820422_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Quaff

1"41 6 A C i �(_ (Sz)
Type of Visit: `U Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D Departure Time: County: S ( Region:
Farm Name: `��4 U c`a�'�Owner Email:
Owner Name: &4t"I �� Cj�_4 �'e Phone:
Mailing Address:
Physical Address:
Facility Contact: �l <<✓t vL(y jl L�it�f�`— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: PC/ 'n5-
Certification Number:D
Certification Number:
Longitude:
Desk c2ifffent Design Cnrrent Design Current
Swine CapacityFop. Wet Poultry Capacity Pop. Cattle Capacity Pup.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
V
/ I owl
Layer
Dairy Cow
I
INon-Layer
I
Dairy Calf
Dairy Heifer
r. Design Current Dry Cow
D Pout Ca aei P.o Non -Dal
Layers
Beef Stocker
kTurkeys
Gilts
Nan -La ers
113eef Feeder
Boars
OtHTurke
Other
Pullets
Poults
ther
Beef Brood Cow
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �AFo
❑ Yes
E]-NA--F] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ -Ne-0 NA ❑ NE
a. If yes, is waste level into the structura I freeboard? [] Yes ❑ No a� ❑ N F
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o r❑ 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
�rEINA
❑ 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
[ _Ne— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EJ-Na—❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ca o ❑ 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 WDrift ❑ Application Outside of Approved Area
12. CropT e(s): �-� s � `I tJe in � /'1' 6""Ce
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17_ Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�]­No
❑ Yes L__I 14
❑ Yes ff fro
❑NA ❑NE
❑ NA ❑ NF
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes E31o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [ go ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps 0 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ql�o ❑ NA ❑ NE.
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3No 0 NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: jDate of Inspection: u
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�o ❑ NA
❑ NE
15. Is the facility out of compliance with permit conditions related to sludge? If yes, check
D 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
[a-Ko_ ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[i ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes EJ i�o ❑ NA ❑ NE
❑ Yes [D-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [3-N6­ ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? es �o ❑ NA ❑ 'NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C3 Iqo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better eanlain situations (use additional pages as necessarv).
It(,N'T 0--\ l�_
Ho - 0 - '- .-7
r( 1 y
-)-7_ r b s�t�-����1_11�17
C 6(( arO ' 3 o K- b K 5�
Reviewer/Inspector Name: .� ; L C: i
Reviewer/Inspector Signature:
Page 3 of 3
Phone: - 3 33
Date:
I -/E-
2;4Zffl5

i ype of visit. kyiom ance inspection v vperanon Kev]ew v ztructure nva►uatton V I ecnmea► Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: l Q County:rn
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:(=/7—z
%_r
Facility Contact: "A ti 'u'� C� C k Title: Phone:
Onsite Representative: (� Integrator: LV_r_S� t.
Certified Operator: r Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
WIMP
�I
Destgn,
INN
Current
i De�s�ign' Current
Design Current
„ Swme
Aril �i
Capacity
I
Pop.
, �WIIIIIN
Wet Poultry Capacity Pop.
wattle Capacity Pop.
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
100
/01
4
Dairy Heifer
,. s
D Cow
Farrow to Wean
Design Current
Farrow to Feeder
��''II''
NtD
EI.
. $onit : _}Cap aci Po Gnu fir„i
Non-Dairya
Beef Stocker
Beef Feeder
,
Farrow to Finish
Layers
�aiidlj
Gilts
Non -Layers
Pullets
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults"
Other
10ther
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
ED Yes I"S' o ❑ NA ❑ NE
❑ Yes
❑ No
�
❑ NE
❑ Yes
[] No
�A
❑ NE
❑ Yes
❑ No
[5-NA
❑ NE
❑ Yes
[J-No
❑ NA
❑ NE
❑ Yes
P3"No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4.1s 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 ❑-i*—❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: / o i
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 3 �_
5. Are there any immediate threats to the integrity of any of the structures observed?
D 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
❑?4r-E] 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?
es ❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6%❑ 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
❑! -Ko—❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg-t o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D-Nu- ❑ 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 f� ❑ Evidence of Wind Drift ❑ /Afpplication Outside of Approved Area
12. Crop'Iype(s): r_tj! L �T b ✓x�,Z � q� (/' _rC'y
13. Soil'Fype(s): D
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A-Xv
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
es
❑ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17- Does the facility lack adequate acreage for land application?
❑ Yes
I__i K
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-N6'
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'I l�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
E].N u
❑ 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
[3-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: 3'c
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]'lam 0 NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑- Flo ❑ 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
Ejr❑ NA
ON E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q" Rio ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3+ft -❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the []Yes [J.N� NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? I f yes, check the appropriate box below. ❑ Yes [ -K6 -❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ['-1-Ne ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q-Ne ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E31No ❑ NA ❑ NE
Comments (refer to question �)Explain any YES answers and/or any additional recotnmendatioos or any other c6mEh6nts: i' w
Use drawings of facility to better explain situattons (use 'additional pages as necessary_g(4
-e v-A /4 q 07c,
vci— 30 ,?,r 9s(
Reviewer/Inspector Name: V Phone:TO - �33�K33 Y
Reviewer/Inspector Signature:Z Date: �.,/1i t !
Page 3 of 3 21412015

i ype of visit: tv Lompttance inspection V operation Review u structure Y--valuation U I eenntCat Assistance
Reason for Visit: ("Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ,6 "t
Farm Name �Ll Vds �' - Owner Email:
C
Owner Name: es �� Phone:
Mailing Address:
Physical Address:
Facility Contact: tSke~ e,3 -LV4 t! 5Title:
Onsite Representative: t t
Certified Operator: Q 0.^e-1
Back-up Operator: S;
Region:l" e'O
Phone:
Integrator: ft��
Certification Number: 17& 6 s
Certification Number:
Location of Farm: Latitude: Longitude:
,.
DesignCurrenf^ DesignCtrrent Design Current
Swine CapactyPop� rWet':I'oultry Capacity Pop Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Al ]Non-Layery Dairy Calf
Feeder to Finish QD D '' - Dairy Heifer
,:.
Farrow to Wean �} DesignCurren Dry Cow
Farrow to Feeder 'D Plt . Ca act #Fo Non -Dairy ou
Farrow to Finish uLayers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
;. Turkeys
,, Turkey Poults
Other Other Jill
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes'
' ❑ 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
[�!fNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste. management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
hfo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[3"N'o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: KZ -Liz Date of Inspection:,
Waste Collection & Treatment �.,�"'�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ LS
Yes o ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes [ji-Nm ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
TNNo
❑ 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
L2-mo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2-175o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[?'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;KNo ❑ 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 Approved Area
12. Crop Type(s): '( r-J►M..�[J lut4 !�/'�2,e— S6.0 r r�GiC' �'1 -
w. s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
['fNo
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�qo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [!rNo ❑ NA ❑ NE
the appropriate box_
❑ W UP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes EfNo ❑ 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? \ V] Yes ETNo ❑ NA ❑ NE,
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

w
PFacility'Number: 'Z - Date of lns ectio
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[�t-Go
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/lnspector fait 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 E2�No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ole
P-q,7
r c
Reviewer/inspector Name:
a k
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 2r'�o ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Phone: 33 —S33
-
2/4/2011

