820487_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

l'ype of visit: U -Compliance Inspection U Operation Review U Structure <J'valuation U 'Technical Assistance
Reason for Visit: CJRoutine O Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j'l Arrival Time: Departure Time: County: �' fK1�5�►v Region: F/z.0
Farm Name: (� � C Ei &A rft r'1 F'av "''I Owner Email:
Owner Name: K��1�li."ilh L,_ -e Phone:
Mailing Address:
Physical Address:
Facility Contact: �µ,1 ��`5 t✓ tti3 tG� Title: Phone:
Onsite Representative: t Integrator: V G �� W �'^� ✓'` c
Certified Operator: 8�W, 'O6.
".t" kx
Back-up Operator: cla J t o
Location of Farm: Latitude:
Certification Number: Z-5 q 7Z•
Certification Number: 47b G %
yet v
Longitude:
w.
Destgn , Current
[rD %
Design
Eurreat
Design Current
Swine Capacity Pop.
Wet Pv.ult>y
Capacity
Pop.
104
Cattle Capacity Pop.
Wean to sh
Layer
❑ Yes
[:]No
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Des�gigtf
Current
Dry Cow
Farrow to Feeder
D P.oult ,
R
Ca aei
P,o ,
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Oche
TurkeyPoults
OthU,
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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? (1f 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
[rD %
[DNA
❑ NE
❑ Yes
Q No
Q A
0 NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ Yes �o
[] NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page 1 of 2/4/2015 Continued

Facih Number: Z - Date of Inspection: /414/e
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
dNo
❑ NA
❑ NE
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0-M
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑' +lA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
Spillway?:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ef No
❑ NA
Designed Freeboard (in):
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E!fNo
❑ NA
Observed Freeboard (in): Z S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ea -No
❑ NA
❑ NE
(i -e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
®'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C'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
[g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LE'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [" No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 9 'rrrVX tX-06k m lWe'If
13. Soil Type(s): Ca 1 O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!I'&o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [T 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?
Reauired Records & Documents
[—]Yes �o ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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
ff '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
Ef 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 2/4/2011 Continued

IFacifl Number: - Date of Inspection: (!
2�. 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
[DN'
❑ 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
ED No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
G-Vio
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2~Ilo-
❑ 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
CTITo
❑ NA ❑ NE
permit? (i.e., discharge. freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C]No
❑ NA ❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'-5-o
0 NA ❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
U -Na
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA ❑ NE
Comments{refer ta"rquestion ): Ezplaitt any YES answers rind/ , any aclditi"oi recoWin-eddations or any outer comments.
Use drawings oYLacility to better explain situations (use additional pages as necessary,).
°It 3o�-CSS(
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phoneli o- l.�3 3c3 7
--'r
Date:
214/2 I5

1Y1/1 S 11 ftPRIL 11 U_D
V D1Vi-sion of Water Resources - _ OF Number - q4,, if Division of Soil and Water Conservation
a0 Other Agee=cy
Type of Visit:Commpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
�
Reason for Visit: (� Routine 0 Complaint () Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I lr&je Arrival Time: Departure Time: County: 491— Region: {%
Farm Name: G ll kC,?
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �{ �& CAV­wt4 Title: Phone:
Onsite Representative: Al Integrator: _I WQ
Certified Operator: t. Certification Number: 116 qE(6
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
__
Design
Current
s--_= Design Current
Swine rapacity Pop.
Wet i'oultr}
Capacih'
, _Pnp.
CattleCapaeity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
UNon-La er
'"
Dai Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
D . Po.ultr
La ers
Non -Layers
Pullets
Design
Ca aeit
Current
Po
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cot
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Turke s
Other
Turkey Poults-
101 10ther
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ol
0 No ❑ NA ❑ N E
a. Was the conveyance man-made? ❑ Yes [7—No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes Ej_No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes fNo ❑ 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 2/412015 Continued

Faciliq Number:Date of Inspection: A.
�—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZS
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
�o- 0 N ❑NE
❑ No 2-1q_A ❑ NE
Structure 6
❑ Yes 52-M
❑ Yes t o
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Ef5o [DNA ❑ NE
& Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q'N—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 G21No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Vo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes ao ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2:n, 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): 1"l�+U if �-r/ i V eci �K• �[�
R" r
13. Type(s): I
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
Soil
❑ NA
❑ NE
the appropriate box.
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
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�No
❑ NA
❑ NE
acres determination?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes[ o
L
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
❑ Yes 6"N.
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes 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[ o
L
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - XM7 jDate of Inspection:
r
[i <
❑ NA ❑ NE
24' Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[-leo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[;Jo<o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes
eNo
❑ Non-compliant sludge levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3 N
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
O'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�fNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[i <
❑ 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
2<o
❑ NA ❑ NE
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
eNo
❑ 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
[3 N
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E!rNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ jNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3No
❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or any additional recon iinendetinas or. any at1ier co&en"`
Use drawings of facility to better explain situations (use additional pages as necessary).:"
�3 -��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone�raW33 3,73__
Date: &J
21412015

