820454_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

Type of Visit: eFCompliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for'Visit: outine 0 Complaint O Follow-uo 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: ,1 Arrival Time: Departure Time: ,'t-/ County: Jcz��pfB `— Region:J�7i
Farm Name: Y Q r rn S
Owner Name: �j p c k— —K E�a�rns
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �-��' f Y� %1',��r`� Title: / refit
Onsite Representative:
Certified Operator: jrn v�r�
Back-up Operator:
Phone:
Integrator:f—i���
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. city V1et.Poultry .,CapaPop:
:':r fir,
Design Current
Cattle F� Eapacity Pop.
f
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
p>�
Design Current
D . I;onit : C ci P.o
Layers
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turke PoultsM11Other
Beef Brood Cow
—.Turkeys
Other
t i
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes to ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: J
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?_
Designed Freeboard (in) --
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[J]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
[rrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Windj Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /lit l f i >—_ rri,f I 11 UL /,,�tr/nc�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I_ I 'v0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[JhZo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D<o
❑ 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
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑WU1P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - l Date of Inspection: /
J 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El"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 provide documentation of an actively certified operator in charge? ❑ Yes [f]'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes El -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
ff"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ETNo
❑ 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
LJ 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 Reviewerlinspector 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
[DNo
❑ NA
❑ NE
rmov-r_ 1-V � S % VSy�v^-
Cam4' P1 Yd' VA A)ot'L)
Reviewer/Inspector Name:
Phone: 9JD
ReviewerMnspector Signature:
Page 3 of 3
Date: /,;2-
21412015

!f
Type of Visit: ompiiance Inspection Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Q'ka—utine Q Complaint Q Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: / Arrival Time: n Departure Time: County: Region:
Farm Name -
Owner Name: 1
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: fry /i1�o� Title: /f�� c. Phone:
Onsite Representative: r as i �n vv r-- Integrator: f�
Certified Operator:, yr �'"%fi�c"� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
esign
Current
Design Current
Swine
Ea aci Po
V4'et Poult np
bmsaci'o
p
Gattle Ca acip•
P h'' R
airy Cow
Wean to Finish
Nan La 'Cr
Dairy Calf
Wean to Feeder
..
6
airy Heifer
Feeder to Finish
Farrow to Wean
Q
Design'
Current
]DryCow
Farrow to Feeder
Il Pouit .
Ca 36
�P,o
Non-Dai
Farrow to Finish
Ia ers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Co —
q
Otter
Turke Poult.s
!kl,
Other
OtherJ�f'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes &J-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge teach waters of the State? (1f yes, notify DWR)
[—]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
„M— No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[3-No
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

Facili Number: Date of Inspection:
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 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 othee structures observed?
❑ Yes
SNo
❑ 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
[X No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Callo
❑ NA
[] NE
8. Do any of the structures 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
C2kNo
❑ NA
❑ NE
maintenance or improvement?
Waste A lication
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 ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift /❑ Application Outside of Approved Area
12. Crop Type(s): %j%J�l� CJ f ,��rcil_
I3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑Yes [2 No ❑NA El NE
❑ Yes [B-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
allo
❑ 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
[y].No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:/—
t 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 21 No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes [A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
MNo
❑ 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
[allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Q 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
O_No
❑ NA
❑ NE
Comments (refer�quest�aa ##). EzpEara any YES answers andfor,any addrtionai recammeadataons.:or.aoy:other cnmmeo`ts: �
1,ht
140
Use drawings of #aril ty to: bet#er,;explaim situahogs,: (t se additiodid page`s_ as necessary):
Reviewer/Inspector Name:
Phone: 9`j'I) �3 t�3-CIsJ
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1%`7-
21412015

