820474_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qual

iv'i"lion of Water Resources
=.Nttmber - Q O Division of Solt and Water Conservation
I
®other Agency
Type of Visit: ompHance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: AI Arrival Time:Departure Time: ;d County: �So//Region:Fj_1�0
Farm Name: r f c�.-[, ✓-''ilk ���++ Owner Email:
Owner Name: �. 1jr.��5 L--`'C✓ Phone:
Mailing Address:
Physical Address:
Facility Contact:; Title: Phone:
Onsite Representative: t Integrator: tom% —�7
Certified Operator: _V t. (S 40Pt ZA.)91I Cd `f Certification Number: /co � �{
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
_ -
Swine==
Wean to Finish
Design Current
Capacity Pop.
WOW
Layer
Design
Capacity
Current
Pop.
Design Carreat
Cattte Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Non —Layer
I
Feeder to Finish
.31? b Lf
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D P,oul
Layers
Design
Ca aci
Curreat
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Non -Layers
Boars
-
Other
Other
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream Irnaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3'go
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EAeKX
❑ 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
A
❑ 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
Fj"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: POZ- Date of Inspection: -
Waste Collection & Treatment
4_ is storagkcapacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes B<o❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No [3N7d�_­D NE
Stru re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 't Q
5- Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [R-Iloo ❑ 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
621Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 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
F No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
Pr o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [D 'vu ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C U N'Ij S6 0 F 7,-.St a G
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?
❑ Yes
io
❑ 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
�VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
ElYes No
❑ 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 o
❑ 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 ZOSludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 • 21412015 Continued

Facill Number: VZ - Date of Inspection: 9 / Ot
Ocf
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? 1f yes, check
[:]Yes
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
vo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
o ❑ NA
❑ NE
Other Issues
29. 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?
24. 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 Signatut
❑ Yes 4L o ❑ NA ❑ NE
❑ Yes fff No ❑ NA [] NE
❑ Yes 0<0 ❑ NA ❑ NE
❑ Yes O< ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
U '; ❑ NA ❑ NE
No ❑ NA ❑ NE
[TNo ❑ NA ❑ NE
Date:
2/4aO S
Page 3 of 3

h �
�6'^#,�-�. �VS � gyp;'" °{"'�uW:q W%,� ,d'ropy F��' enwle �',,'� k s..���wPv�G� O '�°�o.::� y� h�i - yr,�rt''�I�'� �. ��� � �'��� w'"� � �•
Type of Visit: (a"Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: l?IQutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - -A& LV
Arrival Time: Departure Time: r O County:^ Regionr(Zo
Farm Name: _ 3_ Gt�'as/1t.�J,,�� Owner Email:
Owner Name: -J 4j Phone:
Mailing Address:
Physical Address:
Facility Contact: a e, baokaLt Title: Phone:
OnsiteRepresentative: rt Integrator:
Certified Operator: z t- Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current r sign Current
S.Wine _-Capacity Pop. Po ltr} Capacity tPop. Cattle Capacity Pap.
Wean to Finish La er Dairy Cow
Wean to Feeder -Layer Dairy Calf
Feeder to Finish f ~' a _ _ :"' Dairy Heifer
Farrow to Wean U n Dry Cow
Farrow to Feeder D '1? ultr Ca achy -Po .. Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars 1pullets Beef Brood Cow "}
Turkeys
_Other Turke ['oults a;
Other Other G
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [Zkl " ❑ NA ❑ NE;
❑ Yes ❑ No [ ❑ NE
b. Did the discharge reach waters of the State? (If ves. notify DWR)
❑ Yes
❑ No
Q NA
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
�lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[2rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!TNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 214 2075 Continued