131
Tulvf�--- R _ .T)b
Type of Visit: Q<Rmpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:-+ County:/•l Region:
Farm Name: rte / Owner Email:
Owner Name: f<4feA,L Phone:
Mailing Address:
Physical Address:
Facility Contact:
�40-44 Title:
Onsite Representative: i t
Certified Operator: Le'(-, "
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
146-s
Certification Number:
Certification Number:
Longitude:
Design Current
❑ NE
Design
Current
Design Cnrrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
_
Design
current
Cow
Farrow to Feeder
D . Pqul
Ca aci m„
Fo
Non-Daity
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [! "WA ❑ NE
❑ Yes ❑ No [3'9A ❑ NE
❑ Yes ❑ No
❑ Yes [�J'Ro
❑ Yes [l No
[:�1GA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Fpcili Number: - Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural fireeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?.-
Designed
pillway?:
Designed Freeboard (in): n
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
[5No ❑ NA ❑ NE
❑ No [�r<A ❑ NE
Structure 6
❑ Yes [JINo ❑ NA D NE
❑ Yes []No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes []0No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [5No ❑ 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 EjNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!j'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 p Heavy Metals (Cu, Zn, etc.)
[] PAN O PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5 (, D
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CjeNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
S. Is there a lack of properly operating waste application equipment?
❑ Yes
Lino
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the 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
[Zio
❑ NA
❑ NE
the appropriate box.
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E#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 [] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes E; No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Fskility Number: - Date of Inspection:
❑ Yes
[] No
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MRONo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ffrNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List stnto ure(s) and date of first survey indicating non-compliance:
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
[n No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
MNo
❑ 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
[!fNo
❑ 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
ey'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eNo
0 NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[+ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
['No
❑ NA
❑ NE
Mt:V Ie W Cr1111bPV.1'LVr INdrue:
Reviewer/Inspector Signature:
Page 3 of 3
rnone: %�+v
Date: # '-L' li
1/4/2011

tm s r
Type of Visit: WCotn�llance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: S y
Farm Name: (f (`1'4'jnn 994, Owner Email:
Owner Name: e Vc % WV Phone:
Mailing Address:
Physical Address:
Facility Contact:
Ccct � [,�tl�t9 CA Title:
Onsite Representative: 1�
Certified Operator: {� 4G/Irt— CII'yE oy
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: C. tlo►� `C ff"
Certification Number: 7 4?4 q Y_G
Certification Number:
Longitude:
_ Design CurrentDestgnCorrent
Me
❑ No
CD KA
Design Current
Capacity Pop.
VI!et POultry
Capacity Pop.
Cattle Capacity Pop.
Finish
La er
❑ NA
Da Cow
Feeder
-Layer
Da Calf
o Finish
Dai Heifer
o Wean
' ~
,II'oult .
.:.
Design�Cnrreat
Caaci �P:o
Cow
Non -Dairy
o FeederDi
V
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
o 4 -, _
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes NA ❑ NE
[]Yes
❑ No
CD KA
0 NE
[:]Yes
O No
3'<'A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes
❑ No
[3""NA
❑ NE
2. Is there evidence of past discharge from any part of the operation? ❑•Yes
[]1No
❑ 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 I of 3 2/4/2011 Continued

Facil' Number. -ZF Date of Inspection: '
,. Waste Collection & Treatment
❑ Yes
�<o
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q,<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
lT o'o
[] NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'1\io
❑ NA
Spillway?:
18. is there a lack ofproperly operating waste application equipment?
❑ Yes
[?/No
❑ NA
Designed Freeboard (in):
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Nb
❑ 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
!o
❑ NA
[D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F]Xo
❑ 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
[;Yf4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence//of Wind Drift ``❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):--
14. Do the receiving crops differ from those d ignated in the CAWMP?
❑ Yes
U 1- o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q,<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
r3,1�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'1\io
❑ NA
❑ NE
18. is there a lack ofproperly operating waste application equipment?
❑ Yes
[?/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[R<
❑ 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 D4o ❑ 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 [�lo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [4o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

.- 4
FacUity dumber: - Date of Inspection: p—
f5
J 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej< ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3 -Ko' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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
EjlNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P ' V ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
IJr o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[TNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[E] No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[c]'&o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
2N ❑ NA E] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FN❑ NA ❑ NE
Comments (refer to question;#) Explain any YES answers and/or any additional recommendationsto5a4yother comments.
Use drawings of facility to better ezplain situations (Use additional pages as necessary}:`
` 41o-,1---
Reviewer/Inspector Name:
t
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q33 -3,93A ,� � 3_ 3
Date: ��} F'`6
Gv4s
114/1014