wh ",
t
Type of Visit: U-Coroaine
'nee Inspection U Operation Review p Structure Evaluation U Technical Assistance
Reason for Visit: O Complaint O Follow-up p Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: N ' v7 County: Region:
Farm Name: I 1\ r ,-'., -Y " Owner Email:
Owner Name: Q , ` ✓ r,r FA i4k6 % G Phone:
Mailing Address:
Physical Address:
Facility Contact: C�ir z-z�!' Uoi` Title: Y
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Faroe:
Latitude:
Phone:
Integrator: c ,
Certification Number:
Certification Number:
Longitude:
Design
Current Design Cur}renE = Design Current
evi�
Swine
Capacity
Pop. ry Capacity Po
s s
Cattle Capacity Pop.
Laver
Dai Cow
Non -Laver s'
Dai Calf
DairyHeifer
Ilt_ Design �nrr�en
D Cow
D . Fault , .. Ca ac►t Po
Non -Dairy
k. ;.
La ers
Beef Stacker
on -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
-_ Turke Puults .
Other
Other k 3�
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean f7A
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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 DWA)
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 -No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
[] Yes
[] No
❑ Yes
No
❑ Yes
Fa No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: K - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [gNo ❑ NA ❑ NE
I 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?: car
Designed Freeboard (in): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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 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 �.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 14 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
le, r.rsr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K No ❑ NA ❑ NE
I S. Does the receiving crop and/or land application site need improvement? ❑ Yes [LNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes La No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes allo ❑ NA ❑ NE
❑ Yes [K 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
[allo
❑ NA
❑ NE
the appropriate box_
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes. check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" RainfaIl Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23. If selected, did the facility rail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fZ No ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

Facility Number: - Date of Inspection: - , —f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j. 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 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 g 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 ONE
❑ NA ❑ NE
❑ Yes [4No ❑ NA ❑ NE
❑Yes ZNo ❑NA ❑NE
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes j2jNo ❑ NA ❑ NE
❑ Yes
q No
❑ Yes
allo
❑ Yes
[a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
( q :h # ExppHilh any YE5 answers -and/or any addritional;recommendations or as other comments.
Use drawings.:o facility, to bette �explatn s'ityabons y
Comments refer to oesho
T
' •'� �" :(use. additional pa�es�as necessary} ", "` �. � �; �„ �:;
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21417015

. .,
i
1`ype of Visit: �L Mpliance inspection V operation Keview V btructure Evaluation () "l'echnical Assistance
Reason for Visit: Mine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: a / Arrival Time: .3 Departure Time: County: 15-sue Region:
Farm Name: cj� ��j1� �Gt✓rtt j Owner Email:
Owner Name- �a �C %� ; JL�� �ci//t?� I-GG Phone:
Mailing Address:
Physical Address:
Facility Contact: L pB'`e— Title: r-
Onsite Representative: wax
Certified Operator:
Phone:
Integrator: /K127
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�v
INDCurrent
Design
Current
Design Current
Swine Capacity Pop.
Wef Poultry
Capacity
Pop.
Cattle Eapacity Pop.
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . P,aulti`
Ca eeity
1'0
Dry Cow
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
In 4- ,6 .
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)?
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 ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Q NA
❑ NE
�] Yes
❑ No
[a NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

jFacWty Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ WE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AM-
Spillway?:
Designed Freeboard (in): /19-
Observed Freeboard (in): _fig
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 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes [SNo
❑ 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 M 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 Q No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100/. 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 ApprovedArea
12. Crop Type(s): zn 1 znl � Z��_ff 'e: r ��'� r y� ✓ /��
13. Soil Type(s): 'AZn1_
14. Do the receiving crops differ from those designated in the CAWMP? © Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 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
.q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R1 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
,�Kj 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 IZ 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes PJLNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
MNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®, No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, cheek the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ AppIication Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
[zk No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Cp No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2 No
❑ NA
❑ NE
�.
Com>xients (refer to question .#) ExWidn any YES sins►ve. auadlor,any additional;recommendattonsrar�any aher camments.1'
Use drawn of facility to better- explain sitnations_(use addifionn fA pages as necessary}` -`R
11-3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date.
21412014