Facility Number: 7 Date of In L24
Waste Colfection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!j'lqo ^ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ET iA ❑ NE
Struc re I StructureStructure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 0
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
[.] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[]Yes
Wo
❑ 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
C: No
❑ NA
❑ NE
S. Do any of the structures 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
[fNo
❑ 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 4No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°/a or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n� Evidence of Wind Drift �}❑ Application Outside of Approved Area
7 12. Crop Type(s): �rr�f,�fe-�jt & Oar
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
C3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ea<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E a*N" o
❑ NA
❑ NE
Reauired Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E 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.
❑ es
;a -No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:)Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facill Number: Date of Inspection: 2. t,r.
Ir
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!R o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [5 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 [3"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ 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 V(N 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
ZNo
❑ 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
[ZrNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ErNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
[ rNo
❑ NA
❑ NE
Comments (refer to question :#.) Explain any�YES answers and/or any additio6id reconiimeudations or anyotber conun-166fs:' '
Use drawings:of facility to better.explara�situations (nse additional pages. as necessa - �"
ry)�. J.
C C6
-/ � {` flJ 'JV/
Cat 6 1�s'
Reviewer/inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone: �a —L(77,T3 �l
Date: P44Q
21412015

Type of Visit: OTompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: C>1foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: gum Departure Time: i County: *
Farm Name: C3 t-3wy 4-vcC Owner Email:
Owner Name: qr
Mailing Address:
Physical Address:
Phone:
Region: FW
Facility Contact: (?&LtA 7 ,ex L Title: Phone:
Onsite Representative: Integrator: �J S
Certified Operator: ey`5 Certification Number: T "Osr
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current'.
Design Current Design Current
Swine Capacity Pop.
Wet Moult ry Capactty Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
�Y
km
'•
DairyHeifer
Farrow to Wean
rDesignCurrent
Cow
Farrow to Feeder
D P,oult •
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
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)?
❑ Yes Ea kn ❑ NA ❑ NE
[:]Yes
[:]No
[3-NA
❑ NE
[:]Yes
[:]No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No [] 11�A ❑ NE
❑ Yes [ErNo ❑ NA ❑ NE
[—]Yes ]�No ❑ NA ❑ NE
Page I of 3 21412011 Continued

I=aciii Number: - Date of Ins ection: Ll
A-4i
te Collection & Treatment
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 [2-N7V— ❑ NE
Structure l 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
Io
❑ 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
[3�<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[i3'1Go
❑ 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
❑ 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
[tf
❑ 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 ❑ EvidenceofWind Drift [:]Application Outside of Approved Area
12. Crop Type(s): err
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[goo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[a<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
E <o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
B30'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L'7 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
❑ NE
the appropriate box.
❑WLUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ET'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
EfNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

lFacity Number: bate of Inspection: 96 \1
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:)Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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 [;3< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [+r No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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?
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 G2rNo ❑ NA ❑ NE
❑ Yes [ZNo
❑ Yes 12<o
❑ Yes
[;�rNo
❑ Yes
0"No
[:]Yes
eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:( Date:
Page 3 of 3 2/4/20 I

1 ype of v esit: tz-tompliance Inspection U Operation Review U Structure Evaluation U 'Technical Assistance
Reason for Visit: 01(outine 0 Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: �F--�-J Departure Time: County: Region.w_:�
Farm Name: % &4"4_1 -1 ^G Owner Email:
Owner Name: f Phone:
Mailing Address:
Physical Address:
Facility Contact: (G t- 5 '90v't`' J Title: Phone:
Onsite Representative: i Integrator: V"4
Certified Operator: _ � �j�(t,— GJ ✓ r Certification Number: LTy l rP ^
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design £Current -� - Design CnrrFent��tY � Design i:urrenk
SKiae Capacity Pop. Wet P,ouitry F' Ca act Po =� Cattle CannPo
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean - Design�Current` _ Dry Cow
Farrow to Feeder DPoul Caac �# '" �Po Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Nan -La ers Beef Feeder
BoarsI 1puliets Nq Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�— NA
❑ NE
Discharge originated at: ❑ Structure C3 Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
[—]No
NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Q--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
[]rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3<
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff �No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[FaciJity Number: - Date of Inspection:
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E ivu ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (2NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 1.
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes rR-Tq-o- ❑ NA ❑ NE
❑ Yes [D'No ❑ 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 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 E j o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3-?To- ❑ 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): tlW-L yLq -woo s Cc
13. Soil Type(s): w r' l) k U, t � 1 t U
14. Do the receiving crops differ from those designated in the CA WMP? 1
❑ Yes
D-Nts
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3-No—
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C],X6-
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Elgo_
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [
T
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes to
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
[] NE
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
�rNo23.
NA
❑ NE
Page 2 of 3 21412011 Continued

