820439_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

v 1 k'
Type of Visit: Compliance Inspection V Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: eFRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [� Arrival Time: O Departure Time: ,`3a County: Region: ;Pr__li
Farm Mame:' 2 Un! ire F--Olm C}Fta;12't—,owner Email:
Owner Name: 2&222 =5 egrp Phone:
Mailing Address:
Physical Address:
Facility Contact: ov--In Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p Application Field ❑ Other:
a. Was the conveyance pian -made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [r N ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes [:]No
❑ Yes [] No
❑ Yes �o
❑ Yes io
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
0 N ONE
E] NA ❑NE
Page t of 3 21412015 Continued
-W-l"Swine
Capacity Pop.
t
Wet Poultry
Capacity
Pop.
Cattie Capaci op.
Wean to Finish
Laver
Da Cow
EWean to Feeder
Non -La er
Da Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Poul
Ca aci
P.o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
PuIIets
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 p Application Field ❑ Other:
a. Was the conveyance pian -made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [r N ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes [:]No
❑ Yes [] No
❑ Yes �o
❑ Yes io
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
0 N ONE
E] NA ❑NE
Page t of 3 21412015 Continued

1
Facili Number: 15ate of Inspection: --1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [D -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 7-
f
Observed Freeboard (in): 3 ;�;' �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3<o [DNA ❑ 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 �lo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E]<o ❑ NA ❑ NE
S. 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 ❑'bio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E Io ❑ NA ❑ NE
maintenance or improvement?
I I . 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): C _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3—<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E j o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
1$_ Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [allo ❑ NA ❑ NE
[:]Yes [3'I4o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E jlVo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 -Wo
❑ 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.
0 Yes
Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall p Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Eaeo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E!f/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�r o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3/No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EYN'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
31 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
[ErNo
0 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-o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
D -15-O
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]�X6
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional Dazes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: —
Date:�O
21412015

r?
Type of Visit: QMomnce Inspection U Operation Review O Q Structure Evaluation Technical Assistance
A I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D D Departure Time: '12 V County:, Az__59 � Region: '% kJ
Farts Name: ct/ tO�wil:
�tne Ema�
Owner Name: ��m �S frwr// Phone:
Mailing Address:
Physical Address:
Facility Contact: r raa h //z_- & Title: Phone:
Onsite Representative:; �'�.,e� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Discharecs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2kNo ❑ NA ❑ NL
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [ & No
[:]Yes (El No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued
Desiayc"
urrent
wine11,11 Capaop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
I? I;oult ,
Ca aci
P,o
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gifts
Non -La ers
Beef Fuer
Boars
Pullets
Beef Brood Cow
-
- 1.
Turkeys
er°- -
raher
Turke Points
Other
Discharecs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2kNo ❑ NA ❑ NL
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [ & No
[:]Yes (El No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection-
Waste
ns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
qNo
❑ NA
❑ NE
Designed Freeboard (in): —
❑ Yes
E5 No
—\
❑ NA
❑ NE
Observed Freeboard (in): -3 p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
RNo
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[KNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 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 D Hydraulic Overload ❑ Frozen Ground p 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 designated in the CAWMP? [—]Yes �KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5jNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5 No
—\
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ 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 La No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ELNo
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 2/412015 Continued

Facili Number:Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes jo No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j5jNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
r] NA
❑ NE
❑ Yes NT ❑ NA [:]NE
❑ Yes �allo ❑ NA ❑ NE
3I . Do subsurface the drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
Cg -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&No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
MNo
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional usees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

t
type of visit: w—uompuance inspection V uperanon tcevtew V structure r;valustion V l ecttnical Assistance I
Reason for Visit: Gdttoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - Arrival Time:FT' 0c) Departure Time: : pc7 County:
Farm Name: FO'-rt--I
Owner Email:
Owner Name:It /mac, j>/ f- %/ Phone:
Mailing Address:
Physical Address:
Region: E2r v
Facility Contact: r &Ppr,fj% Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
p ��. Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
..
Design `Curretlt
Design
Current
Design &SH . nt
Swine
Capacity_ Pop.
�i'et Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder11
INon-Layer
I
Dairy Calf
eeder to Finish
7DJ11ADairy
Heifer
Farrow to Wean
I
Design
Cttrrent
Dry Cow
Farrow to Feeder
D . P,oul
CaPa ci
P,o ,I'Non-DaLry
'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
--
the
=
Turkeys
r
F:
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify D W R) ❑ Yes ❑ No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ N£
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes JaNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 10 No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