(Type of Visit: UCom fiance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: G Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: op 11 Departure Time: 1 ounty: Region:
Farm Name:S,r."` Ct-Owner Email: —�
Owner Name: J t'J I ^GC 01 tA\ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 03'cymyq u.{
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 4 qz___
16 �' Certification Number: 17
6 S
Certification Number:
Longitude:
Do Current Design Current- pesign Current
Swm Cap act Pop. Wet Poultry Capacity Pop: Cattle Capacity Pop_
Wean to Finish
La er
r
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Da Heifer
Feeder to Finish
Design Currents
Farrow to Wean
DEX Cow
Farrow to Feeder
D . P.oult . Ca aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
a
Beef Brood Co
Bew
,,_
Turkeys
-- - --
Turkey Poults
Others
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P-K5 ❑ NA ❑ NE
[:]Yes
❑ No
�
❑ NE
[—]Yes
❑ No
[3�NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts ar potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
[]-W�
❑ NE
[:]Yes
a 1VU
[] NA
❑ NE
[:]Yes
<o
❑ NA
❑ NE
Page I of 3 21412014 Conddnued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity {structural plus storm storage plus heavy rainfall} less than adequate? ❑Yes No ❑ NA/ ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes [:]No E3- A ❑ N E
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LK56
❑ 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
❑4o
❑ 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 strictures need maintenance or improvement?
[] Yes
[]14�u
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E?r'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): Q (tbpy �
13. Soil Type(s): A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�`No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [J o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes eNo
❑ Yes R(No
❑NA ❑NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EjNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
[JNo
❑ 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
[3 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
D Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
E�fNo
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

r
F*cil -ity Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o n1 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge Ievels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
2& 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
3 I. 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 No ❑ NA ❑ NE
❑ Yes 21"No
❑ Yes �No
❑ Yes [3No
❑ Yes ONo
❑ Yes [allo
❑ NA ❑ NE
❑NA ❑NE
]NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 19-
�-FFT"
21412014

t vas
Type of Visit: -{ omp - nce Inspection V Operation Review Q Structure EvaluationQ Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time County: Region?WD
Farm Name: Owner Email:
Owner Name: VIA Clio a� Phone:
Mailing Address:
Physical Address:
Facility Contact: --.S l� � � tMe: Phone:
Onsite Representative: Integrator: ()V2-_ G ­'
Certified Operator: { l Certification Number: l U
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current' �� � -
Design
Current''
Design Current
Swine
Capacity Pop. `Wet P,oetltry
Capacity
Pope
Cattle Capacity Pop.
Wean to Finish
- Layer Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
{,�
DairyHeifer
Farrow to Wean:
IDesign
Current
Dry Cow
Farrow to Feeder
_
=D : iF!ouI
Ca `aci
Po . r- :
Non -Dairy
Farrow to Finish
Gilts
I Layers
Non -La ers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
'` Turke s
Other
Turlccy Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
U;Nv--E]
NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
Ea-NT ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[] No
E4� 0 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)
E] Yes
❑ No
[ ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3-lq
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-N*—D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �r to Ll
Spillway? --
Designed Freeboard (in):
Observed Freeboard (in): r
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E Nrr-
❑ 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
IJ"lro
❑ 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
25'N'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Er o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3'lgo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ " '
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Ej-1q_o__ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift. , ❑ Application Outside of Approved Area
12. Crop Type(s): '� �Jt l l� '.5-g o (, /W j_ 1 I l Vej-
13- Soil Type(s): �?AIA:
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff 'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E'<io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2'iq'o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eg "'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
04
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
Efr i�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1 7 1 "
❑ 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 [j.N6— ❑ 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 [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FiNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ectior
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes EJ'No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
do
❑ 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
EKo
❑ 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
to
❑ 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
To
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[;[�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations -or any other comments.
Use drawinLFs of facility to better explain situations (use additional paizes as necessarv).
C�(' 16 i4q,1
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
4 ') Phone 9 { t/ �7
G
Date: rd
`
21412011

�)vs 1� I
'S16013
Type of Visit: ED Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine Q Complaint 0 Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: P 0 County -
Farm Name UOIri F(&M -.;,c 1-10)11-1 y Owner Email:
Owner Name: 1�, 0 C �U� Phone:
Mailing Address:
Physical Address: � �o 1p 6up1/ fioim Ln ; LA Hb 0-1IMOA
Facility Contact: ` m:?j Mec4fel) Title: (Done r Phone:
Onsite Representative:
Certified Operator: 3omes MC CV11?f1
Back-up Operator:
Location of Farm:
Latitude:
Integrator: PIOi2ae—
Certification Number:
Certification Number:
Longitude:
Region: F>?O
Yk
Caea Current �*�", µ Des gnCurrenty:n
Swtne � � ��pctty Pop ��W�t�Poultry Capsctiy Pop.
Wean to Finish La er
Wean to Feeder Non -La er
Feeder to Finish "_ r _. ' `
Farrow to Wean -Designer@urrent
Farrow to Feeder D . foul Ca achy! I',o P.
Farrow to Finish Layers
Gists Non -Layers ers
Boars Pullets
Turkeys
Other Turkey Puults
Design Current
Cattle Capacity Pap.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes allo ❑ NA ❑ NE
a. Was the conveyance man-made? [:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reacb waters of the Stale? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes R'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters tg Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

•, Facili Number; - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JR No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: mwl f I-!D `/ 10-1t/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 52 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 CR-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 5;� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CR 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 . ;t,.` ❑ Yes U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes N-No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ' ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus D 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):
)11 JlPf— �G6
13. Soil Type(s): YVL-L(�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C;� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [XNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment"?
Reauired Records & Documents
❑ Yes r"No ❑ NA ❑ NE
[:]Yes [-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[5kNo
❑ NA ❑ NE
the appropriate box"
❑ WUP ❑Checklists ❑ Design 0 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 EENonthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
5jrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA ❑ NE
Page 2 of 3
21412011 Continued
L

Facili Number: a jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes & No ❑ NA D NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [�-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No C@ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes O 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 �j No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes RNo ❑ NA 0 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. t3V; Yes [:]No ❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other: S �y
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes C&No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes CRNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers'and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
3 pike, s r� dirt -JFr d;� C�ov� so d-o� J nef oback �10vdf*' {
I- �i ir�s t c 4 l �; `a1 Thin rat i )�r rorn (c.� r 4r Oye Q m� /Cm
nr�l� � nt:
Reviewer/Inspector Name
Reviewer/]nspeetor Signal -tire:
Page 3 of 3
'To a/) Sel]n�'i�'f M1 _ Phone: 7.3,30 J
Date: Ain
214 Olt