IFaciHty Number: - Date of Inspection: 16,am IS
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] "" ❑ NA ❑ NE
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes EJ-Mo— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [3-No 0 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
La -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
[3-Vo— ❑ 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
Q-No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[ 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
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o ❑ NA
❑ NE
Comments, (refer to question #), Explaimany. YES answers: and/or. any addihoni irecommendations or; any other comments
Use drawings of fac+hty-to better explarn§ituad s (use additional pages as n ry)'.
caU oo,T0-N I. -It -13 (S P
f -qI 3
Reviewer/Inspector Name:
t r.
Reviewer/Inspector Signature:
Page 3 of 3
1 f%
cft
0 re
Phone: 13 J 3 3
Date: I
2142014

Z 1 ms
Type of visit: Cj,Cam lia Inspection Q Operation Review O Structure
Reason for Visit: outine O Complaint O Follow-up O Referral Q
L)
Date of Visit: rrival Time: Departure Time:
Farm Name: V fi::�z V C Owner Email:
Owner Name: y _ Phone:
Mailing Address:
y 0 Otber O Denied Access I
County:5� Region:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: P�l _
Certified Operator: ��4[ !1(�t �� Certification Number:i!'T
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current a y Design Currentw
Design Current
5rvine Capacity Pap. WetPaultry .iydCapactty Pop
Cattle Capacity Pop.
Wean to Finish er
Dairy Cow
Dairy Calf
Heifer
Wean to Feeder
-Layer
Feeder to Finish'Dairy
Farrow to Wean`;Design Current
Dry Cow
Farrow to Feeder D . 1Pou1y;Ca`-stiff Po
Non -Da'
Farrow to Finish La era
Beef Stocker
Gilts
Non -La era
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other TurkeyPoints
Other Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E3-t"­0 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D-N'X-
❑ 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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
02-No
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

Fa ili Number: - Date of Inspection:
4aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structare 1
Identifier: 1
Spillway?:
Strue 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No NA ❑ NE
❑ Yes �❑ 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 E� o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes 5 ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): 6 L` z'SJfLe
W1 I
13. Soil Type(s): ' k&d1W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I-1 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[! ""
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]-Na
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Dfi'10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M41o"❑
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&o
❑ 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 o ❑ 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�>NVJ[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ElYes NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
FacilityNumber: -L1Date of inspection:
s
21. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes_ �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D. 6_[3 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No^ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ' ao ❑ 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 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 EaF6�❑ 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 " 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
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[DNo
❑ NA
❑ NE
Comments (refer to question ##) Explain any YES answers and/or any additional recommendations or arty other comments .;. rt
Use -drawings of facilityto�better explain situations (use additional pages as necessary).
�D
SSA S �
t
Reviewer/Inspector Name:
a
Reviewer/Inspector Signature: U021/ Date:
Page 3 of
1

