f�e. VC,( $ Phone:
9/0, e�33 . 33oa
t
Reviewer/Inspector Signature: Date:
—.Z9` 2610
12/28/04 Gontrnued

w
Facility Number: 492 —7,2 Date of Inspection F
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 ❑ Checklists
❑ Design ❑Maps [:1 Other
[:]Yes No ❑ NA ❑ NE
❑ Yes B14o ❑ NA ❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I No
❑ NA
❑ NE
21 .
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
to
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather
Code
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo
❑ NA
❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
El9 Yes
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[31ro
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9Io
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E, NNo�o
[:1 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLATT) certification?
[IB Yes
o
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CTNo
❑ 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
,�
U No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ETC
❑ NA
❑ NE
Addrtonl Comments and/or Drawings:
12128/04
12128/04