Type of Visit: 4D C.,ommppliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
tr Reason for Visit: ttoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /i{ Arrival Time: Departure Timer County:-,��.p�d'L Region:
��
Q
Farm Name: �` �4lrits Owner Email: ��
Owner Name: �}..yY d' Fa ,rn3 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ! t-
Onsite Representative:�-
Certified Operator: 2; yr, rx-y Nla©rM
Back-up Operator:
Location of Farm:
Latitude:
'e, Phalle:
Integrator: %/T� !�✓O ['—
Certification Number: / I:f 3 y3
Certification Number:
Longitude:
Design
Current
Design Current Design Current
SRine -
C>apaCity
Pap.
11
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dai Caw
Wean to Finish
Wean to Feeder
jNon-Layer Dai Calf
Feeder to Finish
Dai heifer
Q
MC)
Design Current Dry Cow
Farrow to Wean
Farrow to Feeder
D . P,ou1t Ca aci Pao Non -Dairy
Farrow to Finish
La ers Beef Stocker
Non -La ers Beef Feeder
Gilts
Boars
Pullets Beef Brood Cow
Turke s
-4
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Eg 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 DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Centinued

]Facility Number: - J/ Ds ection: —
i
' Waste Collection & Treatment
F
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
—]Yes
�Ip
❑ 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):
Observed Freeboard (in):�
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 plant?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ 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
[XNo
❑ 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 ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101/1. 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): YWe'lle (Sri / �.1J�4 : i .dam I fl ✓ r:"S +� --
13. Soil Type(s):�-�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (A 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes A No [] NA ❑ NE
❑ Yes [? No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes K No ❑ NA [:],NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes [BNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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 [a No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

1f Facility Number: - ©ate of Inspection: q— 1
5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes '91 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E4 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 gj No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes [ANo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the.Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 KNo [] NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
[:]Yes
�No
❑ NA
❑ NE
❑ Yes
[0 No
[DNA
[] NE
❑ Yes
[a No
❑ NA
Q NE
Yes
allo
0 NA
F] NE
Comments (refer to -question;#): EX'iatii "VIES -'answers and/or any additional recot p4endations or any other comments
-�. - 3•t*
Use drawings of facility to better. explain situatioiis(use additional pages as necessary):. `; :-
Reviewer/Inspector Name: t'" Phone: 4l�`K33 33�
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: ,.,ornpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Reason for Visit: tcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '� Departure Time: "-o County Region: L__=
Farm Name: t]r 11(,L, a K E:a Lrnzg - Owner Email:
Owner Name; ��4�� � ; ✓a / � ,.m ��11 G � Phone:
Mailing Address:
Physical Address:
l; acility Contact: ., O'10D I`r-- Title: C,
Onsite Representative:-� %71Qprr fry /1%yl
Certified Operator: 7Inc yu,y i*I00P-r-
e . Phone:
Integrator- e2 j, !
Certification Number:3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
!yam
rpent
CPo
x
H*+,
'
Cp rent
Swine r �
r
CaeSaCr
p
s
Wet Pqultry
_
CapaC ty�'CP pent
*F �
Eapa lCg'ty op.
Wean to Finish
to
Wean to Feeder
La er
-Layer
Dai Cow
iry Calf
Feeder to Finish
iry Heifer
Farrow to Wean
ag90
CurrentDry
Cow
Farrow to Feeder
D .'!P,oul
Ca a -i Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[&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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes '
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - $` Date of Inspection: / —]4/
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
® 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
gj 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
g] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
11 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
0 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
❑ 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): i tI5,4' 1
Qv�d -Yr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes KNo
❑ NA
D. NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes RNo ❑ NA ❑ NE
[:]Yes ®--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
KNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LEI No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: �-- -I Date of Ins ection:
t 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 21 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes � No [:3 NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
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
Cj�,No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or 0 y.27other comments
Use. drawings of;facility to better explain situatioiis�(use additional pages as necessary). -
l��r�rcv k:�_-caJs 7—r3
sue-13 #o 7'30~1D!-y-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�`dr3� 3i
Date: 7
21412011