I�r►+oE
1a]i.
F3
Facility No_ $"a_ q )}. ^Farm Name PfIVOL Date 55 jLq 11-3
Permit COC (z OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Drops
HUMP Fwxw��
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft)
L4��
Liquid Trt. Zone ft
3,7
,
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
B
i rn i _A
.11��C�+--�---
Fill
ft�giqav-YO'
"-W
Soil Test Date I a1; ul Crop Yield Transfer Sheets
pH Fields Wettable Acres ..i RAIN GAUGE
Lime Needed WUP Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu-IyZn-I 1 in Inspections G•-r Check Lists
Needs 5 (5-1<25) ✓ 120 min lnsp_ Storm Water
Needs P _ Y" AJO Weather Codes
IWaste Date I %J11] I:7 I L4 C} l3
+ 60 Da
N {Ib11000 Gal} ,3.,n
.�
..
1i;ilri�ilTl�li1
♦
� f� �.�
��
INi
33 sir IA41\Fbf y^S,g3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm +ffV3 .r Lagoon #
App, Hardware Top Dike
Stop Pump
Start Pump
lQrr t l�t�r�• c.
6A k3 jcr
�j ! �+%
NJ
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac

Vm
51MS �i11 Id1ON
i'vis'ion of Water Quality
Facility NuQther �� - ® O Division of Soil and Water Conservation
© Other Agency
Type of Visit: 9 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: SOrt
Farm Name: BCLVOI 1 46 �nc. � i,Jf �1� Owner Email:
Owner Name: _TalmpJ oa olul lio/1 Phone:
Mailing Address:
Region: f1041)
Physical Address: 550 y ' �—�� � 4a MB Rernk4 Lome i t— OhMa,
Facility Contact: Djnxs Title: _ QhI��r Phone:
Onsite Representative: J 101" 14 C (L/ h — Integrator:
Certified Operator: 7Qm�� C Cr<�n Certification Number: 17$(Pr
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
T D si n 'Current - Desi n'Ca�rrent r
Desi n Curren
g
cP p. Wet;Poultry Capacity Rop:
Swine �apa
Cattle Cacity Pop.
ap
Wean to Finish
Laye;
Dairy Cow
Wean to Feeder
Non -Layer
Ddiry Calf
Feeder to Finish
A T-'
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D P,ouI
Capa P_ P.
Non -Dairy
Farrow to Finish
Layers
113eef Stocker
Gilts
Non -Layers
113eef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
l
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:
❑ Yes R1 No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ,® No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: 4gX - 4aL Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: HO t,T
Spillway?:
Designed Freeboard (in): 19_
Observed Freeboard (in): @G 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CR 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
4 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
®No
DNA
❑ 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 pan 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
CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR 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 0 Evidence of Wind Drift ❑ Applicati_on, �Outside ofApprovedArea
12.Crop Typc(s): t1V:!'t� /�!'fL1" � LidQ �2�)P � f}lC1177I� sL'ty �LfCIT l�t��
13. Soil Type(s): NQ A ' No 13 !
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 DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box_
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1U1 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [—]No (r NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: '6-&, 1 Date of Inspection: I a I JIR fla
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fp No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
01 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
Eq No
❑ NA
❑ NE
❑ Yes
❑ No
[,;�j NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes No
[:]Yes No
[—]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exalain.situations (use additional vases as necessarv).
NOS
1�D
7burry ha-ledot —thesr*A AV4Q hv.,Ie 6_V/1fre'c�7 hare--,, refeh_ts no lvkr "r.affA C001(0%s
ive l rnUrrr v1 � ct J -6 e0s,
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Z chn±ier
Phone:
Date:([ $, C)of�
2/412011

Facility No.'O' Farm Name
Permit COC v
Re IV o, r Date I ": )S
OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1 j-
211-1y
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
a.5-
Liquid Trt_ Zone (ft)Q
Ratio Sludge to Treatment Volume ifs 0.45
Date out of com liancel POA?
Dt fiRq4l
Soil Test Date 3r��r�,
Crop Yield
Transfer Sheets
pH Fields tiU
Wettable Acres
RAIN GAUGE
Lime Needed 4E-
WUP
Dead box or incinerator
Lime Applied _
Weekly Freeboard
Mortality Records
Cu-I Zn-I
1 in Inspections W
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
M. F■ - -
�"!Te----NOR
-
PuIll/Field..
..
f
FIE
-AlVerifHONE NUMBERS and �fP fttions ��
Date last WUP FRO FRO or Farm Records
Date last WUP at farm`HO) Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac

AJm 5 /r3-/W //z0 i! —/;&A
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Arrival Time: Departure Time: County: Region: F.--;
Farm Name:�j7�lr/yVl �jt �, /�YJ , �% Owner Email:
Owner Name: �(> ,x Tom/ Phone:
Mailing Address: L__// /" ` c; '2-03%
Phvsical Address:
Facility Contact: �j�y?,-S A& � PAJ Title: f Phone:
Onsite Representative: Integrator: Ae
Certified Operator:_ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swims a �4
4111
Design bCurrent
C•a Iac�' Po VVet Poult
P tJ p•. ry
Design
Ca aci
P ty
Current
Po P•
Cattle
Design Current
Ca aci Po
P it P•
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Q
may;
Dr maul. •
Design
Ca achy
"
"Current
j Pop.
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
F 113eefl3roodCow
4.4
Qther _ x
Other
Turkeys
Turkev Poults
rl-ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L , 10
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
0'9A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
E GA
❑ 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
[R"KA
❑ NE
2. Is there evidence ofa past discharge from any pan of the operation?
❑ Yes
02,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
524o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility tiunnber: - Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [B No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No 5'NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldIdentifier:1_�_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L?-T�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
U;J Ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or en-Oronmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
[Rr�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ri—l-Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks. and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
[E to
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes. check the appropriate box below.
[] Yes
ga<
[DNA
❑ NE
❑ Excessive Ponding ❑ hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu. Gn. 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 Tvpe(s):
13. Soil Tvpe(s): U
14. Do the receiving craps differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving: crop and/or land application site need improvement?
❑ Yes
E3<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ , o
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
rv-41No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U�Flo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QKo"
❑ 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
0 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
10
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P�'IQA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
221. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g1 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the tacility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
E3<o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
�E
❑ Yes
Ea o
❑ NA
❑ NE
[:]Yes 420<o ❑ NA ❑ NE
❑ Yes �o [] NA ❑ N E
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
,16tcL e,, CYa� /2/31 12_z;v/
Reviewer/Inspector Name:
Reviewer/Inspector Signat
Page 3 of 3
21vU
❑ NA
❑ NE
Ek�o
❑ NA
❑ NE
C24o
❑ NA
❑ NE
Zk4o/
❑ NA
❑ NE
Phone: 7/0
Date:
21412011