Type of Visit: Q Comvliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: QRoutine O Complaint 0 FoHow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 03' County- Region: Q
Farm Name: eSw V7A R rn5 t._I_C Owner Email
Owner Name: 3 W Vf%RtyLLC, _ Phone:
Mailing Address:
Physical Address:
Facility Contact: CukhLSQ_� Title: Phone:
Onsite Representative: �SAVN l:. ' Integrator: MOR flVj M V L�
Certified Operator: ir {r 0PA.,?_ L-S _ Certification Number: 9 g%-E 9 @
Back-up Operator:
Location or Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity .Pop.
Wet Poultry
@specify
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish 3 y
S$
DairyHeifer
Farrow to Wean
Design
Current
D Coin
Farrow to Feeder
D ; �P,oultr,
Ca achy
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
athcr
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 oCthe State (gallons)?
[:]Yes Q No ❑ NA ❑ NE
❑ Yes D No
❑ Yes ❑ No
[11NA ❑ NE
[RNA ❑ NE
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 [:VAo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facifi Number: c6 R - C42 Date of Inspection: 3 A=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G2"No
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
A 8
❑ NA ❑ NE
[:]/NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[:]Yes �JNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Ea 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 dNo
❑ 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 we[ stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [/No
❑ NA
❑ NE
maintenance or improvement?
Waste Amlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [C(No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [3/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): E Rc�yt?a �l . G R�2E Vu�g--k1= aZ9A a
13. Soil Type(s): �„j_+a t Qt�xv� ��t? ��v�R� 11 F-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 6 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [ f No [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E�Ne
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QTNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[j No
[] NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
FJNA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - t-r'T Date of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [yNo ❑ NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Sf No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ENo ❑ 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 dNo ❑ 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 Rj 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 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
Comments (refer to question ft Explain any YES answers and/or any a
Use drawings of'7acility to,better explain situations (use additional vaeei
Reviewer/Inspector Name:
commendations or nni
dNo
❑ NA
❑ NE
[�No
[] NA
❑ NE
[jNo
❑ NA
❑ NE
C;yNo
❑ NA
❑ NE
Phone: QWY_5�'1aO05I
Reviewer/Inspector Signature: % .
Page 3 of 3
Date: ?j Y
21412011

i
tr,r<s G !A/ i1 V-,}—
Type of Visit: Q Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: &I routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Fk itee W 1ELrx,_7-, Owner Email:
Owner Name: -+4\y.ee_ tj . FZLeV.'_.S Phone:
Mailing Address:
Region:
Physical Address: j Facility Contact: � �C,�,f--BLS "cfl�tc-L _ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Sty ovypzo Certification Number: F
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
"EMesIgnCurrent
Design.
Current
Design Current
Swine Pop.
N'et,P€iultry Capacih
1'op.
Cattle:'
Capacity Pop.
f.iapacity
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to FinishDairy
Heifer
Farrow to Wean
•' Desiga
Current
Dry Cow
Farrow to Feeder
a.`Ca achy
Pop.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts Non -Lavers
Beef Feeder
Boars
1pullets
Turke s
Beef Brood Cow
s
r
Other
TurkeX Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
[] Yes
�
E311a
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Ficid ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
g3<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[—]Yes
[:]No
[
❑ 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
E34A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2<0'
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facial Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g-,10o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [y -VA ❑ 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
0 o
❑ 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
O'5Io
❑ 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
[v]'No
[3 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
K] 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
Eallo
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
02,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �o [DNA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &., waw
r1k I f
13. Soil Type(s):
r
14. Do the receiving crops differ from those designated in the CAWMP?
IS. 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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes
FR'"No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
[] Yes
Gj-<o
❑ NA
❑ NE
❑ Yes
[Do
❑ NA
❑ NE
2-fes
[:]No
❑ NA
❑ NE
❑ Yes [g-< ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []'f o
❑ 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 E3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NAA ❑NE
OJ-Ky ❑ NE
Page 2 of 3 21412011 Continued

Facie Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? s [:]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes E3-�4o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [jFailure to develop a POA for sludge levels
❑Non -compliant sludge Ievels 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 CR No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No �A ❑ 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 the 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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to
of
pt-ec'us-e__
any YES :answers and/or any additional recommendati
situations(use additional pages as necessary]
❑ Yes 0To ❑ NA ❑ NE
❑ Yes 02,<o ❑ NA ❑ NE
❑ Yes EaiQo ❑ NA ❑ NE
❑ Yes
H-14 o❑ NA
❑ NE
[:)Yes
02 o ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
[:]Yes
NA
E;0/[_]
❑ NE
�dtre55 W�e_ { cyl OC'4k CA'-_ 4 k-s-P 1 Aj fA)e f"
I ly I I cz- r'- -
AD -tA f-- :Y-�D1�. 4
/ �i-�I
Lit
(A3
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
Vfflzaw.�
wIm ,
1611" cso_ VOL V,�
Phone: %/U 4/�71 — 4 a j 333
Date: 1.5 / //
4120 h