9
D
Type of Visit: QrCv fiance inspection U Operation Review U Structure Evaluation U Tecbnical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: rrival Time: Departure Time: County:R on
?n
Farm Name: f"cG`.kLIOL Owner Email:
Owner Name: V V �f(/t L r �[f �-fl �� wt Phone:
Mailing Address:
Physical Address:
Facility Contact: &I
Phone:
Onsite Representative: Integrator:
Certified Operator: k>!H�t Y"� Certification Number:?rn`
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Diseharees 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 span -made?
❑ Yes []IW [DNA ❑ NE
❑ Yes ❑ No`nlA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 0 No [Z NA ❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [VIVA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes C7,Noo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E , o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
S wine
DestgnCurrent
'4JPMa s�� 5��}'..'If"5Mjl
Ca aer 1io
_p ty p.
p,
Wet P,au�ltrvju
Des n °Cu rent
p ,ty Pap
' Ca a
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish- -
Farrow to Wean - Design. " Ci ent;
Da'y Heifer
D Cow
Farrow to Feeder
Dr. 1!oult .
Ca act �Po �A
Nan -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Diseharees 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 span -made?
❑ Yes []IW [DNA ❑ NE
❑ Yes ❑ No`nlA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 0 No [Z NA ❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [VIVA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes C7,Noo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E , o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

jFac!P1j Number: jDate of Ins ection:In
Waste Collection & Treatment
14. Do the receiving crops differ from tbost designated in the CAWMP?
❑ Yes
[ZJ X -o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E - o ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
❑No EDN�❑
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
Spillway?:
17. Docs the facility lack adequate acreage for land application?
❑ Yes
Cj'N,
Designed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in): d� )
❑ NA
❑ NE
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[0,Ne--F] NA
❑ NE
waste management or closure plan?
❑ NE
the appropriate box.
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?
❑ Yeses
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[144D�[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ep<d E] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes «lQ'"" ❑ 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
�r, ❑j Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): �" ' `-'l J 6z) A't7_-4j1_
� d-
13. Soil Type(s): `
14. Do the receiving crops differ from tbost designated in the CAWMP?
❑ Yes
[ZJ X -o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ loo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[B.4o'
❑ NA
❑ NE
acres determination?
17. Docs the facility lack adequate acreage for land application?
❑ Yes
Cj'N,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ 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
El<o
❑ 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 ETNo ❑ 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? [3 Yes ❑ NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? F] Yes �Zo ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Faci r Number: - Date of Inspection: /
211. Did the facility fail to calibrate waste application equipment a5 required by the permit. E] Yes OD -Ko❑ NA [:] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg,? o [:INA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? El Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E -]IVO_ Yes ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑,Ko ❑ 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 E No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
R-1-1qo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0No
❑ NA
❑ NF
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

Type of Visit: 0,6ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: G4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:}/
Farm Name: R Owner Email:
Owner Name: ,4 Q Dnp C ARRr, t, Phone:
Mailing Address:
Physical Address
Region: FRO
Facility Contact: C Title: r.,n;eg � �)ciA1�TPhone:
Onsite Representative: 02 a in q- Integrator: 4.C,' 6'.9,0 1F0izr\S
Certified Operator: E�r���li (�a{ZRo l 1 Certification Number: q1$ /,A y!a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischart!es and Stream Impacts
I . Is any discharge observed from any part of the operation? 0 Yes ►/O No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? 0 Yes [:]No [35NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No aNA ❑ 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)
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 ❑ No
❑ Yes allo
❑ Yes [ErNo
[g'NA ❑ NE
C] NA [j NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current
.
Design
Current.
Design Current
Swine
Capacity Pop.
Wet Poultry
CapacityPop.
Cattle Capacity P.
Wean to I~inis.. ,
„ h
Layer
Dairy Cow
Wean to Feeder
Non La er
I
Dairy Calf
Feeder to Finish
' y 3u
N
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P�oultr., ..
Ca acity
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
_
Pullets
Beef Brood Cow
- =
Turkeys
Other
Turkey Poults
Other
Other
Dischart!es and Stream Impacts
I . Is any discharge observed from any part of the operation? 0 Yes ►/O No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? 0 Yes [:]No [35NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No aNA ❑ 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)
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 ❑ No
❑ Yes allo
❑ Yes [ErNo
[g'NA ❑ NE
C] NA [j NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - q 8=7 jDate of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No [ A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: x'
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): O91.0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ef 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 [TNo [] 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 [VrNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [jYes G3"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 [2'*&o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [;j'No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3"No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area�
12. Crop Type(s): trl2f�t^Et�� c3 [ C f�n2�� / 2 --Cy_ a
13. Soil Type(s): CAxrj_ %g_q j GO\jc'. o G a
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 [v]"No ❑ NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [1"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 [ rNo ❑ NA (] NE
[:]Yes CTNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? E] Yes (No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes Q'No ❑ NA ❑ NE
the appropriate box.
[]WUP ❑Checklists E] Design [:]Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [SKNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [�'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