lFacility Number: - Date of inspection:
[] Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
No
❑ NA ❑ NE
the appropriate box.
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
� No
❑ NA
❑ NE
a. I f yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
Identifier:
❑ Yes
® No
❑ NA [] NE
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): —<� 3�33_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(54 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
M_No
❑ NA
❑ NE
waste management or closure pian?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[]Yes
[HNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste siructures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
jo 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, 7.n, etc.)
❑ PAN ❑ PAN > 100/6 or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurefSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �10911 do- /B v
13. Soil Type(s): "s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes }❑ No 0 NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes ANo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes �No [:]NA ❑ NE
❑ Yes Lo No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below_
❑ Yes
I. No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZ_No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

[Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E] No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;�] No ❑ NA C] NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes � No ❑ NA [] NE
❑ Yes [No ❑ NA ❑ NE
[] Yes g�Vo ❑ NA ❑ NE
❑ Yes
®' No
❑ NA
❑ NE
[D Yes
0],No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
allo
[] NA
❑ NE
Comments. (refer to question #): Explain any YES answers and/or any additional- recommendations or any other comments.
Use drawings of facitity to better explain situations (ase additional pages as necessary).
Reviewer/Inspector Name: C� _ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: ()'Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access !I
Date of Visit: � Arrival Time: : ov Departure Time: f County: bz- Region: ! D
Farm Name: �-� f fFJ r� r rG� m. / �f-i! Owner Email:
9V
Owner Name: ;;fy" 3 Phone:
Mailing Address:
Physical Address:
Facility Contact: f=-+ /Yz� Title:�cUn tifl� Phone:
Onsite Representative: 5 of—�O--
Integrator:
Certified Operator: '.5 Z� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
❑ No
[:]NA
rrent
Design Current
❑No
Swine Capacity Pop.
Wet PoultryIIIPIatyPap.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
D ' Calf
Wean to Feeder Non -Layer
Feeder to Finish
fl
D Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,ottl
Ca aci
P,o
Non -Pat
Farrow to Finish
Layers
Beef Stocker
Gilts
on -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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes MNo [:]NA ❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
[]Yes
❑No
[-]NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑No
❑ Yes ENo
[:]Yes CKNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page l of 3 2/4/2014 Continued

Facili Number: - Date of Inspection: 67
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? []Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
[:]Yes [&No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
5g No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�&No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
[:] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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): Lh'l(C Uri r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
KNo
❑ NA
❑ NE
acres determination?
17. Docs the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
CffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S No
[:] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RLNo
❑ 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 54 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [gNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [S -No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: --/�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3 No
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
KNo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�o
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
®-No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[E No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
2LNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®..No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better extalain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/Or�"�l�fa�j 33 00
Date: lv !� �✓
2/412011

AAM A�
NCDENR
North Carolina Department of Environment and Natural Resources
Pal McCrory
Governor
James Horrell
Greg Horrell Farm #2 & Addition
8461 Tomahawk Hwy
Haff ells, NC 28444
Dear James Horrell:
F?ECE! VIED
July 2, 2014 JUL _ 8 20141
John E. Skvaria, III
Secretary
DENR4AM7EWLLEREGIONAL OFRCE
Subject: Additional Information Request
Application No_ AWS820439
Greg Hornell Farm #2 & Addition
Sampson County
The Animal Feeding Operation Branch of the Division of Water Resources (Division) has completed a
preliminary review of your renewal permit application package. Additional information is required
before we may continue our review. Please address and submit the following item(s) within 30 (thirty)_
days of receipt of this letter:
Missin Copies of Field Maps only.
Our records show that we have received a copy of your waste utilization plan (WUP) or
nutrient management plan (NMP). JJowever, copies of the field maps are missing in your WUP
or NMP.
Please reference the subject application number when pro -tiding the requested information. All revised
and/or additional documentation shall be signed, dated and sent to my attention at the address below.
Information can also be submitted electronically at [e-mail].
Please feel free to contact me at [phone] if you have any questions regarding this letter,
Sincerely,
J. R. Joshi
Animal Feeding Operations Branch
cc: Fayetteville Regional Office, Water Quality Regional Operations Section
WQROS Unit Central Files - AWS820439
Murphy -Brown LLC
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone]Internet ht ://www,ncdenr. ov/
An Equal opportunity 1 Affirmative Action Employer— Made in part by recycled paper