Type of Visit 0 Compliance Inspection Q Operation. Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ denied Access
Date urvisit: q? ArrivaI Timme: /, 0 Departure Time: County: a Region:
Farm Name: 1"'C��Y m 2! � I Owner Email:
Owner Name: r ' ��4t� Phone:
Mailing Address:
Physical Address:
Facility Contact: GinnCavy— Title: Phone No:
Mc1,1�1 ic.
Onsite Representative: Integrator: �rown
Certified Operator: r �!a 1 �f�r'e Operator Certification Number: 96'��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Ell
01 = u Longitude: 0 ° a 4 = "
Swine
Design Current
Capacity Population
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
I
1
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
I
1
p
❑ Dairyflelfer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Boars
Othe
❑ Other
❑ Other
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?
❑Yes IPNo (I NA ❑NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No 09 NA
❑ NE
❑ Yes (P No ❑ NA
❑ NE
❑ Yes (!�No ❑ NA
❑ NE
Page 1 of 3 12/18104 Continued

Facility Number: — Date of Inspection f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CfhNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No *NA ❑ NE
Structu I Structuu 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 El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 DWO
7. Do any of the structures need maintenance or improvement? []Yes CgNo ❑ NA ❑ NE
S. 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 [I Yes [ No El NA ❑ NE
maintenance/improvement?
i 1. 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 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable rap WiEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s)14 Rev-= C- aL),In,
13. Soil type(s)
9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fi� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El 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
LP No
ElNA
❑ NE
Corti mints (r:OWto question :Egplain'any YES answers and/or any recommendations or any other comments -
Userdraw- in s of facility to better ex lain situate ni use additional pages as_nrcessa
g tY P ( p g ry):
Reviewer/Inspector Name �„ [ Phone: d ' S30a
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection li
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M 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
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
T No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
T No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
T No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�&No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[� No
[INA
[I NE
and report the mortality rates that were higher than normal?
1
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
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Addrtioual;�Commeuts aud/_or Drtiv�ngs: s' - _ -- �`�`
H
Page.? of 3 12128104

12
Type of Visit i♦ Compliance -Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 40 Routine O Complaint O Follow up 0 Referral 4 Emergency U Other ❑ Denied Access
Date or visit: Arrival Time: - 3 _ Departure Time: (� pQ County: rSAMP5 0/" Region: J ? Q
Farm Name:fr`!h al �)' 3 1 Owner Email:
Owner Name: rb UC Phone:
Mailing Address:
Physical Address
Facility Contact: tr' Title: Phone No:
Onsite Representative: Integrator: ,"I i'D4vh Lu
Certified Operator: Avvv Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: = ° = I = v
5r�ine
Design
Capacity
Current MIDesign
Population 'V1'e Eoultry Capacity
10 Layer
10 Non -Layer 1
Current
Population
Design Current
Cattle Capacity Popuiation
❑ Wean to Finish
❑ Wean to Feeder
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non- Dairy
❑ Beef Stocker
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
IM0 Dty Pory
trlt
❑ La ers
❑ Non -La ers
Pullets.
❑ Turkeys
❑ Turkey Poults
❑ Beef Feeder
❑Beef Brood Cowl
plumber of Structures:
❑ Othcr ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
po
F "
[I NA
El NE
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ONA
❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
e. What is the estimated volume that reached waters of the State. (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i I Facility Number: Date of Inspection o Z
Waste Collection & Treatment
4_ is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
'RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA (INE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 tructure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in): 21 K 67 '
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tm No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
t
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
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste ApBlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No ❑ NA ❑ NE
maintenance/improvement?
`
11. Is there, evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
T No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > i0% 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(5)�Fj^�¢(tq C��� i 1-CSf`u..�.
�`❑
(P4�5)
4t
13. Soil type(s) t Re —A— ' I_(e —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer tv question #) Explain any YES�answers and/or any recommendai dns or any other commen,ilk
,
x
Use drawings of facility to beEter eaplam situahons�(use additional page`s as Accessary): c� rrt b
Reviewer/inspector Name I •; Phone: r'�
Reviewer/Inspector Signature: Date: It5 L
12128104 Continued