[FacWty Number: a - (487 Date of ins tion: 4tja�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [fNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo
the appropriate box(es) below.
M Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes &�No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2No
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
(2/No
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
[3/No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C�No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN 0
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Q/No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[D/No
❑ NA ❑ NE
0 N ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE,
❑NA ❑NE
❑ NA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Q � ,g , Date: z L-
Page 3 of 3 21417011

Type of Visit: (D'Corrtpliance Inspection U Operation Review t� Structure Evaluation t) Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: _«�]
+
Farm Name: Owner Email:
Owner Name: ,��+il'e_!� t �7'"G` Phone:
Mailing Address:
Physical Address:
Region: T
Facility Contact: e 'itle: Phone:
Onsite Representative: Integrator: —74z!, 1.&�p^�j
Certified Operator: > krrb Certification Number:`` 6 a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes fo [] NA ❑ NE
❑ Yes
❑ No
20<A
[] NE
[—]Yes
❑No
Design Current,
Design
Current ..
- Dr
esign Cujt
Swine
Capacity Pap. x'. Wet Poultry
Capaeity
Pop.
Cattle Capacity
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
.- s
-
Dai Heifer
Farrow to Wean
Desigi►
Currentf�
Q Cow
Farrow to Feeder
1 D . I'oult , _
-a aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes fo [] NA ❑ NE
❑ Yes
❑ No
20<A
[] NE
[—]Yes
❑No
v 'TA
❑ NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes [:]No F[� ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [::]Yes fo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [01qo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Dateof ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C <o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No U;I-A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
[::]Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
2<o
❑ NA ❑ NE
the appropriate box.
Designed Freeboard (in):T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ Weather Code
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
[ o
❑ NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E j o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
to
❑ NA
❑ NE
$_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2-<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
H<O
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
/�
E" 1"u
❑ NA
❑ NF.
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑//Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): (9 ir»
L6 &a
U '
13. Soil Type(s). t II JV\
14. Do the receiving; crops differ from Ase designated in the CAWMP?
❑ Yes
I ?,<
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
El Yes
'�
2<o
❑ NA
❑ NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes
Q -Ko
❑ 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
2<o
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ o
❑ NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:]No
[D-1 ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -AIxrl Date of inspection: 61IL1111
14. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and dale 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes &]-Ko'
❑ Yes [] No
[3 NA E] NE
U -K' ❑ NE
[:]Yes
2 o
❑ NA
❑ NE
❑ Yes
10
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes ['110 E]NA E]NE
[:]Yes No ❑ NA ❑ NE
[—]Yes ��o ❑ NA ❑ NE
y - � u
Comments (refer to question xp ain any .Answers and/or any additional recommendations or an o o er cpmmen
Use drawings of facility to better explain situations (use additional pages as necessary).
0'4tj'�' U -7e4 aqzL�ei ��..�
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date:
2/ !1011

,B -r 2-0# -ZO/O
Type of Visit Q'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrivtl Time: G1.��0 Departure Time: 9•�3Sg.r County: �A"P�N Region:
h'', '•Y
Farm Name: C gij yca rj.' Owner Email:
owner Name! 4,9:�CAWe_ 1. n K.0ll Phone -
Mailing Address:
Physical Address: I
Facility Contact: �at-vs sarw�'c k_ Title: �� G Phone No:
Onsite Representative: Integrator: (f© 1441 V_; C_ �It4S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
WE
Location of Farm: Latitude: =0 =6 =61 Longitude: =11=1 = "
w
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes +P No ❑ NA ❑ NE
❑ Yes
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry C*apacity Population
Cattle Capacity Populafion
❑ Wean to Finish
110
Laver
I
❑ Dairy Cow
❑ Wean to Feeder
I
I[] Non -Layer I
❑ NA
❑ Dairy Calf
❑ Feeder to Finish
01
❑ NA
❑ Dairy Heifer
Farrow to Wean
Gita 1 36-7
©� Pouf
❑ Dry Cow
❑ Farrow to Feeder
r�s-4Pkv 1914
❑ Non -Dairy
❑ Farrow to Finish
Pr u,.
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeX Poults
10 Other
Number of Structures:
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes +P No ❑ NA ❑ NE
❑ Yes
❑ No
N
❑ NE
❑ Yes
❑ No
,E SA
L7 �[A
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
M<o
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128/04 Continued

Facility Number: 8Z- Ljig%
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-7
5. Are there any immediate threats to the integn ity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes CTNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,_,,�
9. Does any part of the waste management system other than the waste structures require ❑ Yes L`TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement? _,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ L1Yes < ❑ NA EINE
❑ 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. Croptype(s) 13GYh44d", C6,a e-7 e 1pr�.`.✓ rD.S.
13. Soil type(s) Cq i rJ A04 G o /ds ha vo
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre dctennination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo ❑ NA ❑ NE
CT'N' ❑ NA ❑ NE
UT'No ❑ NA ❑ NE
No ❑ NA ❑ NE
UJINo ❑ NA ❑ NE
Comme4ts (refer to question #) ExPlatn any: YES answers and/or any recommendations or any other comments ,
Use dra .
Rwmgs of facility to better explain situations. (use additional pages as necessary)';"
�.�
Reviewertinspector Name F—R,2 �e✓e.%.s Phone: 9/0.-3-��3-360
Reviewertinspector Signature: R Date: 2 - Z- Z0/0
12/28/04 Continued