:
�r
/I /
- ivi'sion of -Water Quality
Facility Number -s.Z%J O Division of Soil and Water Conservation
OQ Other AgeQcy
type of Visit: EMompliancetnspection 0 Operation Review O Structure Evaluation O Technical Assistance
Zesson for Visit: iBrg-o—utine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
vniC u1 v1nii. 14 1 `/-11 Hrnvxi s nue:l Z VLJ I LCYnrwre aline; I I / I UCZ I t.uuuty. icegiuu. r > y
Farm Name: 44e r r- , J'J -Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: LIL- Title: _e'!!) U Phone:
irl
Onsite Representative:
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
r9"°Destgu
Current
Design Current
Swine Capacity Pop.
Wet Poultry
apacrty
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish 7 Q
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oul .r
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
-
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)
e. 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 $�LNo ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes ENo
[:]Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility [lumber: - Date of Inspection:
If
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway? -
Designed Freeboard (in): t C�_
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Q 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
CNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
54 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
(3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
0 No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Meavy Metals (Cu, Zn, etc.)
0 PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L2=" / e2L� — -- -
13. Soil Type(s): C,0,r�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 'No [—]NA E] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes IR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fallo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I& Is there a lack of properly operating waste application equipment?
❑ Yes VZ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Za No 0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [,Z No
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis 0 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 1/412017 Continued

Facility Number: jDate of Inspection: -J7-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
[g 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
[a 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
U3No
❑ 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
ELNo
❑ NA
❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

r
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: G'>Itoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! Departure Time: County: Region:
Farm Name: �J Ui tDF/C j%/ r'/���'' Owner Email:
Owner Name: iE.,v Phone:
Mailing Address:
Physical Address:
Facility Contact: r //� �l Title:jlhyar Phone:
Air
C,
Onsite Representative: Integrator: _.,2tPe' /Z..'
Certified Operator: Certification Numbe .
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Tf 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 gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes �Q No
[:]Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current'
Design
Current
Design
Current
Swine
Capacity Pop. ' WeI oultry
Capacity
Pap.
ap
Cable Cacity
Pop.
Weaill
n to Finish
0
La er
Dairy Cow
Wean to Feeder
Non -Layer
Daia Calf
Feeder to Finish
' ``
ll Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . ;P.oul
Ca achy
F,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Tf 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 gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes �Q No
[:]Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

I
[Facility Number: - Date of Inspection: f� /
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ZI No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Lg No
❑ NA
❑ NE
maintenance or improvement?
Waste Apulication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy 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). zi—
13. Soil Type(s): 4 .44
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 154 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z -No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
r%7/ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ta No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E@ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
Co No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
T"
Date:
2/4/2011

rc
Itype of visit: t-g-uompnance inspection V uperanon tceview V structure r:vatuatnon V ieennicat Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time•"•Departure Time: f ! D� County: D_'—Region:
/7 .. ar—_ _ A AI 3� "� rs�
Farm Name:
Owner Name: �ryj &— . - Lh1 Phone:
Mailing Address:
Email:
Physical Address:
Facility Contact: rj j �yY Y7 rr r r Title: � rL' Y..✓ Phone:
Onsite Representative: �/�'�x.� _ Integrator: rk L w�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
_ Design Current
Design .Current
Design Cnrrent
Swine Capacity Pop:
Wet Poultry
Capacity
Pap.
Cattle Capacity P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
11 11111 I I :1111111-N,`'
Turkeys
Othe
urkey Poults
Other
10ther
Discharees 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 E] NE
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes [:]No
[:]Yes No
❑ Yes ® No
Q NA ❑ NE
E3 NA E] NE
❑ NA ❑ NE
E] NA E] NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
W