s Facility Number: `r Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IP No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual 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
[1 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
r 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
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JPNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
T 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
[n 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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
ti
Additional Cotttmeatsand/,�or
T
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: D'3! 3p Departure Time: p 1/ County: ���i� Region:
Farm Name; ) A3 Owner Email:
Owner Name: f.J �-t Phone:
Mailing Address:
Physical Address:
Facility Contact: `� LiCACE Title: Pbone No:
Ottsite Representative: Integrator:
rvk) n U G
f Q v�
Certified Operator: Ja.rr•Q s �/r %�° Operator Certification Number:
Back-up Operator:
Back-up Certification Humber:
Location of Farm: Latitude: E_—] o E_-1' El" Longitude: = o � ` 0 "
Design Current
Design... Current
*=, Design Current
Swine CapaciYEN
Wet Poultry Capty Populatiou
Catt�e.>- Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
iry Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean Q
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
- --
❑ Turke s
Other
❑ Other
❑ Turke Poults
❑ Other
� .�
iVumber of Structures
Dischart=-es & Stream lmnacts
1. is any discharge observed from any part of the operation?
❑ Yes
�5 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes(00
WA
L7 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
1P NA
tt
[3 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
�p
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
[P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: A -
Spillway?:
Designed Freeboard (in):
Observed Freeboard 5 j 6-1
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JO 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
1INo
❑ 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
'9 No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
An
❑ NA El NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 14% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind rift ❑ Application Outside of Area
�❑
12. Crop types) � t�rvu.4li a 6J ct$5 0?6") , �CLrQ
13. Soil type(s) Fri/ i i _]te A- 1 Fn7ojo k ::&.,I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
EP 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
W No
❑ NA ❑ NE
"r,��, j _ �� m �'•.,.. .,,..,���-T'm" ors' - --.._ „«r - -
Comtments (refer�to�gaes4 n #) Explain any �YES,answers<and/or ally �ecommeadadOIIS Or�any�other�COmments. ,
S.�Yr`'L ,�,a''CP"_F �^; ♦ yitta'f
k L-
Use drawings of+facility to betterexplaul s�taat�ons.<(use addrtionallpages as�n�ecessary•)• ���,�.
-
AL
r
Reviewer/Inspector Name Phone: _3
Reviewer/Inspector Signature: Date: it
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes F] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes nNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
@)No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
n No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[D No
❑ 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?
❑ Yes
IoNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�9 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
MNo
[I NA
ElNE
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
;9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
( No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - - 0 Other Agency
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation E) Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % = OQ eparture Time: = ounty: l�% Region:
Farm Name: Owner Email:
Owner Name: 1 "I ��0 �►ll�t'1 Phone:
Mailing Address:
Physical Address:
Facility Contact: CT:9a r Title: Phone No:
Onsite Representative: N Integrator: UAI92 10n
Certified Operator: �1aL'-� -ye Operator Certification Number: gwr
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ U = . Longitude: = ° = 1 = "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean .130
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischartzes & 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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures- I
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 TANo El NA El NE
❑ Yes ❑ No �IA
11
❑ NE
El Yes El No NA
❑ NE
❑ Yes ❑ No ''NA
❑ NE
❑ Yes JbNo ❑ NA
❑ NE
❑ Yes IS No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Suture 1 Stru ture 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y ail
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 IV No ❑ NA ❑ NE
❑ Yes ❑ No B NA ❑ NE
Structure 5 Structure 6
❑ Yes EdNo ❑ NA ❑ NE
❑ Yes W No ❑ 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 n 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 R No ❑ NA ❑ NE
maintenance or improvement?
Waste Ap-alication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
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 30 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
09No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ENo
❑ NA
❑ NE
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
1�bNo
❑ 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 Phone: f7 -
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: 799--y Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes toNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:rNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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
1E 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
Q9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Vo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[%No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V No
❑ NA
❑ NE
Otber 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
ONo
❑ 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
§5 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P9 No
❑ NA
❑ NE
Comments and/or Dra%ings:
12128104