Facility Number: f32— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ ❑ ❑ ❑ ❑
❑ Yes LTJ No ❑ NA ❑ NE
❑ Yes 03 No ❑ NA ❑ NE
WUP Checklists Design Maps Other
AL
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
G<
❑ NA
❑ NF
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNoo
❑ NA
[3 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E,,
Lf No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[" No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eN o
❑ NA
❑ NE
Other Issues
AL
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E 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
BN
❑ 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
CJINo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?❑
Yes
EfNo
[INA
[:1NE
AdditxnuairComments�aetd/oF DE angst "��. ��.-.,� � �
AL
bd
12128/04

"ETK!S io -os- 2490 9
Type of Visit ®'Compliance Inspection O Operation Review O Structure Evaluation: Q Technical Assistance
Reason for Visit L7 routine Q Complaint Q Follow up Q Referral d Emergency Q Other ❑ Denied Access
Date of Visit: -2/ -Q / �Arrival Time: Departure Time: /.' County: s Region: ICRO
Farm Name: v `""~ Owner Email:
Owner Name: /��✓NL�hl'►��� Phone:
Mailing Address:
Physical Address:
Facility Contact: r3 ��''^f rZ� _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: n �-
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e =I 0 " Longitude: 0 ° =I = u
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design C*u%ent
Cattle Capacity Population
❑ Wcan to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑ Dairy Calf
❑ I~ der to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Heifer
arrow to Wean Z
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
❑ Non-DAiry
❑ Farrow to Finish
❑ La er5
❑ BeefStocker
❑ Gilts
❑Non -La ers
❑ Beef feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Turke s
Other
❑ Other
❑ TurkPoults
❑ Other
Number of Strvetures:
,—,
ISA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Discharlies & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
MIN.
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No�
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
No
[:13
3,9A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[� Yes
Ngo
,—,
ISA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[I Yes
,,❑
E_,No'❑
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
L`I o ❑ NA
❑ NE
other than from a discharge?
11118104
Continued

11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L'fl ❑ 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) cry �— C �r t_J ��� �rr: r.. �0. S • /��/tviG� !^i�%.Ijv
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E Nva ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? [I Yes B'Co ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes R— o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes EMo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes EM—o ❑ NA ❑ NE
.. - 4kk
C©rinments (refer to question #): Ezplain'any YE5,'answers and/or any, , ommendanoosior7any'otherjcotnment ~
�,-
Use drawings of facility to better explain situations.4use additional pages as necgssar3};
T
Reviewer/lnspectar Name .. r`C:�. i Phone:
Reviewertinspector Signature: Date:
12/28/04 Continued
Facility Number: 82 —8 7 Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
L'1"No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B'<o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
�,/
LTNo ❑ NA
❑ NE
through a waste management or closure plan?
Hany 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
L`Tlo ❑ NA
LINE
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
<0 ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�
,__�No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L'fl ❑ 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) cry �— C �r t_J ��� �rr: r.. �0. S • /��/tviG� !^i�%.Ijv
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E Nva ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? [I Yes B'Co ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes R— o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes EMo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes EM—o ❑ NA ❑ NE
.. - 4kk
C©rinments (refer to question #): Ezplain'any YE5,'answers and/or any, , ommendanoosior7any'otherjcotnment ~
�,-
Use drawings of facility to better explain situations.4use additional pages as necgssar3};
T
Reviewer/lnspectar Name .. r`C:�. i Phone:
Reviewertinspector Signature: Date:
12/28/04 Continued

Facility Number: 5 —518 Date of Inspection -Z/~
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes deNo ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
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 E] Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
ElYes
EK
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,E
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,ET<oo
ENo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yesl<a
General Permit? (ie/ discharge, freeboard problems, over application)
[:1 NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:1 Yes
B o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3No
❑ 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
�,
Lilo
❑ 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
NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Adda4anal Co tmen&' '0lo Drawings
12!18/04
12!18/04