Facility Number: - Date of inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L7_ 3 l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ED 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?
❑ Yes
allo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env onmental threat,
o
notify DWQ
7. Do any of the structures need maintenance or improvement?
es
[] NE
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
t4 No
❑ NA
ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any pari of the waste management system other than the waste structures require
❑ Yes
(a No
❑ NA
❑ NE
maintenance or improvement?
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
C] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
[ Yes
M No
[] NA
[—]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 64 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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): ve
13. Soil Type(s): ('
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
® No
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
0 NA
❑ NE
Re uired Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[4 No
C] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R1 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design E] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [K No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes (a No ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: r2z - q 13 r I I Date of Inspection: & — 6 --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [, No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[:INA 0 N
0 N 0 N
❑ Yes [ R No ❑ NA ONE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes M.- No [DNA ❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: eFComptiance Inspection C) Operation Review U Structure Evaluation C) Technical Assistance
Reason for Visit: @1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t L.L!J Arrival Time: 'D Departure Time: County.
Farm Name: '7-4-aey�r� r � u ' owner Email:
10,
Owner Name: X?_ _--4 6- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: A r a 2 pry's%� T Title: Phone:
Onsite Representative: Seale, Integrator: �r
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Desiga Current
z
W.
Designer Carrent
Design Current
Swine
apcityaPop
C .
\Vet Po ltry
CapacPaP.
Cattle Capatity Pop.
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
0 No
❑ NA
❑ NE
Wean to Finish
❑ Yes
No
[] NA
airy Cow
Wean to Feeder
❑ Yes
No
C] NA
airy Calf
Feeder to Finish
–471>0&
" -
Dai Heifer
Farrow to Wean
E Destgn;�,Curent
D Cow
Farrow to Feeder
'© P,oultr.Ce>>
acttzPo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other ._
Wn
TurkeX I'oults
Other
Other
^F
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
C] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: -I Date of—Inspection: ZZZ1
—
[,No
[DNA
❑ NE
Waste Collection & Treatment
❑ Yes
® No
❑ NA
❑ NE
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
5�j No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in): l -
Observed Freeboard (in): _ y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
(A Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
®No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes S 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): // 1,9!/r
13. Soil Type(s): (r
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 [D No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[,No
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(. No
❑ NA
D NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
-� 24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
�Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Z No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No 0 NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA ❑ NE
Comments (refer to question ii): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone:
Date:
2/4/1011

.`
Type of Visit (Dr6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f)Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'lime: `p O Departure Time:j�,' Q County: e"�' Region:
_,.-_
Farm Name:
Owner Name:
Mailing Address:
ner Email:
'hone:
Physical Address:
Facility Contact: �� ,/A"/'e Title: �GU/r�/r Phone No:
Onsite Representative: Lli==f Integrator; 44
Certified Operator: - Operator Certification Number: �/, Z"
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =.
=41 Longitude: = ° Q C ❑ N
Desigts Current
Design Current
Design Current
Swine (►apacity Population
W'et Poultry Capacity Population
Cattle Capacity opttlatiott
❑ Wean to Finish
[[:]Layer
❑ Dairy Cow
❑ Wean to Feeder I IIIE]
Non -La er
❑ Dairy Calf
Feeder to Finish 3 �v
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Ury Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other 1
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream lm acts
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 J.No ❑ NA ❑ NF.
❑ Yes
❑ No
❑ NA
❑ NL
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
1KNo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
`
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E9 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?-.
Designed Freeboard (in): /
Observed Freeboard (in): 33 _ ?j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CHNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
allo
❑ 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?
[3 Yes
No
❑ NA [IN E
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U.No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA ❑ NE
mai ntenattce/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 El Application Outside
of Area
12. Crop type(s) Ijrf I Jtw-r_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
D3.No ❑ NA ❑ NE
C.No ❑ NA ❑ NE
R No ❑ NA ❑ NE
❑.No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).
IReviewer/inspector Name I � _ �,, %jam. Phone:"p-- -- 001
Reviewer/inspector Signature: _ _ Date: Z,_;7Q/D
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
1
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®-No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
S No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as requires} by the permit?
❑ Yes
®No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
allo
❑ 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
2LNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
Comments andfor
Page 3 of 3 12128104

Type of Visit tMompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit &AO- utine Q Complaint Q Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrive[ Time: Departure Time: County; Region:
Farm Name: 1 ff` 0' -Owner Email:
Owner Name: Ir r» r. 7 11�1 f -a � [ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1"e Title: �? 'r z— ✓ Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number -
Back -up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = = Longitude: 0 ° = , 0 "
Discharges & Stream Impacts
. 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 [K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
rrent
nFroc-PIRINtion
Design Current
Design Current
Sc� in(
Wet Poultry Capacity Population
do
Cattle Capacity Popuiati©tt
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
to Feeder to Finish <
[I Yes
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dai ry
❑ Farrow to Finish
❑ i..a ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ ©ther
❑ TurkeyI?oults
❑ Other
Number of Structures:
Discharges & Stream Impacts
. 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 [K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ NA
EINE
❑ Yes
❑ No
[I Yes
®No
❑NA
EINE
❑ Yes
tO No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:
,T
Waste Collection & Treatment
Date of Inspection/T /1
4_ is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [:D -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 [9No ❑ 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
T Do any of the structures need maintenance or improvement? ayes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 15kNo ❑ 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 15 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes S.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°!0 or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop {Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ 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 qNo ❑ NA ❑ NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes R -No ❑ NA ❑ NE
aa.
Comments (refer to. question #): Explain any YES answer=sand/or any recommendations or any olpeents.
Use drawings of facility to better: explain situations. (use additional pages as neeessarj�) ..q F ,
Reviewer/Inspector Name Zr V -f_ * '�� Phone;
Reviewer/Inspector Signature: Date; i
12/28/04 Continued

0
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &. Permit readily available? ❑ Yes (9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropirate box. ❑ WUP D Checklists ❑ Desi Maps Design ❑ ap ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 N ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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
(Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
{0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
S�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(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
(KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;*No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

___
ivision of Water Anality
(Facility Numbt'r -3� 0 Otter A 10. gil and Water Conservation
Type of Visit I3,c'Smpliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit autine Q Complaint Q Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 'p Departure Time: �Dr� County Region:
Farm Name: ir /%-I'm Owner Email:
Owner Name: 4 Phone:
Mailing Address:
Physical Address: [�
Facility Contact: ✓C ,! �Title: Phone No:
Onsite Representative: f 5 � Integrator: ,f2.Ztee:" & -
'or
Certified Operator: Operator Certification Number: /,��4pw
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: =0
=1 Longitude: =0=, o=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 10 Non -Layer
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1- Is any discharge observed from any pari of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle "' Capacity
Calf
U Dry Cow
❑
Non -Dairy
❑ Beef Stocker `.
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)?
Beef Brood Cowl
Number of Structures:Eili
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes fO No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
E] NA
0 N
❑Yes
El No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
§dNo
[INA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
I
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
%No
Waste Collection & Treatment
C] NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /2
Observed Freeboard (in): `3 L 3 &
e�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IN 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
J9No
❑ 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?
KYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
sYes
�lo
El NA
EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
f&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P.No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M -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)gr_-"n413. Soil Soil type(s) aa 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �R No ❑ NA LINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JB No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Z No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
%No
[INA
C] NE
ts.
Comments (referto question # ExnyAYESFanswersjamWorJ-Anyj ommennationsrorranvlothericomments-!iiiiiiiii
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector NamePhone: 33��
Reviewer/Inspector Signature: -- Date:
Page 2 of 3 112128104 Continued

Facility Number: — Date of Inspection - a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RINo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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 RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PSNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®,No
❑ NA
❑ NE
Other Issges
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
JRNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9No
❑ NA
EINE
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
2, 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
C&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Page 3 of 3 12/28/04

j
ivi
2 sion of Water Quality
Facility Number �p 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
outine O Complaint
0 Follow up O Referral Q Emergency
O Other [I Denied Access
Date of Visit: Arrival Time: i p �Departure Time: County: Region: 4EZ:a
Farm Name: (.7 a zy/ trz/ rl rwrk_ Owner Email:
Owner Name: &rk / i �//`e �� Phone:
Mailing Address:
Physical Address:
Facility Contact: a✓61 Or / ell Title:
Onsite Representative: SLly t
Certified Operator: SQ
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Phone No:
Integrator: /[, /
Operator Certification Number:
Back-up Certification Number:
o= [� Longitude: ETI—_11 E]"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation9
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. 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 Z[No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12/28/04 Continued

1 Facility Number: ,3
Date of inspection
Waste Collection & T'restment
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3t�
Structure 2 Structure 3
Structure 4
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 9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure b
❑ Yes 25 No ❑ NA ❑ NE
❑ Yes X.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? (4 Yes ❑ No ' ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [A 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P5No ❑ 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 types) [�/!.1/jIGL ! S/7%r��►'2ri ��.1 L�DIIZ (i�ir��/✓lfp�a!';s�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
[:INA
❑NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
R_No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: O/Q-�1��� 33 PO
ReviewerAnspector Signature: Date: /f 42 �7
12/28104 Continued

` Facility Number: �.— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? *�RYesNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J9 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (9No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 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
9) No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
RNo
❑ 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
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04
12/28/04

Date of Visit: rd;�` - 4 Arrival Time: i D O Departure Time: Q; County: j5gtz
W.Ap— Region:
Farm Name: r� ►` e - f�Or-/`r��>/ �.�.s-�75y` Owner Email:
Owner Name:Z02=a 5 61CA� _ &4/'/� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _542'%I / _ Integrator: 1r�lS
Certified Operator: S Operator Certification Number: 16 7� �
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I
= 11 Longitude: = ° 0 I 0 u
Swine
❑ Wean to Finish
❑ Wean to Feeder
Design Current
Capacity Population
Wet 1'oultty
❑ Layer
❑ Non -Layer
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ Dai Cow
❑ Dai Calf
Feeder to Finish
Ot7
Dai Heifer
❑ Farrow to Wean
Dry Poultry
= ❑ D Cow
❑ Farrow to Feeder
❑ NA
Non -Dairy
❑ Farrow to Finish
❑ No
❑ NA
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ Beef Brood Cow
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Other
❑ Other
❑ NA
❑ NE
Num e& of 8truetures:
❑ Yes
ESNo
❑ NA
❑ N£
Discharges & Stream Impacts
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Type of Visit (K-ompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outing Q Complaint Q Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
I. Is any discharge observed from any part of the operation?
❑ Yes
®No
[--INA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ESNo
❑ NA
❑ N£
other than from a discharge?
Page 1 of 3
11/28104
Continued

Facility Number: A 439 Date of Inspection 1113'
Waste Collection & Treatment
t®No ❑NA ❑NE
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 13No [INA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):49;2- 3 19 -3 D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
IS 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?
O Yes
❑ No
LINA
❑NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Z 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
0 Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Applicadon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
Window
12- Crop type(s) j3 Cr-Irtuola !-
13. Soil type(s) Ca J3
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
NNo
❑ 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
Z No
❑ NA
❑ NE
Comments (refer to question ft): Explain any YES answers and/or any recommendations or -any other comments. :
Use drawings of facility to better explain situations. (use additional pages as necessary): :
T
Reviewer/inspector Name -VDD
Reviewer/Inspector Signature: Date: 1
Page 2 of 3 12128104 Continued

Facility Number: gg —J,—J,V Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
93 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
1A 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
28.
Were any additional problems noted which cause non-compliance of the permit or CAWNW?
❑ Yes
[21No
❑ 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
[Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®, No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector tail to discuss review/inspection with an on-site representative?
❑ Yes
4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

-41 41.1�at�b' ,r,s,ly�H a�;aeftrv` "
division of Water Quality.
•a leery `aka �+1C�
Faeil�ty�NLumber Division of Sod and Fater Conscrvuhan
Q Other Agency
Type of Visit *Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine O Complaint 0 Follow up O Referral O Emergency a Other ❑ Denied Access
Date of Visit: 7 •s- Arriva! "t irne: tY,3 aDeparture Time;
� county:.�tw_y6,iv�_ Region: 51-f-0—
Farm Name: G� for-r_a%�F+�r-,,.? •y,s/i�,%,r�a,_ Owner Email: _--_
Owner Name: ,�wN+e s (rcc> f�o!'rr// Phone: C1/0 -
e
1/0`
Mailing Address: _$i%trl 7"n.►,a%a�.,�( h%9�wa�y
Physical Address:
Facility Contact: Gr_r—/zrc�� er% Title:
Onsite Representative: �rre9-0.Fre
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification dumber: _%�i 7,0 T
Back-up Certification Number:
I.atitude: =o =' =" longitude: 00=' ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
Dry Poultry
L! Non -Laver<
❑ Pullets
ILl Turkev Poult.�I I I
Discharges & Stream Impacts
I . Is any discharge observed Irons any part of the operation'?
Discharge oriitinated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Nun -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
b. Did the discharge reach waters of the State'? (I f yes. notify DWQ)
c. What is the estimated volume that reached waters of the State fvallons)!
Number of Structures: O
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan 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 D<0 ❑ NA ❑ NE
❑ Yvs
❑ No
❑ NA
❑ NE
❑y, s
❑Na
El NA
El NE
❑ NA
❑ NE,
❑ Yes❑
No
❑ Yes
f o
❑ NA
❑ NL
❑ Yes
o
❑ NA
❑ NE
12/28/04 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Stgjcture 2 Structure 3 Structure 4
Identifier:
Spillway?: ao ---
Designed
- Designed Freeboard (in): / 9. ir
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 Q - Ko ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes B No ❑ NA ❑ NE
❑ Yes L'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 Dlo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [l'F10 ❑ 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 EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Dfio ❑ NA ❑ NE 1
maintenance/improvement'? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. C3 Yes E� o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ,
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
.2, ! 3 •q s-
12. Crop type(s)
13. Soil type(s) [�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 -Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA [-SNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes ❑ No ❑ NA BIE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA 0'1 E
18. Is there a lack of properly operating waste application equipment? ❑ Yes Flo ❑ NA ❑ NE
FIe43C ^ 017j.r 4-n Pel t.,r JR/'C 4rreoj
Ii.-dtogJ 4f yec4ers,,7
Reviewer/inspector Name ,8 ' Phone: Gia'Y
Reviewer/Inspector Signature: Date: 7-e '4757-
12128104 Continued

i
Facility Number: 8:j — y3 Date of Inspection �1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑-<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check ❑ Yes L 'No ❑ NA ❑ NE
the appropirate box. ❑ f Chec ' is ❑ DDp gn Elyars__'�'❑ O
er-
21. Does record keeping need improvement? If yes, check the appropriate box below. � ❑ NA ❑ NE
❑ G ❑ � G - 7 USK: * �, S, El y -1y� J� �U4 .,�, es ❑ o
❑ Rainf2d! ❑-Stoc 1+4g ❑ iia- ❑ ns ❑ ns 1 ..,----^�
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26_ Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspecior fail to discuss review/inspection with an on-site representative?
33_ Does facility require a follow-up visit by same agency?
Additional 6m' mteets andfor Drawings:
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
Ef wo
❑ NA
❑ NE
❑ Yes
9,Ko
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
©-10
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
iQ:KE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
D'%
❑ NA
❑ NE
❑ Yes
25o
❑ NA
❑ NE
❑ Yes
[ 'No
❑ NA
❑ NE
❑ Yes
2�4o
❑ NA
❑ NE
❑ Yes
D,<o
❑ NA
❑ NE
11128/04

Type of Visit © Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (& Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit-. �-Q Time:
rO Not Operational Below Threshold
Permitted [C Certified ❑ Conditionally Certified [] Registered Date Last Operated or Above 'Threshold:
t Q>�n:
S a w. EP-10FarmName: r-l�LN0►�C_lf Fsr te
Owner Name: Q VW% G. H a . v- t [ Phone No: 4j o_ + ,3.i- %2n
Mailing Address: G 7a V a 4a L. it, 7—. a d AL N. C
Facility Contact., 6-«a Herten! 'Title: Phone No:
Onsite Representative:r f , integrator: At.i'�Av
"* II// '70 9
Certified Operator: G a 40wri[ Operator Certification Dumber: ,D
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' 0" Longitude
Design- Ctsrrent ,^ Design ,:Current - Destgn Cntrent
_,
Swine : Ga achy Pb` ulatmn=Pouldiy _ Capacity = Pa ulati6h _:Cattle- ` ' Ca actty.='Po ulstian
❑ Wean to Feeder Laver ❑Dain
Feeder to Finish 7 3 a FM Non -Laver m ❑ Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ©tal Design Capacift
Gilts __ —
Boars '6 _ . �T6tai SSLw
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Snrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
& Does discharge bypass a lagoon system" (1 f yes. notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Taste CaLlectign & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier: 1 -2 _ 3
Frceboard (inches): It
05/03101
❑ Yes Q<0
❑ Yes 93"No
❑ Yes D<
�r
❑ Yes E�-3,<�o
Yes
❑ Yes L!I"No
❑ Yes 1Z No
Structure 6
Continued

j Facility Number: & —439 1 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [- <o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes do
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancerimprovement? ❑ Yes ❑-fio
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [a'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ONO
elevation markings?
Waste Application
10. Are there any buffers that need maintenaacerimprovement? ❑ Yes [f No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yes [ErNo
❑ Excessive Pondin ❑ PAN ❑ Hydraulic Overload [3 Frozen Ground [3 Copper and/or Zinc
1�jS'�
I2. Crop type 6 er.�,..�.. Sr/1 lyra.:, Ovel ,-,-j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes M4116-
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes B11-6
❑ Yes ❑ No
❑ Yes 014o'
❑ Yes Gq4o'
❑ Yes C mo
.Camtss:mts (refer w q�on �k a j►�;�sss a�/or any. or any othar cam_ .:�- _
tLlse � off,a�Sty M better _ (usc a� pagrs ss nearssary}_� Wield Copy ❑Final Notes �'`
'Y,'L �' Y��4�+c.,Y-�"�_—.� ��Z�'- ' ����..e� F-, 1r.�•�stX"�'��f-"�_ „._^'tom."' - .'�.ns ��.
�f, r/O/r� l� 5 / /Unh�q� JOI�t [ /ftr✓ rCntlV�c liprf S IS
Reviewer/Inspector Name aZi
Reviewer/Inspector Signature: Date: 02
12112103 IKI Confinucd

Facility Number: T.2 —14391 Date of Inspection
Reonired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Gigli
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/yXf, c4cak `fists, n, pwpg, etc.) ❑ Yes 446
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G?No
24. Is facility not in comMance with my app le setback 6&eria in effect at the time of design? [:]Yes[�-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
04fo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
>rLOar, v Ole. HOIfell i�/ /, 7
�s 9 e�'h rI 4-w.kt c1 S er .S��nf $ �7�yf
(ie/ discharge, freeboard problems, over application)
❑ Yes
QAFCr__
27. Did Reviewer/Inspector fail to discuss review/mspeation with on-site representative?
❑ Yes
QAhf
2$. Does facility require a follow-up visit by same agency?
❑ Yes
-B<0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[+}M
NI MES Permitted Facilities
�rAAA.'.re�
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
M Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbneakers on irrigation equipment?
❑Wes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
p -NO,
34. Did the facility fail to calibrate waste application equipment? ❑ Yes B_NO_
35. Does record keeping for NPDES required foams need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ sfte ag-Farr- ❑ geld ❑ ❑ Inspection After 1" Rain
❑ ❑ AsQual
Q No violations or deficiencies were noted during this visit_ You will receive no farther correspondence about this visit.
#.P3 ��%�o� 1imt fn U-200 3. 7 -Al _7004/ SOiI �-P1T to%�iJ 1pr 1,.nr
>rLOar, v Ole. HOIfell i�/ /, 7
�s 9 e�'h rI 4-w.kt c1 S er .S��nf $ �7�yf
y?oma
Csjsr;,�9 7dOS� �s s'@ 444. have .
.1 n L i�s.%
Atot 4.44- Fe, in f7�1.'R' So.l+tonG hlevld ia! ' /�tr5rn ! �d�.'�9
'"J le ����a�i7 erell �s, Mr. HartPl1
�rAAA.'.re�
MW
12112/03