r
Type of Visit: &<ompfiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (EYfo`utine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / / Arrival Time: ���e: : o� Departure Time: � County:
Farm Name : �1,,� ; Jrr 1rAl/?1.3 4 G Owner Email:
�
Owner Name: M5 Phone:
Mailing Address:
Physical Address:
Region: 11—/Z a
Facility Contact: rr-e Title: 72 Phone:
Onsite Representative: airfr—p�r I fTfnu /i'(�yr� Integrator:jurp,�
Certified Operator: 1�e tin y /y 'P6'rr-- Certification Number: l 31--3,9f 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Des�gn� Cirricen_t' I',
Capacity SPop:
Wet Poultry
Design�Current
Capacrtyr Pop
Design Current
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non La cr
iry Calf
Feeder to Finish
= -
Dai Heifer
Farrow to Wean
&00 k00
e
Dry Cow
Farrow to Feeder
D . Foetit .
Ca aci Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
113eef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
OthPAIMM
Turkey Poults
Other
101
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)?
❑ Yes K No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes � No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facill Numbdr: - 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): 3 �.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[S 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
O 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 P,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): &i J1z2t(s7fl l k"A / JJ rmlla6L--
13. Soil Type(s): $L�, 92-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes 17 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ej No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 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

acili Number: - r Date of Inspection:
16 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 structures) 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 ZI No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
a 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
&I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[,qNo
❑ 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
KNo
❑ 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
R] No
❑ NA
❑ NE
Comments(refer10 question ft Explain any YES: answers and/dr�any additionalrecommendation or;any�other comments;*
Use drawings:of facility to better explain situations (use additional=pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: C}/O�— 3 33 &0
Date: /";7 /f�i�
21412011
Page 3 of 3

Date of Visit: Arrival Time: I k!.- Departure Time: ' 1D County: Region: !�
Farm Name: at'101�Owner Email:
Owner Name: G Phone:
Mailing Address:
Physical Address:
Facility Contact: r2r_-znE f z ftat e Title: Phone:
OF
Onsite Representative: 'ice Integrator: /il�ir,�lfry
Certified Operator: r% I.-0 !y Certification Number: ,� 3
11
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Carren.
Design Current
et Poultry
Capacity
P,op.
Cattle CapacitPo
Finish
17WFeeder
La er
Dai Cow
Non -La er
Feeder
Dai Calf
o Finish
Dai Heifer
w to Wean
D
T1 PO
=-1D . P,oultr
DsiD
Ga aci
Cow
w to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Gilts
01 Boars
Pullets
L
Beef Brood Cow
Turkeys
ING1�
_ „ �- �. . - ...
Other
Turkey Poults
Other
Other
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)?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes No
❑Yes E]No
❑ NA 0 NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [A No ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

j Facility Numbet: jDate 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): I?
Observed Freeboard (in): qV
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 arc 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 pubHe health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2 No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
0 Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
Eg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
Crop Window ❑/ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /�1Ls'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2) 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 Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 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 NJ No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili 'Number: jDate 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 ® 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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® 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
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to,question ff • Explain an YES answers'and/oran additional recommendations organ ether comments.
Q )• P Y Y .. y y�
Use drawings of faeility..to better explain situations (use additionid pages as necessary). ;
_,�.. ..
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �W3�.
Date: z p//
21412011

t
Type of Visit 0 mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: p Arrival Time: .'pp Departure Time: ! Ocr% County: Region: IZ
Farm Name: / r,2''�' Owner Email
Owner Name: L a CT 7� - v B LS i- L G Phone:
Mailing Address:
Physical Address: f
Facility Contact: 'rr' Moor Title: i S,x Phone No:
Onsite Representative: I ►?9 Mv% A'92m(�" Integrator: 'Of
� ,
Certified Operator: 127120/ct. Operator Certification Number:. :S3�1
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: a o + FJ Longitude: = 6 =' =1 u
DesignINC. Design, CurrentDesigCurrent Wet Poultry c �Ca11Ie Ca aci Pa uiationP #CapacityP�pulat on P h P
_.
❑ Wean to Finish ❑ l a er ❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf
❑ Feeder to Finish ` '�`""``� - ° ❑ Daia Heifer
Farrow to Wean p a / D a --* El Dry Cow
❑ Farrow to Feeder ElElElNon-La Non -Layers ElFarrow to Finish ElN ers Beef Stocker
❑
El Gilts ❑ Beef Feeder
❑ Boars ❑ Pullets 3 ❑ Beef Brood Co
„ ❑ Turke s
ff
Other p y -. . F 4. R , Turkey Pouits
❑ Other ❑Other Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CgNo
❑ 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 discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: - Date of Inspection LLB
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UNo ❑ 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
S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
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?
❑ Yes
[4 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CgNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No ❑ NA
❑ NE
maintenance/improvement?
1 l . 1s there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
JR No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ofArea
12. Crop type(s) jmK�.� .9/Yla,t'� G*��`1- �L ✓�� % //Tlr fry!-
�!'8/✓
__
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CO No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9No ❑ NA ❑ NE
Cor�uments(refe�q too#)Egpiam�aoyY n v, ers an any recommendations or any other comments.
Use drawings of fac�Lt� to tietter ezpla►n,situah�ons. {use additional pag s"st 11 cessary)ry
�Vfe-F'A F.Ki YC�az��La+�A`. nyi 'I��3`3'.�k �+ri.'��
Reviewer/Inspector Name 4 . Phone:_
Reviewer/Inspector Signature: Date:
Page 2 of 3 1228104 Continued