91 i1 S 9-05-00 I?-e—
!~i laivision of Water Anality
Faclility Number Sz$ 7 Q Division of Soil and Water Conservation
--- --� ---� — d Other Agency
Type of Visile
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: IS Z0--00 1 A��rriival Time: /�'�OA— Departure Time: /O.'3Yq,., County: �i r�N Region: r�0
Farm Name: KO -JAI errt t CaYY'a ! I ��` `'""` rC r"�J Owner Email:
Owner Name: I e lore_ M CA "-b // Phone:
Mailing Address:
Physical Address:
Facility Contact: - CCA&41 � �Ce Vs,/IG I� Title:�1 SQA- / /Phone No:
Onsite Representative: t .0 4 S 8a a'w c k _ Integrator: Lolea+ t �a1-ha S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ i ="
Longitude: =0=6
a=6 ❑ µ
Swtn-
Design Curren#
Wet Poultry
Design Curren# �B-Curren�, _ Design t
Q
Capacity Poptilation
Gap$city Population..[tle�� Capacity Popula#ion
a. Was the conveyance man-made?
❑ Yes
❑ Wean to Finish
10
Layer
❑ Dairy Cow
❑ Wean to Feeder
10
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish,
❑ Dairy Heifer
® Farrow to Wean
�f4©aDr
It
Dry Poury.
„ ❑ © Caw
❑ Farrow to Feeder
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
° ❑ Non -Dai
ElFarrow to Finish
❑ NA
❑ Layers
ElBeef Stocker
❑ Gilts
is No
❑ Non -Layers
❑ Beef Feeder
❑ Boars
E0:1Pullets
❑Beef Brood Cow
`sEl
Other❑Turkey
Page 1 of 3
Turkeys-
Points
Continued
❑ Other
1
10 Other
" . Number,of btructur+?s:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
AA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�E
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
B<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ yes
Bl�o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
is No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: 82-18'7
Date of Inspection -2Ct-o
Waste Collection & Treatment
Soil type(s) GoA Coa i Ao!,
,�/1'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
L7o
[INA
❑ NE
a. If yes, is waste level into the structural freeboard?
ElYes
EJ<o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
L--:r'*N"o
❑ NA
❑ NE
17.
Spillway?:
❑ Yes
E3 No
❑ NA
❑ NE
Designed Freeboard (in):
Is there a lack of properly operating waste application equipment?
❑ Yes
B<o
❑ NA
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L7 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
EJ 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 DT'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q'1 o' ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any par[ of the waste management system other than the waste structures require ❑ Yes 0<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes No ❑ NA ❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B7 qo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l d 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) �c�:9;,.d (.o.,v
4N.vr,A/
13.
Soil type(s) GoA Coa i Ao!,
Reviewer/InspectorName Phone: 1/40, V33,3330
14.
1.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N/o
❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
LI No
Er
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[:] Yes
L--:r'*N"o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E3 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
B<o
❑ NA
❑ NE
C� (refergetestiopi;#)Ezplatn anyYSansvi+ers andlofanyF�r�ecommndations or an other comments.
�Use;,,sirawtngs o[tfacility;,to iaetter explatntsttnattons�(use addtttotial�pages astnecessary): �.
Reviewer/InspectorName Phone: 1/40, V33,3330
Reviewer/Inspector Signature: Date: S-2 D - 2-D0t3
Page 2 of 3 12/2$/04 Continued

r 1
Facility Number: $Z —.9$ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo [INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. ElL7 Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q 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
Doo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[__1 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[__1 Yes
,_�o
C-1NAE]NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,L,.S,�Nro
I�o
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t� Pro
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2<
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[❑ Yes
9'go
❑ 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
ENo
❑ 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
E3<o
[) NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[j•1Cio ❑ NA
❑ NE
Additional-Cornhients-:and/or Dirawiin
Page 3 of 3 12/28/04

46
0 Division of Water Quality
Facility NumberSZ
Z11 0 Division of Soiland Water Conservation
0 Other Agency r
Type of Visit @PCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1A0 -6v/-0 7 1 Arrival Time: 19WAAA Departure Time: County: -� "�Oso.� Region: 11C'0
Farm Name: ke/VNGA� C4EVbIl �/✓1 Owner Email:
Owner Name: N&1e4 ezwkz�fl p , Phone:
Mailing Address: 4Zd1 /. /Z
Physical Address:
Facility Contact:�aKL S_&Lk2y _;'t KL Title: _ �� ��i Phone No:
C -CI
Onsite Representatives +,T/ 3; Integrator: ��QV_/ —
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=d
❑is Longitude: = 0 ❑ I ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I10 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ 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 f
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
7.
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?
i
=1
❑ Yes Q'No ❑ NA ❑ NF
❑ Yes
[ 7No
❑ NA
❑ NE
❑ Yes
[;VNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
Cl Yes
[P No
❑ NA
❑ NE
❑ Yes
�X No
❑ NA
❑ NE
12/28/04 Continued

. 4:
Facility Number: 9*2— '}$71 Date of ]Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[X No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes[
No
❑ NA
[:1NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
VNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [;9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONO ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes[ No ❑ NA ElNE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [$No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ FAN > 10% or l0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
r�.,Outside,of,Area
12. Croptype(s) L�ev►t
SA
13. Soil type(s) r3pA CAiri&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes -[,V- No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CyNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [ff No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes M No ❑ NA ❑ NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes ;M No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or: any other comments `z
'Use drawings of facility to better explain situations. (use additional pages as necessary):
Re'viewer/Inspector Name
Reviewer/inspector Signature:
Page 2 of 3
#LN1 e.l 5
Phone: 910• x,33.3300
Date: JO—O' Zc) Q 7
12/28/04 Continued