Type of visit 0 Compliance Inspection Q Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: � ] Arrival Time: % 2; vs arture Time: b ,` /s County: Region:
Farm Name: _ R6 wN at 2- 3 _ raIA31) Owner Emad:
Owner Name: U/ Phone:
Mailing Address:
Physical Address:
Facility Contact: [� 21 r Title: Phone No:
Onsite Representative: it Integrator; u-,124,, Browy1
Certified Operator: Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = R = I = H Longitude: = ° ❑ I ❑ -
Design Current
µDesign ,Current
Design Garrent
Swine
Capacity Population
Wet Poultry Ca art rPo elation
P._ t3 p
Cattle Ca aci Po elation
P t3 p
_ ,�.
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
Layer
❑ Dairy Calf
❑ Feeder to Finish
r°bra of
❑ Dairy Heifer
r
Farrow to Wean
❑
Farrow to Feeder �� q Q>�
❑ Farrow to Finish
❑ Gilts
❑
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 No ❑ NA ❑ NE
[]Yes
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 No ❑ NA ❑ NE
[]Yes
❑ No
MNA
❑ NE
❑Yes
❑No
WNA
El NE
1� NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

�Faeility Number: y7q I Date of Inspection =�P--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Lp No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (N 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 b No ❑ NA Cl NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E.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? 7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E ] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R1 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
P No
❑ NA
❑ NE
Comments (refer to question ft Explain any YESEanswers and/or any recommendations or°any other comments.
Use drawings of facility to better explain situatioq use additional pages as necessary): ]
Reviewer/Inspector Nance^ — T " Phone: ►33-3300
Reviewer/Inspector Signature: YJYA 160Ad Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropriate box. ❑ VTUp ElChecklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Ieeeboard ❑ 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
F No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
bNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[p No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JA No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q3 No
❑ NA
❑ NE
Additional Comments`aridlor Drawings:
i
�a Lag or�ti � I a3 I �4 t re Ca { rr C C14 S[uoty S ys , � v"
S4 C
,
Page 3 of 3 12/28/04

Type of Visit JQ Compliance Inspection () Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 40Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: ''1' f' Arrival Time: Departure Time: County: Region: P46
Farm Name: 6nt& Owner Email:
Owner Name: i�w i,4 1vL? f ( .rt_ Phone: _
Mailing Address: — 8SIP �.'�%'��Gl:.td1 �. &1L
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
��Phone No-
Integrator: _ /I/��A - �rrrr,�_rv�_
Operator Certification Number: ss
Back-up Certification Number:
Latitude: = e =. Longitude: =]o a 1 = W
Design Current Design Current ' ' Design
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Pw
❑ Wean to Finish
❑ Wean to Feeder _
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder iWO jO i -27
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Nan -La ers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [I Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifei
❑ Dry Cow
0 Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
Number of Structures:
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?
1
❑ Yes 16No ❑ NA ❑ NE
[]Yes
❑ No
N""A
LINE
❑ Yes
❑No
,.,A
�NA
V
El NE
2�NA
❑ NE
❑ Yes
❑ No
❑ Yes
V.No
❑ NA
❑ NE
❑ Yes
�XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes QKNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
)9 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: g
Spillway?: Il () i4 Q
Designed Freeboard (in): r �(
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �j 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 JZNo
❑ 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 ,6No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below"
[:)Yes kNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
(� Z25' 0-t-5" 1 i,l • ; SD
12. Crop types) et 4.OL - q t ? t� � .: e - Q rrL �r'tk . 4 czt; ►� - Q f"d�
,, u
13. Soil type(s) CaAAA- , Rktg U i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes g'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:]
Yes
ERNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
lam, any¢ YESj answers! andJor:
��.��i�la
I$in�sitoations.� (use �atiditional;
Reviewer/Inspector Name Phone: -1 L
Reviewer/Inspector Signature: Date: 9 ZL7_�
IZ'28104 Continued