! Facility Number: — Date of Inspection /�-
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tZ 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 EZ 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 EgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5(No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[A 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
KNo
❑ 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
&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
Additional Commerits_and/or, raw•ings:`
Page 3 of 3 12128104

'Ara iz-zz -Zoo 9
Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit �utine G Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2-/7-09 Arrival Time: !0>a10,*,., . Departure Time: County: SuiMlpSo+� Region: r20
Farm Name: �ou� �-- K Fa�-v't Owner Email:
OwnerName: $ 6 cV, R; U e.r Favwts L Lt- Phone:
Mailing Address:
Physical Address:
Facility Contact: Gee0- i•Aon�-tr Title: Tc-�-i^ 5'acx_
Phone No:
Onsite Representative: -3 1 ­^ j �O °'� `- Integrator:
Certified Operator: !l!f ODre. _ KGN1V y N Operator Certification Number: 19 3 *3
Back-up Operator:
Back-up Certification Number:
Location of Farm: - , Latitude: = o = . = " Longitude: 0 ° 0 I =
Design Current Design
Swine Capacity Population Vet Poultry Capacity
Current Design
Population Cattle Capacity
❑ Dairy Cow
Cnrrent
Population
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
Dry poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy —
[J Beef Stocker
El Beef Feeder
Farrow to Wean
❑ Farrow to Feeder
O
// 0 0
Farrow to Finish
❑ Layers
Non -Layers
❑ Gifts
❑ Boars
Other
❑ Beef Brood Co
❑ Pullets
❑ Turke s
❑ Turkc Poults
❑ Other
Number of Structures: El
❑ Other
Discharges & Stream Impacts
/
1. Is any discharge observed from any part of the operation?
❑ Yes
2 N.
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
�,/
ETNNA
[INE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[INo
ETNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
[9�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

j •
Facility Number: $Z —Jr Date of Inspection
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes lJ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes IJ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ LQ2
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes El <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? ElYes UJhrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��
9. Does any part of the waste management system other than the waste structures require ❑Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance/improvement? ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) Ct?1s4-1v0 . 5m,1A Gm; " i0, S .
13. Soil type(s) NON+oN (130B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ET No
❑ NA
❑ NE
"No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ON o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Use drawEngs of facrlity to better exlaen situatio s (use addtttonal pages as necessary): y
{ q ), p } y endattoas or an other comments. ,
IReviewerllnspector Name Ric— k Re—v e (S i Phone: 91o,#33, 330
Reviewerllnspector Signature: /Q — Date: /2 - f 7 — Z-00 9
12129104 Continued