I
Type of Visit &Tom fiance inspection Q Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit fdttoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �3D ld Arrival Time: c Departure Time: 1 / : XO County: Region:
Farm Name: �I�ra�✓�J / +rf —� �- �� l[y Owner Email:
Owner Name: Fpx w Phone:
Mailing Address: f . h YI 70 1_,
Physical Address:
Facility Contact: /%%� _ Title: 09ciwlec Phone No:
Onsite Representative: Integrator:'
Certified Operator: -s`�'� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ = Longitude: E:] e = '
Design Current
Design Ct
I,!,
Design C+urrent
S"Ifle Capacity Population
wet Poultry Capacity opulation
Cattle Capacity Population
❑ Wcan to Finish
❑ La cr
❑ DairyCow
an to Feeder
on-aer❑
Dai Calfder
PESTW7,Lc to Finish �a©D
-
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry _--
❑ Dry Cow
❑ Farrow to Feeder
-
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -La yersPullets
Beef Feeder
EBOUSGilts
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other INumber
of Structures
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure []Application Field 9 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?
W Yes No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ NA
❑ NE
%Yes
❑ No
❑ Yes
�10
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

�r
Facility Nurnher: - Date of Inspection /d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —^_A?-
Observed Freeboard (in): Z 3 ,
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 property addressed and/or managed
❑ Yes
❑ No
❑ NA ❑ N E
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
❑ No
❑ NA ❑ NE
8- Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
❑ No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers. setbacks. or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ N)✓
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ 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) 19r_" 0 !t ��i d'S 1 /i7i�14 — f �tl f
-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16- Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
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):
f 1j�t`�-. ��' m rr- h d' � � OS�/"r' � � L(Jrr'� �,_ C'b�s-r�ee��+-✓ < < 5 %/y j �''j �
�
Ile /�'as 7;�; Au
;3:ji'_� iL"!'fit s arm rC�lCt}Nrrc/dt � Le I R fry+- /c>z-,
C w��� Ou 1iavc !'r vf�f cs, 4i t7�3�3,9/S/
Reviewer/Inspector Name -- - - - -- ,r� — - T- Phone: 33aa
Reviewer/inspector Signature: Date: /,2—
12128104 Continuer!

Facility Number: — Date of Inspection 30
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑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
9-Rainfall ❑ Stocking ❑ Crop Yield ® 120 Minute Inspections ,Monthly and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EqNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LRNo
❑ 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
0,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZLNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ELNo
❑ 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
Z�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
B,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
ELNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,ayes
RWo
❑ NA
❑ NE
Additional Comments andfor Drawings:
Al,r : Sri u/ds Fe — X v 15,
f [7 ai` ed z L ,,k O T
12128104

I
Type of Visit 0'Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit eVoutine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ILfL;�;l! Arrival Time: / . c a Departure Time: 'a County: Region:
Farm Name: �' 1 —i (— 0 Owner Email:
Owner Name: _ Tom_ s e s C.rf��rti Phone:
Mailing Address:
Physical Address:
Facility Contact: _��6 ifu 11rK- Title: �L(/%�r� Phone No:
Onsite Representative: Integrator:
Certified Operator: �'�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =e [�4 = Longitude: =° 06 = fi
- ��
Swine yS
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
El Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
10,0
❑Laver
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Dai Cow
❑ Da Calf
❑ Daia Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
-__
...
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑Other
❑Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
allo
❑ 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
❑ NA
❑ N E
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
(]Yes
RINo
❑ NA
❑ N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R No
❑ NA
❑ NE
other than from a discharge?
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
C:No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑Yes
[]No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):/��II�} _
Observed Freeboard (in): 3) `-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15�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
[gNo ❑ 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 sructures lack adequate markers as required by the permit?
❑ Yes
5,)\lo
❑ 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
5LNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If ves. check the appropriate box below.
❑ Yes
6No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of AcceptableCrop Window [I Evidence ofWind Drift ❑ Application Outside of Area
12. Crop type(s) yrlw .,{{f©rrrl�rr�st 1 W �M r �. X of lli,
13. Soil type(s) k >/ 1.Uzij3
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J&Vo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;JNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
0 Yes
No
❑ NA ❑ Nl
IT Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. .
Use drawings of facility to better explain situations. (use additi6nal pages as necessary):
O
Reviewer/Inspector Name Phone: 9" 0—,4y3=3300
Reviewer/Inspector Signature: Date: /10
lz/zol Vff l.Vrsesll"C"

Facility Number: — Date of ]inspection � —D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V[No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ERNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JRNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EkNo
❑ 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
f &No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EkNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ 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
9No
❑ 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
0,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
kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RYo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I
Type of visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
011butine 0 Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: I ': i7 Departure Time: County Region
__�— � e-�
Farm Name: 1" a/Yl�� �'/ `-l0 r1J Owner Email::
Owner Name:FiI�1t5G C�,/���- Phone:
Mailing Address:
Physical Address:
Facility Contact: d ---s G /1 Title:
Onsite Representative:
Certified Operator: �
Back-up Operator:
Location of Farm:
Swine
Phone No:
integrator:
Operator Certification Number: Y� _
Back-up Certification Number:
Latitude: 0 0= l Longitude: 00❑ 1= u
Design "Current Design Current
Capacity...Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
4.0b0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non-L.
Pullets
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
- �-'LLB
Design � Current _
Cattle Capacity 'Pop ulation•;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non- Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
A
❑ Yes QjNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[)-JNo
❑ NA
❑ NE
❑ Yes
P..No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

r
Facility Number: — Date of Inspection S
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /710
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in): p�<} 2y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C,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
qNo
❑ 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? ayes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ 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
ENO
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
CgNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) /V 1e''.��r�f/%/Ir3�n � 44 1
&Lr nr u/; 1-1,
13.
Soil type(s) lLJ 1L-r
^T
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[jNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
R,No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Q No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
IM No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any other comments.
Use draw' ings of facility to better explain`situnitfons. (use additional pages as necessary):
� rl � b4rt �"A_ cr7_� 1_17ov vi bab
ReviewerllnspectorName �'� .r�—� Y4 Phone:fa""��]�"��yc)
Reviewer/Inspector Signature: Date:rf�
n___ _r »r1oin�

Facility Number: Date of Inspection l SOle
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 ❑ 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
f,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3allo
❑ 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
FINo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non -Compliance of the permit or CAWMP?
❑ Yes
U,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�jNo
❑ 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
Ifyes. 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ yes
P.No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Q Division of Water Quality �`aa -D�
Facility Number © Division of Soil and Water Conservation
Q Other Agency
Type of Visit ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 46 outine Q Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 21� �Q Departure Time: County:.�
Farm Name: .,? L art a + F /'�---Zp— L�1 1 //D% �� ��% Owner Email:
Ownpr Nsme: i1 R;YI,",, /lri �( _U ! / 1�k, Phone:
Mailing Address:
Physical Address:
Facility Contact. 22 6`a. if --_ Title:
Onsite Representative:
Certified Operator: _ _5ze_[�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region:
Phone No.
Integrator: n'
Operator Certification Number: _/Z_1_b.�
Back-up Certification Number:
Latitude: 00 =' =" Longitude: =c =' = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I 1 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcv Poults
❑ Other ...-- —
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Da4y Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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)''
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation!
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V-No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
fg-No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

t
Facilih7 Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CK No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 6 D
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JO 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
9 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
CR 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
59No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tK No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
19 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 off Wind Driift! ❑ Application Outside
o�f+Area
1?. Crop typc(s)',Z,1 1 ! ��L�f��S' > I /'� Iy�n�i' + (
13. Soiltype(s) �j 12
! Via.E
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
PNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'.?
❑ Ycs
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ti�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone,
Reviewer/Inspector Signature: Date:
IZl_Br/04 Continued

i Facility Number: — Date of Inspection`—�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El 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 (,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
] No
Cl NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMA?
❑ 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
I f 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 Revi ewerA nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14 No
❑ NA
❑ NE
12128104

Type of Visit &Complian Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Arrival Time: ; DDeeparture Time: ` t1 County: Region: ��
Farm Name: [= �l r�- & eLLI o l 7T� �h i✓` Owner Email:
Owner Name f %%%a C ��n Phone:
Mailing Address: Ale
Physical Address: /
Facility Contact: //�+�l�s ��u �/_Title:
Onsite Representative: _S _
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �rC2 rs-_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0Q =' � Longitude: =o [—]' 0 "
Design Current
D se gii} `C•urrent
f, "'
Design Current
Swine
Capacity Ropulation
r x
Wet Poultry pacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
D (o w
❑ Dairy Heifer
❑ Farrow to Wean
x"L
p , Poult
ry rY Y
❑ D Cow
❑ Farrow to Feeder
. W
ElNon-Dairy
El Farrow to Finish
La ers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
-..�
Other
❑ Other
�,
p
Number of Structures:
❑
❑ Non -La crs
❑ Pullets
[I Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream impacts
1, is any discharge observed from any part of the operation'?
❑ Yes
X[No
El NA
El NE
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
El Yes
El No
El NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
El Yes
❑ No
El NA
[I 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)
El
❑ No
El
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
N No
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
XNo
El NA
El NE
other than from a discharge?
Page 1 of 3
12128104
Continued

}
Facility Number: Date of Inspection 6
I`• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14 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 L,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
[R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EffNo
❑ 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
[2No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
g No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LXNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14 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
11 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number• — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes INo El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JR No ❑ NA ❑ NE
Structure 1 Structure j2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:8j— L 1/0 i &I1)� J
Spillway?:
Designed Freeboard (in): &
Observed Freeboard (in): 3S_ —33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JXNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes [3No []NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [21 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�4 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
D9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9LNo
❑ 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):
�di►►'L � � �(-iU I vI
Reviewer/inspector Name ��1�✓ C 7 j �^— Phone:
Y
Reviewer/inspector Signature: Date: Z/l
Page 2 of 3 I2128104 Continued

n
(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number d. Date of Visit: Time: L J
O Not Operational 0 Below Threshold
ER'ermitted ee fied [] Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ........... L! �Z_ County: _._....__._..__. _._ C</1 P-
Owner Name:......... » !.�r1n.�.�.......... ........ ...... ...................................... Phone No:..9p..:..`��4?..:..7 - `/i4 s(c�..:...3vlT
Mailing Address:... ........ y .�........_ �.�r.,�t. �' ..........% . C.... s .......................... ......-..._----
Facility Contact:GtT!Cs...... /??L CiTitle:......._._......._..... -. -.__.. Phone No:
Onsite Representative: .3��. t„;_ /l1c C.,./!P%L y integrator: P�cs�u� .
................... _......W.....
Certified Operator: - _._ J it!^+ C �,t'£y »».». » �........ Operator Certification Number:.
Location of Farm:
•
M'Sivine © Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Design -Current Design Current Design; =Current
Swine Capacity Po ula6_.- ' N try Capadtv -Population - ` Cattle act :__ Po i"tion -_
Wean to Feeder ❑Layer ❑ Dairy
eerier to Finish a 10 'r ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Fender Other
Farrow to Finish _- ToW DEMgII. Capacity
Gilts
p Boars Total SSLW 1­7
,t„_, Nrunbcr of /Lagoorn
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c- If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes [-o
❑ Yes G114-0
❑ Yes &1qo
❑ Yes 0,90-
❑ Yes fo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ago
Waste Collection & Treatment f
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway ❑ Yes ❑'No
Structure 1 Structure 2 Structure ; Structure 4 Structure 5 Structure 6
I til'rer: ............ _.
.................. ............................ . »._....................... .......... ... ........................ ........ ..... ....—....................... ...................................
Freeboard (inches):.
12112103 Continued

Facility Number:
Date of Inspection f Cr
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zine
❑ Yes ©-No
❑ Yes Bl�o
❑ Yes M-Ka
❑ Yes QW6
❑ Yes B-No
❑ Yes ©-N&
❑ Yes E to
12. Crop type 06 erInVr,4r SM l� l ru,'.;�_S �:r�.,•+> its<� P�47 -- �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes l�.,�o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a tack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [ -M
❑ Yes [ o
❑ Yes MW6-
❑ Yes D-No
❑ Yes Q-No
❑ Yes ❑ No
❑ Yes 0-No
❑ Yes ❑ No
❑ Yes 8-No
_w
Reviewer w.
/Inspector Name /�''�r..-�1 I.�•rr.7�'!c'x. ,. ��rrr.-� ��XIQy �. .. ._ ;
Reviewer/Llspector Signature: 4.L/c Date: L - ��
12112103 Continued

Facility Number:
Date of Inspection y -a
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Ewo-
22_
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
E]No
23.
Does record keeping needimprovement? If yes, check the appropriate box below.
❑ Yes
S-W
❑ Waste Application ❑ Freeboards❑ Waste Analysis—❑ Soil Sampling-
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[9-No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
9NO
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O-Mo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Bles
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
DWo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑-No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
O-No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
[}IO'
35.
Does record keeping for NPDES required forms need improvement? If yes, check the avvrovriate box below.
❑ Yes
[-No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
tlillttonal Cammeais andfor-Drswrngs ,--its
-3 } , M".
AIc
P
�
e. u ! GG I cc /tJGv f G 1OA 9 All
U Grn% Gv�1r"2 � /y//ir
e
�c'.��1 C//Avg Y�� �lP.SS Ci✓Co i �/$tf' Lvci%ri'
/ -' C. �GJ�f✓J �F GG� C_Gi...-7�, //r'� f'L/ �:- IGS N C.L
12112103