—I-dcility Number: ;L —y Date of InspectionITL
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER No ❑ NA ❑ NE
the appropriate box. ❑ WDpr ❑ Checklist
s., ❑ Design' El Maps❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Applicatiert ❑ Weekly Freeboard ❑ Waste Analysio'❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification's
❑ RainfaU/U Stocking❑ Crop Yield' ❑ 120 Minute Inspections' ❑ Monthly and V Rain Inspectiogs ❑ Weather Coder
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
To
❑ 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
J@ 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
Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
lDateofvisit: 7/.�//ems/ Tunes
802 y
O Not Operational 0 Below Threshold
In Permitted 12 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... _.--- ........
Farm Name: ........ ,� � r.. n- -� .�D 4 a 3 ..,......_....._� »........ ---- ...... County: S m: '. +? �✓ . W_ ... F. 2` �....
Owner Name: .._» ._._ .....� ........_.... _.. ..... _ ._�....... Phone No:
MailingAddress:......._ ..._......... .. ... ....._............._............._...... _......... - _. .__ ..___...__ ..»._ .._�.
Facility Contact: . �....._� �_.. - --..._.. _ �.. _. Title: Phone No:.
Onsite Representative:
Certified Operator:.... --- aj.!n� kS
Location of Farm:
Integrator.
Operator Certification Number:.....
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? /,l f,¢.
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 ERNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [$ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IN No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... _........... ........... - - - .........._........................ _....... .............�.- - - - » ............._..... ............_.........
— ._...
j. Pe
Freeboard (inches): 3 _
12112103 Continued

Facilih• number: K2 — 517 Date of Inspection E2?
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes [)a No
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan. (If any of questions 4-6 was answered yes, and the situation poses an El Yes ® No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [�i No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type 19',-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ( No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ED No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes �] No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ® No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
21- Did the facility fail to have a actively certified operator in charge? ❑ Yes [a No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [2 No
23. Did Reviewer/Inspector fail to discuss review/inspection %ith on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes] No
0 violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
oC iniinents (refer to question #) Expbaitr any YES"answers and/or say r tnntendatioris or ati� other comments: ``
Use.drawitt s of facility to better explain situations (nse kdditional:pages asec nessary} -T - ®Field Copy El Final Notes k
r
HOr,ser 4'C_ L( tl <C.JR. fr ca 4r W'_ �� � �� Jt<SCPC_V%
4 � � G •' r- �.. eQ � � � G ! dL S 4. U �.�, � is G W� U L,J lei _
r
Reviewer/Inspector Name 4 --
Reviewer/Inspector Signature: Date: mi I
O5103101 / Continued

Site Requires Immediate Attention:
Facility No. 5 -j--
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 34'y zs - , 1995
Time:
Farm Name/Owner: -tk; / -L �
Mailing Address: a3s� T t�- },a V;, S r, w N �'.� 3 IF3
County: S km P S O 1J
Integrator: C kVk R p ►- L s F o o b's Phone: -- - R I oo f +-1
On Site Representative: za,j je_" %. %r. _ Phone: !j to - 0141
Physical AddresslLocation:_ S'k_ -2 - t --' f-r-c. SV-- i o b"#-
Type of Operation: Swine X Poultry Cattle
Design Capacity: t v om Number of Animals on Site: a aQ
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 1 inche Y or No ual Freeboard: Z-- Ft. © Inches
Was any seepage observed from the n(s)9 Yes or�as any erosion o
bw.Wed? Yes or,
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: C c5, oLs'�G
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin e? or No
100 Feet from Wells? YY r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue me: Yes or 0
Is animal waste discharged into water o state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate w management recor (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:_ '5 ,-.5 _
M ICHKsL W 1C.KV_ R
Inspector Name
r1lic- A, o f_/_
Signature
cc: Facility Assessment Unit Use Attachments if Needed.