Facility Number: Date of Inspection -Ofd -07
R_emuired Records & Documents
19. Did the facility fail to have 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 [21 No ❑ NA ❑ NE
the appropirate box.
❑ WLTP ❑ Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [EINo ❑ 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 ❑NTE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ER No ❑ NA 0 -?iE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
()3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(,� No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[,� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[a No
❑ NA
❑ NE
General Permit? (ie/ discharge, freehoard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
EINE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S~OZ -a" 1 Arrival Time: Departure Time: County: Sam Sa.✓ Region:
Farm Name: L C SD tJ i -a, v.•. Owner Email:
Owner Name: e-Ji'JC_ L
�.av-vi: I4 Phone:
Mailing Address:
Phvsical Address: f l
Facility Contact: g� 'V J c0_6"of 1r
—Title:
Onsite Representative: CLAY ---;S S O atm Q i C K
Certified Operator: K c../rJ zAL L. C C 4 r L I
Back-up Operator:
Location of Farm:
Phone No:
Integrator CID 11%.& .1-4 t___
Operator Certification Number:
Back-up Certification Number:
Latitude: =11 =1
="
Longitude: 1:10=1 ="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder i 10 Non -La ei
❑ Feeder to Finish
Farrow to Wean D SD
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other A _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure C] Application Field ❑ Other
a. Was the conveyance man-made?
Design Current :-
Cattle Capacity Populatloli�'-'.­l
:
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: R-11
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
(9 No
❑ NA
❑ NE
❑ Yes
(K No
❑ NA
❑ NE .
❑ NA
❑ NE
❑ Yes
IN No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12/28104 Continued

t V.
Facility Number:
Date of Inspection "02-o1u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes. is waste level into the structural freeboard?
Structure I I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?.
Designed Freeboard (in): 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑Yes1 No
Structure S
❑NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes R1 No ❑ NA ❑ NE
❑ Yes P9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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 [9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gj No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes :3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crops 3 im S ,4mAjti,
type() �c:Y'iM��� �ra �L��i' Grw�n) � � w•.�.w+W
13. Soil type(s) `.oki .t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (d No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes (A No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes X, No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes W No 0 -NA ❑ NE
Reviewer/Inspector Name Phone-, (%o
Reviewer/Inspector Signature: Date: QZ — ZOO (v
12/28/04 Condnued

L
Facility Number: Date of Inspection S-az-O(o
Reauired_ 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 ❑ Desi xrt
}, ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Cl Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
50 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D9 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
C9 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
9 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
12/28!04

t
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: -5ck San+ Region: -/e
Farm Name: C So..� Fa { ..-- Owner Email:
Owner Name: e -IL-4 C. a ryo J/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: C'L.r-' ; s at-mr LaI -'- k
Certified Operator:.,_,. X c NN G _A�,e is& r¢ It
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: ev /i k J,; `-
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=6
Longitude: =0=1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 1. IEJ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder. 7 9 O o
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other R
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
y
Design 'Current',
Cattle Capacity Populatio-fi,ji
❑ Dairy Cow r`
❑ 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 ves'. 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?
❑ Yes [V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
EM No
❑ NA
❑ NE
12/28/04 Continued

r
Facility Number: S2 — g Date of Inspectiun 3 !a at
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
13. Soil type(s) C. C a iA
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
Designed Freeboard (in): S/ `
© No
❑ NA
❑ NE
Observed Freeboard (in):
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
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_)
❑ Yes
®No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes [0 No
❑ NA
❑ NE
through a waste management or closure plan?
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
® Yes ❑ No
❑ NA
❑ NE
8_ Do any of the stuctures 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 E] Yes EO No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) �e rrrz uva q,-,* z c �_ 3 rr► c l �Q i r. , �/-� Yom'. i c 1~
13. Soil type(s) C. C a iA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
t.qpaw . t � s+'�c +c s, �a��, c_-4
Reviewer/Inspector Name iL err a": % Phone: 710 P4
Reviewer/Inspector Signature: Date: 3 f /e j 6.5-
17 Continued

4 -
Facility Number: Date of Inspection 3 !°
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 El 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 El 120 Minute Inspections N Monthly and I" Rain Inspections © Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes iM 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
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
C, StKw C1 V -" 6t. e -O" tOIe.kC'k
t
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
© No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
m 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
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Aiiditioosl �Comme66;andlor 1.rawieigs + �
n +-�
4-O �-{ ct tv`e-k w.� c.�.dC i - 0%.a �G`-►1a�^
GUn� `"►of1S �a'.k� fVr_4..yoia-s�.��Or1�
l
Cf
C, StKw C1 V -" 6t. e -O" tOIe.kC'k
t
0 C 4- . D o l.
61
12128/04

IF -05.
&6^4
Type of Visit (EP"Complianee inspection O Operation Review O Lagoon Evaluation
Reasbn for Visit Gw6ubne O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilirc- lumber
Date of N"isit: 0�— 11iimc:
.�
Nat O erational 0 Below Threshold
ermitted ertified E3 Condifionalh' Certified © Registered
Farm Name: C_ Joy,. Fares►
Owner Name: 46AAe
_
lailing Address:
faD Yc. A;11
�•
A, .
Facility Contact-. 4h, Title:
Onsite Representative: Wic K
Certified Operator: &3 A "11
Location of Farm:
Date Last Operated or Above T reshold:
County: �4 " mm \
Phone No: �i7' S�� % 19,94e)
Phone No: 560)- 7
Integrator: "V 5t.- 5t.-5
Operator Certification Number: da"?
ET -5 -wine ❑ Poultry ❑ Cattle ❑ Horse Y-atitude Longitude �' �•
Design Current Design Current Design Current
Swine capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Laver I I I JE1 Da
❑ Feeder to Finish 10 Non -Laver I I Non -Dain
❑ F ow tc Wean
arrow- to Feeder V 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present ❑ La oon Area ❑ S ray Field Area
Holding Ponds I Solid Traps IDNo Liquid Waste Management System
Discharges & Stream Impacts
I - Is any discharse observed from any part of the operation?
Discharge originated at: ❑ Lawon ❑ Spray Field ❑ Other
a. If discnar_e is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notif}- DWQ)
c. If discharse is observed, what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
?. Is there evidence of past discharge from any part of the operation?
❑Yes ❑ O
❑ Yes ❑ No
❑ Yes El No
❑ Yes ❑ No
❑ Yes Ga' Yo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ff)iQo
Waste Collection & Treatment �
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes B o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05/03/01 Continued

Facility Number:?; — q 91
Date of Inspection E3 V94
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 pian?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8_ Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? -
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ( orx510 [ . l`o.rtf I',rnP ( rwC 1
❑ Yes [9-1q0-_
❑ Yes Q-1Vo
❑ Yes [t]-Nxr
Cl Yes O -,o
❑ Yes �o—
❑ Yes [ oo
❑ Yes
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14.
a) Docs the facility lack adequate acreage for land application?
❑ Yes
B -N -i
Y"q #I
b) Does the facility need a wettable acre determination?
❑ Yes
O'Ne
gAdrr59J,..
A, e4,,al+s 4r.;rf tr
c) This facility is pended for a wettable acre determination?
❑ Yes
[moo Y
15.
Does the receiving crop need improvement?
[-go
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O'Ido"
Renuired Records & Documents
Reviewer/Inspector Signature:
Date: Oa tea`
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
��
E3'l o
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
R434v-
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
03 -No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[J-9-0
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[3-1�0
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�o
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
C9' o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Eg-<o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P'N-o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
urany other c mA ° Q70t1
Us o pgs of facto better eapflaiit situatsons. (nse addthonal pages
toMr.
Pry j ls r� SrewrJ ya be ;tet y
r.�^ 1y ��v, ` h f �(t'.., r
Y"q #I
A'e (f. -4, Al (. N44*r &er
„04 AS air?k �x. it�'14r5 [ ., Lr
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A, e4,,al+s 4r.;rf tr
(-SE
ice ClAtre. It 9+ttd ►' wws Io -45
f �yy�si j d+c •v ry,���
, ll
n
�f,ji �waCr erd rr'F �n ,t5 `F -r U, t-
(�
4i. ;j r.,r,-tp,� 44,t4`7. Wr��.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: Oa tea`
05/03/01 a Continued

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �-� YU �� , 1995
Time: 143 0
Farm NamelOwner:
Mailing Address: C" K) L ' 314
County: 'S �\ G O
Integrator: L, �,�- FA+ _ Phone: to Sto SZ
On Site Representative: A+v" Phone:
Physical Address/Location:e �'iiu{c n Q I --a :ra-L UA +�'N
csu�k� z f%A"rc.s �n U\. v
Type of Operation: Swine Poultry Cattle '
Design Capacity: _12D SI'-- Number of Animals on Site: S 0— -- -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No A teal Freeboard: -' Ft. -(p Inches.
Was any seepage observed from the la oon(s)? Yes oras any erosion o ed? Yes or&)
Is adequate land available or spray? es No Is the cover crop adequate? Yes r No
Crop(s) being utilized: �t 'A C RQ_s
Does the facility meet SCS m nimum setback criteria. 200 feet from Dwelli � es r No
100 Feet from Wells? Ye or
Is the anima] waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water ostate by man-made ditch, flushing system, or other
similar man-made devices? Yes or jo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage withcover crop)? Yes oKN t
Additional Comments:_-�e �& KL 0w' eti �+.� �0 lLus f4c" b.�, A -
1
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.