Date of Visit: � Time: i� d
Facility Number L ZZ
-Not Operational Below Threshold
® Permitted ® Certified [3 Conditionally Certified 0 Registered pate Last Operated or Above Threshold-
Farm Name: T ��%��"� Countw
Owner Name: �.i�fyy.� Phone No: !��4
AlailingAddress: //70 /�+� d.�iyk/E �!/�✓�''� IV % 3
Facility Contact: /Title: Phone No:
Onsite Representative: V /�S` S & ��-/A96 J Integrator: �if�C�•�
Certified Operator: /�^ nl S� _ _ _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' a Longitude ' 4 u
Design Current Design Current Design Current
Swine Capacity Population Poaltry Ca acity Population Cattle Capacity Population:
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I JE3 Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars .Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes X1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes IX No
❑ Yes BNo
❑ Yes 9 No
2. is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X3 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

1 1%
Facility Number: —
Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop tyre fls.�.�.�.->!.t� . sS Ai/ 9.C.0-'6d /f'i _rp4ejC0.<�. GO.C-•t/
❑ Yes X No
❑ Yes �RNo
❑ Yes ;R No
❑ Yes allo
❑ Yes Pa No
❑ Yes KNo
❑ Yes ANo
13_ Do the receiving crops differ with those designated in the Cei{fied Animal Waste ]Management Plan (CAWMP)? ❑ Yes RNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
X1 No
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15.
Does the receiving crop need improvement?
❑ Yes
�RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RSquired
Rec rds & Documents
1$allo
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUp, checklists, des fin, maps,etc.)
❑ Yes
PNo
✓✓ L.,✓✓ ✓
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M1 No
WX
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
❑ Yes
$ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with 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 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question 4): 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): ❑ Field Copy ❑ Final Notes
Reviewer/]nspector Name
Reviewer/Inspector Signature: 01�Date:
05103101 Continued

Facility Number: & —kjZj Date of Inspection
Odor Is M
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes ❑ No
❑ Yes Pallo
❑ Yes Fkj No
❑ Yes M No
❑ Yes 29No
❑ Yes 5vo
Yes ❑ No
05103101

• Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
ype of Visit O 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 S2 422 "ate of Visit: It/212001 Time: 9:0© I'rintedon, 111612001
Q Not Operational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ...................
Farm Name: CAA.Farms..............................................................
Owner Name: Jarxtcs............... ... AICCUKU ............
..............
Mailing Address: F'�A..iQ 1.................................................
................... .
County: S;1pt1A$.RjI........................................... F.i .Q_..........
.........
Phone No:
... 0iHtat2..`.0.............................
Facility Contact: JmIxte5A!1-CuRVA---•------•.................... ............ .I`itle:.0txtxttr............................................... ... Phone No: ....... ............................................
Onsite Representative.- J.al[m;r.i±JcQVllf:ut.................................... Integrator: Prtr�ltage.kar.m...... ----------------------------------------------
Certified Operator:,iamivS...................................... ........................................ Operator Certification Number:1.7.8.65 .............................
of Farm:
From Clinton take 24 west to Bonnetsville & turn right on 1233, farm is 1 mile on left.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • 00 12 Longitude 7$ ` 26 12
Design Current
Swine Canacily Ponulation
❑ Wean to Feeder
® Feeder to Finish
2710
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity 2,710
Total SSI.NV 365,850
Number of Lagoons 1 ® Subsurface Drains Present JIM Lagoon Area IN Spray Field Area
Holding Ponds 1 Solid Traps JCI No Liquid Waste :Management System
Discharges & Stream ink
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar-e is observed. %vas the conveyance man-made'
b. If -discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c- If discharge is observed, what is the estimated flow in uml/min?
d- Does discharge bypass a lagoon systems (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
',i'aste Collection &'treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Strumirc 5
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
StIM(Mil-c b
Identifier: .................................................................. .....
Freeboard (inches): 25
05103/01 Continued

Facility Number: 82-422 Date of Inspection 11/212001 Printed on: 1 1/6f2007
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
[I Yes
N No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
El Yes
®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement'?
❑ Yes
N No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N 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 maintenancehmprovement?
❑ Yes
® No
11.
Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12,
Crop type Coastal Bermuda (Hay) Small Grain Oversced Wheat Soybeans
I3.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N 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
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available'?
❑ Yes
® NO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
N Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Continents (refer to question 4): 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): ❑ Field Copy ❑ Final Motes
SEE REMARKS FOR 82-648 BELVOIR FAIUNIS. INC.
A,
Reviewer/Inspector Nance Paul Sherman
Reviewer/Inspector Sig"ature: Date:
0_5103101 Continued

acility Number: 82--422 D,te of Inspection ]1/212001 Printed on: 11/612001
Odor Issues
25_
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation. asphalt.
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32.
Do the flush tanks lack a submerged till pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional omments and/orDrawings:
05103101

r )b
Facility Number Z Date of Inspection g
Time of Inspection 24 hr. (hh:mm)
® Permitted ® Certified © Conditionally Certified Q Registered 0 NGt Operational Date Last Operated .
Farm Name: ......... if
y.......-.-%'/!!r` ................................................................. Couatti:..... RA l —T- ra......................... ........................
Owner Name: Y.� !....../1*5e ilk! .................................................... Phone No:-...011 l..5 :...ram % .....................
Facility Contact: `rfl 5........1257...E k..,1_4-_ Title: / Phone No: ......
Mailing Address. ......-1l ��......��-..h`vrFr✓��i..�....�f✓..*!�.�� ..-��-----.- �' �.�.�..............................
, �. Integrator: ...... . .........Onsite Representative........... ..................
Certified Operator:..
.............. .................... .C�'� /x,f?........ -....... Operator Certification Number .......
J.7��s-....
Location of Farm:
r............------------- ......---------- ................
� _
Latitude �' �° �. Longitude
Design Current Design 'Current Design Current
Swine Capacity Population. Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy -
Feeder to Finish 27/0 Zlo ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish -Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Laioons.. / _: ❑ Subsurface Drains Present ❑ Lagoon urea ❑ spray Field Area _
Hold><ngPonds 7 Solid Traps No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c- If discharge is observed, what is the estimated flog in gaUmin?
d. Dons discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure d Str uctUre;
Identifier:
Freeboard(inches): ...----....•`•3�.. `......-.--......................... ............ ..................... ............... ............ I...................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes j No
❑ Yes jg No
❑ Yes ®'No
❑ Yes ANo
❑ Yes 'Q No
❑ Yes ® No
❑ Yes allo
Structure 6
............................
❑ Yes b No
Continued on back