Facility Number: $2_ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ��No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes IJ' 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 I"
Rain Inspections❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ON (o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
7No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
Li'I No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LIZo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
12128104

a APUS /-08-09 ,ems
�visian of �4`ater (Quality
iFaci ity Number $Z sy Q Division of Sail and _ ,VRer Conservation
Type of Visit O'Co—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (31outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: jJ: S!! County: S� +•-.A 5'o tj _ Region: Ya
Farm Name: h%L161 c k. St Owner Email:
Owner Name: �tlL R'sV Pt/ f'ar w L Le Phone:
Mailing Address:
Physical Address:
Facility Contact: (;t"ecry Maa r L Title: uL Sperm Phone No:
Onsite Representative,• at-e-t-i— A40crt_.., _ Integrator: _ No►P� •� Hrd-%.l M „
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ t 0 w Longitude: = o ❑
Design Current r Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle C•apatity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
j
Dry Poultry
"
❑ Layers
❑Dairy Heifer
❑ Dry Cow
El Non -Dal
❑ Beef Stocker
91 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non-ts ers
❑ Gilts
❑ Boars
❑ Beef Feeder
Pullets
❑ Beef Brood Cowl
I
El Turkeys
er Oth
.
❑ Other
,rz -
Number of Structures:
❑ Turkey Poults
❑Other
Disci & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 2<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
❑ Yes
❑ No
[3'9A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[]<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
[afo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ff'�o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Coruinued

Facility Number:
Date of inspection /2-A&-0
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?
El NA El NE
El NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A 1
Spillway?: /1/Q
Designed Freeboard (in):
Observed Freeboard (in):
3�
❑ Yes ErNo
❑ Yes BNo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes L'3 No ❑ NA ❑ NE
through a waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ET
lvo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes [3 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 [J o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i0%or 10 lbs El 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) l +�r►�.0 �c.. (on., e. ) . go-x-(r 6y-- ,j (D, S - � t i,lik L,. IS
13. Soil type(s) 176.E
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9OKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[31�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Ll tvo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
D fro
❑ 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 �j �jC ram/ L IS Phone: 9110, qJ3,
Reviewer/Inspector Signature: Date: 12. -%lo - Zvi
12128104 Continued

Facility Number: $2_ —r,/S Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 2'�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9NNo [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ 9 Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �io ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O'I<lo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
0<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ 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
�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
01No
❑ 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
��/
L] No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q<o
❑ NA
❑ NE
Additional Comeneets�attdJorDrawtngs s
r
Page 3 of 3 12128104

�2WG5 �N�..cnL of /o y/zoa g
® Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Z-1Z- Q7 Arrival Time: /a :SS �}..,� Departure Time: /1:35 County: 54 A-tI2Sen! Region:
Farm Name: Z>ou W c- K Sri S Owner Email:
Owner Name: Blab-k R�+vW PtvwtC Phone:
Mailing Address:
Physical Address:
Facility Contact: G rex-t- Title: Phone No:
OnsiteRepresentative: ate-''/ -�+�^` Nlbcrc Integrator: hftj� Bt`OWN
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = r = " Longitude: = o ❑ , =
g.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population.
❑ La er
II 0 Non -La eT
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEy Cow
❑ Non -Dairy
❑ 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 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 M No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[11 No
❑ Yes
® No
❑ NA
❑ NE
❑Yes
®No
El NA
❑NE
12128104 Continued

Facility Number: 2.— � 'y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [A No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
W No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �eh-tv�.ldc� CFd 4-avU Sig••,-d ( 14- uvg d _
1j I'A► ., T 56o4e - Art+uc&I5
13. Soil type(s) �p
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
�i,
M No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[0 No
❑ NA ❑ NE
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
[A 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):
a
Reviewer/Inspector Name P'ieCRJP-hY (-I S Phone: Wo, '(33, 330 D
Reviewer/Inspector Signature: Ra� Date: 1 2 - a - zoo 7
12128104 Continued

Facility Dumber: $`, — #Sr{ Date of Inspection l7-12-Q7
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [j? 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 P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Main Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge"?
❑ Yes
Ir No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
JP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;b 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
[21 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
r�
E1 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
® No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

®Division of Wafer Quality
11FTRJtyWum- Per YZ , j Y O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 4M Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O /O - Olo Arrival Time: I d , DD Departure Time: ,roo County: $a,0V Region: /GA?V
Farm Name: DO`L1l G /L F—aVA^_3 Owner Email:
OwnerNamme: 2L&C-9 R1,vfjC Fr41+"5 LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: �1'C_�-✓ Mop Title: ✓� S�GG . _ Phone No:
OnsiteRepresentative: Gt't��> �]o.�t_��•r�_ j�DaY� Integrator: lxs JOAt„ S^"J"
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =` =' E]" Longitude: =o =, E—_1 u
Design Current
! ' T Design .Current
Design Current
Swine Capacity I'opuiation
Wet Pgraltry ;; Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Non -La er
❑ DairyCow
❑ DairyCalf
❑ Wean to Feeder
Feeder to Finish`i=
Q"
r Tyr , '
❑ Dairy Heifer
❑ D Cow
Farrow to Wean
❑ Farrow to Feeder
❑ Layers ..
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
, ---,
Other
❑ Other
k
❑ Turkey Poults
❑ Other
Number pf Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® 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
[ZNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[A No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: �� — .S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
ElNA [INE
a. If yes, is waste level into the structural freeboard?
❑ Yes
L/No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: j—_
Spillway?: A10
Designed Freeboard (in):
Observed Freeboard (in):
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
[2fNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
( No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NF
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QI No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9No
❑ NA ❑ NF
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. crop type(s) $0-pr kC140- 6 vr 3 e , 5^4* dl Gjrw ; ^l L/'o, s
13. Soil type(s) Bo S
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
J] No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application'?
❑ Yes
;9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�9(No
❑ NA ❑ NE
;Comments.(refer to question #): Explain any YES answers and/or any recommendations or any other eomirneuts ,
Use drawings of facility to better explain situations. (use additional pages as neeessary) ; a
T
Reviewer/Inspector Name F c �e V Phone: /O 3 -33.30
Reviewer/Inspector Signature:k�kAo"�Date: /1J-/0 ~ Z
Page 2 of 3 12128104 Continued

Facility Number: �f�—f�lS[�� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [ONo ❑ 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 1A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J" No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JN 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
R1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[?No
❑ NA
❑ NE
AdditionilConments,and/oriDrawfng%s.:�" ;.
AL
H
Page 3 of 3 12128104

Type of Visit AN Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -/ -pv' Arrival Time: J :,gyp Departure Time: County: 51-1 see, Region: T Iy
Farm Name: ��Kh1 k%& s Owner Email:
OwnerName: Dke e- k Z v ey- u, C Phone: ,2t O 6-3 Y z
Mailing Address: Fo �o % ( �°r ry is & C JQ "41
Physical Address:
Facility Contact: 01r �re r 412 a Title:
Onsite Representative,,: //-e--er 10e0V V /,1 i +x molb_r t
Certified Operator: KQktiH Moore
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: �93�
Back-up Certification Number:
Latitude: [o =' = Longitude: =o ❑ ` [� u
Design Current Desi& Current
Swine Capacity Population Wet Poultry Capacity Population, Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 11o&
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei -.
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ 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 [YNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[!'No
❑ NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
12128104 Continued

J,
Facility Number:
Date of Inspection
Waste Collection & Treatment
/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
[�,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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[moo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
© No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ErNo ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q/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 Cr/op Window El Evidence of Drift ❑q Application Outside
of Area
/Wind
]- o
12. Crop type(s) U fit/` &V .L As Sri wide s � -] I%—_ ! i L1 rA � ti Cti .► � y
13. Soil type(s)ja „`Ceti,,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
d No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes fJ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 4No
[jNo ❑ NA ElNE
❑ Yes ❑ NA ❑ NE
Comments refer to ' aesttoaE'lavlan 'AYES answers and/or an recommendations or an other comments.
Use drawings of facHit—Ab bettert"explidn;srtuatious.,(use additional pag has necessary):
r3a k s � t 5 co � �. � ' �� � -e
Reviewer/Ins ector Name -" r "f
Y. Phone:/S
p `` sew
.. . z
Reviewer/inspector Signature: Date:
12128104 Continued

1
s_r r
Facility Number: — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Ulfgo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 044, ❑ NA ❑ NE
the approprrate box_ ❑ wup ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waw—Apph"be , ❑ wft4ly'l reetroard ❑ w*Ae44ttafysis ❑ Spa A*afysis ❑ waste crs ❑ ion
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Laspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
fffNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
lr NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
OYNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
[P�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
[9'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
f
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
LI 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?
[I Yes
,..�/
LNo
Y
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
IRINo
Cl NA
❑ NE
W��dilicinahCogntnents aadlor ©rawiitgs
t
2128104

Type of Visit r Compliance Inspection O Operation Review O Lagoon Evaluation
lReason for Yts€t O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number S Date of visit: -JG Oil Time: E,J 3 w,
Q Not rational Below Threshold
M'f�ermitted d Cer 'hued [3 fC��ondiittionally Certified Q Registered Date Last Operated or Above Threshold: --- W.
Farm Name: ..... Q/lr.._._._.�5.. d..lir.�� ... _ __ ._ ...._ ._ _ __ .. County:
Owner Name: ��1.r< .a........... Q "a/7..........t Acev�.,4....11-L....................... Phone No:
Mailing Address: iQ�.�� 4a -- - ---- ano fi_NC __ Z81/4;
Facility Contact: .._.lire er.._...._n vo,, e- ....... .._-Title; Phone No:----
Onsite Repr csentative: , G�'PPf _ �t . f �%s� c _ . Integrator: -A /i�fos.�r�
Certified Operator:�,�[�—"rE'- ----., �11gQ�G » __.-._W... Operator Certification
Location of Far -in:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 6 &d
Discharees & Streattt Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Er Igo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes B" 0
c. If discharge is observed, what is the estimated flow in galtmin? �—
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ff'No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [g-90
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes C No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes BlqD
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiCcr: .. .....-.-.....---. ....... ............. ........ ..... ...... ...... .................. .....
Freeboard (inches): 7
12/12/03 Continued

Facility Number: —
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance!unprovement?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [ICopper and/or Zinc
12. Crop type C)Prrr,,l�e 1'(rrnz..�1 . 1(lYi :A 3era�ruw, , Jinn l/ irraill - Gr,
❑ Yes [a'lvo
❑ Yes B No
[:]Yes �Fo
❑ Yes ff No
❑ Yes ETNo
❑ Yes ENo
❑ Yes [moo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes D4410
b) Does the facility need a wettable acre determination? ❑ Yes Q-N�o
c) This facility is pended for a wettable acre determination? ❑ Yes [moo
15. Does the receiving crop need improvement? ❑ Yes &No
16. Is there a lack of adequate waste application equipment? ❑ Yes [}lam
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9'No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes DlZo
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 ❑ Yes ❑<o
Air Quality representative immediately.
Reviewer/Inspector Name
z;
Reviewer/Inspector Signature: J!f , 4 6.t,,.� _ Date:
12112103 Continued

Fatility Number: gg —qofDate of Inspection ?
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the acility fail o have all components of the Certified Animal Waste Management Plan readily available?
(fie! P, fists, drsigtt,yapT etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑sae pp ication ❑ oard ❑ Waste-Amaiy§is ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes 04410
❑ Yes 0'flo-
❑ Yes 10
❑ Yes ❑-NS
❑ Yes O-lib
❑ Yes
❑ Yes [a -No -
El Yes ❑-Ko'
❑ Yes ❑-No
❑ Yes [�To
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention:
Facility No. $' ?_ - -4 s"1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address: .
County:_
Integrator:
On Site R4
Physical A
DATE: 7 - Z 7 , 1995
411
Time: %
-s sL �7z�9
-- <
5 l;z mg-
.•, i o."T�t - - - -
Type of Operation: Swine CZ Poultry Cattle
Design Capacity: //00,0*�w Esc - Number of Animals on Site: A?140
DEM Certification. Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (15�or No Actual Freeboard:�3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o io Was any erosion observed? Yes ocffoo)
Is adequate land available for spray? or No Is the cover crop adequate? dDor No
Crop(s) being utilized: se
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin a or No
100 Feet from Wells? hor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ORS)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 49D
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate was management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover cro))? es or No
Additional Comments:_ ' � fi " _ •, -i x
i�fti.J -A 1 ep- !-T Tg- -
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.