Facility Number: 2 — zz- hate of lusprction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? El Yes F No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 15 "No
8. Does any part of the waste. management system other than waste structures require mainienatice/improvement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes (rNo
Waste Aoolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ElPAN ElYes _ "No
12. Croptype
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes J�j No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes a No
b) Does the facility need a wettable acre determination? ❑ Yes W No
c) This facility is pended for a wettable acre determination? Cl Yes IN No
15. Does the receiving crop need improvement? Yes ❑ No
19
16. Is there a lack of adequate waste application equipment? ❑ Yes N No
Required Records & Documents
17. Fait to have Certificate of Coverage & General Permit readily available? ❑ Yes'N 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 XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes !E� 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 gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes §Q No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes M No
25_ Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
No yiolatiotis or de#ieiencies were nofg . d4rr:irig #his;visit: Yoi} ;wiil reeeiye Rio #'ui-thtar. ;
: comes orideni ce: about this visit: - ' - : - :::::::::::::::: :::::::::::::: :
Comments (refer toqueshon #)' 'ExpIarn any YFS answers and/or any recommendations or_any other comments:
Use drawings of faeiltty to bet#er explain situations (use addrtionarpages as necessary) f
rri W
IS-1
N Co�u�� ,� ,E�%�s �,e.u6�g �,� /dam✓ ,yc.� ,q,.-�
Reviewer/Inspector Nameee
ReviewerAnspector Signature: . . Date:
3/23199

Facility Number: yZ — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fall to discharge at/or Wow Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? 0 Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) C] Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes No
32. Do the flush tanks lack a submerged fill pipe or a perinanent/ternporary cover? RYes. ❑ No
Mdiifional-Comme�ntsand/or` D
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
W'Division of Water Quality
HR Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
Facility Number
© Registered Acertified 13 Applied for Permit 13 Permitted
Date of Inspection
Time of Inspection
0 Not Ope rational
Farm Name: ....................... ...�............ , xl
O,wmer Name: ......... .��........ ......... C. ./,f ['1.........................
Facility Contact: _.... �Pi7J_'I. fl .......... Title: .. . ................. . ...
Mailing Address: ............�......q��....... � .....................................
Onsite Representative:................. f � 1 f�..ev, ...... 19 11)
?.._................../
Certified Operator:.-- .... �. ..Gam{ ................... ...........�'L
Location, of Farm:
County:
Phone No:
24 hr. (hh:mm)
Date Last Operated:
i................ �s`. ...............................
9I°......:� �..- Q_0 16
.....-
.... ............................... Phone No:__ .............................................
efl r7/vr V........e...
Integrator: . ................... f r..... F '?. ...._
Operator Certification Number: ........... ��5.
0
Latitude 0 9 " Longitude • 4 66
'eneral
1. Are there any buffers that need maintenance/improvement? El Yes P(No
2, Is any discharge observed from any part of the operation? ❑ Yes j(] No
Discharge originated at: ❑ Lagoon 0 Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes� /JUNo
c. If discharge is observed, what is the estimated flow in galltnin?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes
0No
3. Is there evidence of past discharge from any part of the operation?
0 Yes
IxNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
[) Yes
�fNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
[Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
0 Yc.y
No
7/25/97

i
Facility Number: —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[XNo
Structures (Lagoons.Nolding Ponds. Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
it No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (tt): ............ ..............
10.
Is seepage observed from any of the structures?
❑ Yes
[;�No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
!a No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
((No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[(No
15.
(If in excess of WMP, or run ff ente -ng waters of the State, noti DWQ)
Crop type ...... ......... lt�rYYZr....................
....---- ---- . ..... �..........................3..........?!!>tilc
alp
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes
[XNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
XNo
18.
Does the receiving crop need improvement?
❑ Yes
[A No
19-
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
54 No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
X No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0: No.violatioils or deficient=ies.wer'enoted-during this:visit..You:will receive -no flirther
co Nspbddeuce about this. visit:- . :
5 c �,� -
c; va
-k -a4jph L 0 'VL It uaf
f
5k-2JJ 4
25/97
.4 .
Reviewer/Inspector Name � j ;` .p `•'_ , x
Reviewer/InspectorSignature: _�1��%����_ ��1Z,yy. Date: f0�—��j Y

T Division of Soil and Water Conservation ❑ Other Agency 6� .
Division of Water Quality
M �'a+�»a4.�.s�3F'"""'0�.'^s,•.'•:r.�!as`< M,..:.....,�^*bY� -.-o.^. tw _: 'M^,�Ya -- ^^•w�-;wn. ,:.+,r�._.w,,...,, <. sb&:� _ .., ..h,'. �. �rwi �.v.,,. ., #.a, ... ,. r�
Its Routine O Complaint O Follo%v.ut) t►f l)W(3 insvcxtion O l: ollow-un of t)SWC review O Other 1
Date of Inspection
F acdity Number Z Z—
Time of Inspection [Z= 24 hr. (hh:min)
�Registered 13Certified El Applied for Permit ©Permitted JE3 Not Opera Date Last Operated:
5
Farm Narne• oun �^--
YWOwner Name: .... aY�.............CCti........,.......... Phone No:.....r:1..[.z-.....t...T.................................,....
Facility Contact: _ ...... I CC-t . � title:.... .................. Phone No: ---. .......
THailing Address:...1.1.I ......(.N ...... .IN,Gj..................................................!s.�.. �.....��j:.............,......... ..2 Z�
...
Onsite Representative:. .... .Cry(' ............ Integraton.....19 .9 � E.. -
�j�� G f ems-- rator Certification Number,._-.,.. 6 Certified Operator;._5c�e5_............... Y.� �_.. � � pe
Location of Farm:
From ... Clinton take .... .24.... w...... to ...... BoRnetsvi le .......turrt r...on...1233,...farm...is..1.rniJ.e...on...'Qft.................
.............. —......... ............. ................. ......... —..................y.♦............. ............. ...r........... .................. ................... —........... ............ ..................... •.................I. I.... ........... I ........... ... w
Latitude $`� • ®1 3 2 1s Longitude [$ • 26 4 12 if
'Design¢ Current
Designer: Current" �~ Designs current
..CapacityPopulatio>� Poultry
Gti<pac>tty Population CattleCapaci#y^ PopuiaE)on�
El
Dairy
Non -Dairy
F1
n Capacity j , ._
eta ssLw
Number#of Lagoonsl;Holding Pnnds
Subsurface
Drains Present ❑ Lagoun Area Spray Field Area
'S,
I b✓., yf fiA`4
❑ quid Waste Management System No Li
Wean to Feeder
�
❑Layer
Feeder to Finish
j �. �
Non -Layer
El Farrow to Wean
❑ Farrow to Feeder
=Y Other
[I Farrow to Finish
Total Deng
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑Spray Field ❑ ©thee
a. if discharge is observed, was the conveyance man-made?
6. If discharge is observed, dill it reach Surface. Water? (If yes, notify DWQ )
c- if discharge is 1)bS{:rVCd, what is the estimated flow -al/min?
d. Does discharge bypass a lagoon system'' ([f yes, notify DR'Q)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than From a discharge'!
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7l25117
El
Yes No
❑ Yes No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
El Yes No
❑ Yes � No
❑ Yes No
❑ Yes No
Coniirrreerl are hack

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLaioons,iloldine fonds. Flush Pits,etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Yes
XO
Structure 5 Structure 6
Identifier:
Freeboard(ft): ...........r..................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ANo
]I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes K{N0
Waste Application
14. Is there physical evidence of over application? ❑ Yes ANo
(If in excess of WMP, or runoff entering waters f the State, notify DWQ)
15. Crop type............. & .- .................................................
........................ .
16. Do the receiving crops differ with those desi nated in a Animal Waste Management Plan (AWN[P)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes XNo
18. Does the receiving crop need improvement? ❑ Yes PO
19. Is there a lack of available waste application equipment? ❑ Yes #1
0
20. Does facility require a follow-up visit by same agency? ❑ Yes PNo
21. Did Reviewerlinspector fail to discuss reviewlinspection with on -site representative? ❑ Yes �No
22_ Does record keeping need improvement? ❑ Yes ❑ No
For Ce,!jified OE Permitted Facilities OnIj
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
NoNiolationsor deficiencieswere notO-during this.visit.- You:will receive no ftirther
Ofr&pondeh6about this:visit:-: : .
��-
D�
ram
S WOYk11%-_j o-� I
7/25/97
Reviewerllns ector Name �« :•� � ••
Reviewer/inspector Signature: Date: AV 7

Facility Number: 2-
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: 1
Time: 12 . n o
General Information:
Farm Name: C SF r rr, s County: a.f
Owner Name: Sinnn,,A YVIc. C j �esn ; _ Phone No: g4I — ' B
On Site Representative: (� 1 P v„,� Integrator: 9t s
Mailing
Physical
Latitude: ! I Longitude: 1 I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow 0 Layer 0 Dairy
0 Nursery ❑ Non -Layer 0 Beef
Feeder )-`7 4 O
OtherType of Livestock- Number of Animals:
Number of Lagoons: f (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
0 Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvement)
Crop type: LG Aa_ _ Acreage -
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOY -- January 17,19%
Yes Q
No P
Yes ❑
No 0
Yes 0
No Jip
Yes ❑
No Q
Yes ❑
No
Yes ❑
No U
Yes 0
No E
Yes ❑
' ,No 53
Yes 0
No @
Yes 0
No Q

Maintenance
Does the facility maintenance need improvement? Yes C] No ip
Is there evidence of past discharge from any part of the operation? Yes C] No M
Does record keeping need improvement? Yes C3 No Hai
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes C3 No 14
Explain any Yes answers:
Signature
cc. Facility Assessment Unit
brawin smear Observations:
Date: / � � (4?
Use Attachments if Needed
- -
.. - -- - - �.r�r+rrr-.ar --...r c-r-.—___ 7nia�t•!s�4' ns,ts. .S.-�1s'�+'S!�e �..-. ;tir•_wkF t�_•' ._. - -
AOI -- January 17,1"6

Site Requires Immediate Attention:
Facility No.- ZZ
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 `" 4 � , 1995
Time:
Farm Name/Owner: G f J fW M -
Mailing Address: fi a C .�rvf�r+- N'6_ 2- 93 zS l4 ` Si Z 7S�f
County:—
Integrator:- 5►9�1�5y� - _ _ - - --
Integrator: C9 „t<.a4-S - r-st--N-- -Phone:
On Site Representative:_ . ro K=YS`_ _ _ Phone:
Physical dress//Location. ✓fo.c/ t- 701 �` `* Z `f ryes/"
�
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: :2 7 / C I= ny t'-,>k N
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:—'—'—"
Circle Yes or No
Does the Animal Waste Lagoon haXq _sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. a Inches
Was any seepage observed from the lagoon(s)? Yes or �o Was any erosion observed? Yes or f2l
Is adequate land available for spray? Yes or No Is the cover crap adequate? Ye- or No
Crop(s) being utilized: C-- r) /, �5 ['k/ P5 err 4 atdf- --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?, 6tes)or No
100 Feet from Wells? Cs or�Io
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or ND,
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ofNo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye-Oor No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Y7
WORTH CAROLIM DEPARTNMU OF ZW1R01QWqT, REALTE 3 NATURAL RZSOURM
Fayetteville Regional Office
Animal Operation Compliance Inspection Po'm
.S�+i:�Wi•�} �� r'v�.'��/_Y..A .y}:�.M<�� ♦�Ld.Ya pr%NR }
'✓�'>/y�'.M�"
/�:lyw�
'DATR
mmu
` 1c U M.� c
.
�w�a� /y■ �yy
f 1 Cbnbn Z632c5
N16) 5qD_ -2 6
44
All questions answered negatively will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
corrections:
SRG'TION I
Aniol oRgra t i on Type • h rlI S k
Horses, cattle, wine, poultry, or sheep
SEMON II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
system)) _
2. Does this facility meet criteria for
Animal Operation REGISTRATION'?
3. Are animals confined fed or maintained
in this facility for a 12-manth period? -
4. Does this facility have a CF.ftTTZIED ANIl�15L
RA$ TE AtWGEMENT PLW.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
b. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
ION
INN

8 OR III
II
kfeld sitil m�anaaemwt
1. to animal wa&Lw sLuckpilod or iagoon
construction within 100 ft. of a USCS
Map Blue Line Stream?
2_ Is animal waste land applied or spray
irrigataA Witt,in 25 ft. of a UCGO Map
33lue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the lard application -site have a
Cover crop in accordance with the
MTIFICATTQN
5_ Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Rest Management Practices
($NP) of the approved QgtT1nCAT1O1V7
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general Condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IV
Commer._ts

rL7G.2S'_"R.AT:0N = CRM FCR ANIMAL FE=07 CPER1.7k'"_CNS
Department of Environment, Healt.t and Natural Resources
Division of Environmental management
Water Quality Section
if the animal waste management system for
your feedlot operation
is
designed to serve more than or
equal to
100 head
of catt?e,
75
horses, 250 swine, 1,000 sheep, or 30,000
biz :s t .at
are served
by
a 1_cuid waste system, t en =his
fcrm ;gust
oe filled
out and mailed
by Oecemzer 31, =993 zursuan: _a
__A NCAC
2-.021? (c)
in ar er to
be
deemed permitted by OEM. Please
Print clearly.
Farm Name:
Mailing Address
C;.u.^.tv Y "dam Phone No� 7`7
Owner (s) Na ne : _ `�n�mE5
Manager (s) Name:
Lessee Name:
Farm Location (Be as saeci=_c as cossible: road names, direction,
niegosL, e_c�) �t.�L�,c]T�`J� cl! �,.I , ?NEisyt�LC
�1 0
Latitude/Longitude if known:
Desicr, capacity of animal waste management system (Number and type
cf confined animal (s)) f a40
Average animal population on the farm (Number and type of animal ($)
raised) �tc�t 1(J5 ASV
Year Production Began: �� ASCS Tract. No. o'
'hype of waste Management System Used:LA-!1221�
Acres Available for Land Application of Waste:
Owner (s) Signature (5) � DATE
DATB: