820530_INSPECTIONS_20171231

NORTH CAROLINA
Department of Ernrronntental Qui

Type of Visit: C -Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up Q Referral Q Emergency (:) Other Q Denied Access
Date of Visit: /D— Arrival Time: Departure Time: ; j` County: Region:
Farm Name: a Cir q i „rike, , Owner Email:
Owner Name: GrS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
integrator: ,z2n
Certification Number:
Certification Number:
Latitude: Longitude:
Design Cprreut
❑ No
Design
Current
Yes
Design Current
Swine Capacity Pop.
Wet aPoultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish A D
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.oul
C aci
P,o
Non -Da
Farrow to Finish
Fayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other `
Turke 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 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 [D<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No
❑ Yes E3-lgo
[:]Yes [J"No
❑ NA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
Pare l of 3 21412015 Continued

Facility Number: 92=- Date of Inspection: D— /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: "tf
Spillway?:
Designed Freeboard (in): _ l_
Observed Freeboard (in): % Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Io ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Q o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [-]Yes Ea o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑-Ko ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rl-'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [j] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D-1go ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E�J1 o ❑ NA ❑ NE
❑ Yes E2 -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 [2-<o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes [ o
❑ 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 EJ�40
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 21412015 Continued

Facility Number: g2, - Date of Ins ection:
/p--
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETf4o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[Ej To
❑ 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
E 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.
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 C3'14o ❑ NA ❑ NE
[-]Yes [D -go ❑ NA ❑ NE
❑ Yes [D -Ko ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes allo
❑ Yes L_l<o
❑ Yes E No
[D NA ❑NE
C] NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answeit and/or any additional recommendations or any othkcamments: x !
_s
Use'drawmgs of facility to better explatn'situations (use_additional pages as necessary):
1cb,�s v rz-cre�
10-17
Reviewer/Inspector Name: Phone-
Reviewer/i
nspector Signature: Date:
Page 3 of 3
2/4/2015

.i
i ype of visit: (lMoroutcline
nee inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Q Complaint 'Q Follow-up O Referral! O Emergency Q Other O Denied Access
Date of Visit: �i-j Arrival Time: D Departure Time: 3,'00 vD County: Region:
Farm Name: L. j- r.Y {� — frrtl ! G Owner Email:
Owner Name: , 7► Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Integrator: / ..
Certified Operator: Certification Number: / D c�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
DestgnCuhrent
Crap` city Pap.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
C$ttle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
,
D . P,qultr.
Design
Ca aci
Currertr
P.o .
Da' Calf
Dai Heifer
D Cow
Non -Dairy
Feeder to Finish �L?
Farrow to Wean
Farrow to Feeder
- Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
O'fher est ^f_
Other
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DW R)
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 RNo ❑ NA ❑ NE
0 Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes 2] No
❑ Yes JZ No
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - ra Date of Inspection:
Waste Collection & Treatment
`4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
�No ❑NA ❑NE
❑ No [] NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): --
Observed Freeboard (in): zrol 7 .
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 [ o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 0 -Yes I`o❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�g 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 Eg-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 [A No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 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 r_K � le -9 51 4" (� ell �t+ 4.�ZS tK� /muss /J9?�/1Y/-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes S -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 [---1 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? D Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes jg]-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 M_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 ® 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 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�No
the appropriate box(es) below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes RNo ❑ 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 [aNo ❑ 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 E� 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
O No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E c.No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
I. No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
ts((refer to question #) Ex01aH any'YK.
ES'4nswers aiiU/or.any additional recommendations,or� otbe comment .;
Commen �i .,_ .: T b
Use,dravgingsbot facthty to better: explain.,sittahonsl(use additional paSes.as necessary). " ._ :_
wg
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of
Phone: %jpy.3-1715_1
Date: �__ Jif— f�
2/4/2015

I ype of visit: compliance inspection V operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: 01outine Q Complaint—0 Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �is y Region:
Farm Name: C1^a & r , Fa✓,w LAC Owner Email:
Owner Name:% `1/'I �3a�s Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:. - Integrator: y �/ Ys ]vim- _
Certified Operator: T r� 1 S Certification Number: D�3SJ
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design .. �Carrent
Capacity... Pap.
Wet Poultry
La er
Design
Capacity
urrent
Pop.
Design Current
Gat#le Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
J.Dairy
a. Was the conveyance man-made?
Calf
.Feeder to FinishAw
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
Dairy Heifer
Farrow to Wean
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dry Cow
Farrow to Feeder
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
D Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
[:]Yes
La ers
❑ NA
❑ NF
Beef Stocker
Gifts
,K No
Non -La us
❑ NE
of the State other than from a discharge?
Beef Feeder
Soars
Pullets
Beef Brood Cow
ry �,
Turkeys
Other
w
Turkey Poults
Other
Other
Discharges and Stream IMD8ct5
1. is any discharge observed from any part of the operation?
❑ Yes
E[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
❑ NF
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[–]Yes
,K No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 71412014 Continued

Facili Number: - I Date of Inspection:
t Waste Collection & Treatment
Si 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 _ _ Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
,?-ObDesigned Freeboard (in): /,?-
❑ Yes
qNo
Observed
served Freeboard (in): `7 r
❑ NE
18. Is there a lack of properly operating waste application equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [B No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
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?
❑ Yes
allo
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?
0yes ❑ No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2 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 LO -No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
[—]Yes BNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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 ❑ Evidenceof Drift ❑ Application Outside of Approved Area
Wind
12. Crop Type(s): L�fCmuet ak-�B�/1 r� 1G0'e1kL •
13. Soil Type(s): !ri(.' a No {3
I4. 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 [3 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MJ
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
lam, No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists F] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minutc 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 E No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - p Dote of ins ection: — 3
t 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
i�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ 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 ameture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CRNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes lf'>• 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
FNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? 1f yes, check the appropriate box below.
❑ Yes
QjNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®No
❑ NA
[:]NE
Reviewer/Inspector Name: 727 Phone:
ReviewerlInspector Signature: _ Date: �d/6
Page 3 of 3 2/4/2015

I ype of visit: t_y-y'uo ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit:JWoutine 0 Complaint QVoIlow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LLQ- Arrival Time: , p{7 Departure Time: ; p p County:Region: fEr—DT
Farm Name: /_3 Owner Email:
Owner Name: a.. (,V Phone:
Mailing Address:
Physical Address:
Facility Contact: TOW,- , 11 Title: ©i.C! rtw_� Phone:
Onsite Representative: �� � -, _ Integrator: Lf' -_5265=
6-1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Eg-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 [gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®-lo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 1/412014 Continued
Design Current
,Design
Eurrent
Design Current
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity P.
ish
rQFleeder
La er
FNon-La
Da' Cow
der
er
Dai Calf
nish
3
Dairy Heifer
Farrow to Wean
Desigq.
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ga' aci "
$a
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -1_a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
...
Other
Turlcey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Eg-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 [gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®-lo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 1/412014 Continued

Facili Number: - s7c 1 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0 Yes ®- No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
B No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
a Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
(0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
E] NE
the appropriate box_
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 ® 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 s
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): zrz 1?1,rL
13. Soil Type(s): o
14. Do the receiving crops differ from those designated in the CA WMP? 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?
❑ Yes
'® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B 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
E] NE
the appropriate box_
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. 0 Yes ❑ No
® Waste Application Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ® Waste Transfers
fo Rainfall ❑ Stocking ® Crop Yield n 120 Minute inspections ® Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑NA ❑NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili dumber: Ds ection:
i
L 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ 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 arnnual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concent?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/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
El No
❑ NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
[]Yes ® No
® Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
(% G D r ft w��� S e �rx°"S/%rI1 5 Oar+ -cam
yi� � d- � i 17'Ti e C 71 r�n2P lis / /
zea e- 60,n>P /]cr5 Ox—ric.�v�.e_ 7fi'�5 ��. �z �t`%J`✓ ✓
AJD
T,~tc
�VV bL 77
,v
Reviewer/Inspector Name: t,.�_ [�--try/�— Phone:
Reviewer/Inspector Signature: Date: �j
Page 3 of 3 214/2011

Type of Visit: (rCom Hance Inspection U Operation Review (] Structure Evaluation U Technical Assistance I
Reason for Visit: outine O Complaint 0 Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 3' County: �'`.��t-�— Region:.
Farm Name: A t"Vj bcif o' 5'11-13 Owner Email: �`'�`
Owner Name: Wg�jo'_ 70we f ( Phone:
Mailing Address:
Physical Address:
Facility Contact: �A���' - (►�1e 1I Title:
Onsite Representative: 5' ek....
Certified Operator: - ��/ , J oJ�?---
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
Dgii Current
❑ No
Design
Eurrent
Design Current
Swine
Ciipscity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Fop.
❑ No
Wean to Finish
❑ NE
Layer
❑ Yes
No
Dairy Cow
❑ NE
Wean to Feeder
[:]Yes
I jNon-ja)Tr
I
❑ NE
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Pogl
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
-
Turkey Poults
OtherOther
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 allo ❑ NA ❑ NE
❑ Yes 0 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
CB.No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

lFacility Number. - Date of Ins ection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a. If yes, is waste level into the structural fireeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1 f
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
F] NA ❑NE
C] NA ❑NE
Structure 5 Structure 6
❑ Yes ®. No ❑ NA ❑ NE
6_ Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 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 T2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes R 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 [S Yes ❑ No
❑ NA
[j NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes MNo
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tFZ No
[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN F] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window L) Evidence
Eviidence of Wind Drift Application Outside of Approved Area
/
12. Crop Type(s):-&--roW4 If)V_e14 X11 / G er, kdZeit, -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 4g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes Eg No ❑ NA ❑ NE
E] Yes 11
-91 No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 10 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.
Q WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. E3 Yes ❑ No
Waste Application Weekly Freeboard ® Waste Analysis ❑ Soil Analysis aWaste 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 [ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - a7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
$aYes
JgNo
❑ NA ❑ NE
' 1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
®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 to provide documentation of an actively certified operator in charge?
❑ Yes
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
§1 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
S 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
Eg 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C?�No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
-" No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA ❑ NE
FLI6are V'J 13
Cal& x'75 Ad, -1171
-30
/`�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214/2014

!Type of Visit: Q'Compha ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: o%'tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timee:�fl J Departure Time: County:
1001,
Farm Name: (,1��l/ Gr/Y11 1 -J Owner Email:
Owner Name: 4,1;4 pSui x -ll Phone:
Mailing Address:
Physical Address:
Facility Contact: ��4Z•-c�d Q�,(/ �o / Title: &*27 *+, -' Phone:
Region: )'=�v
Onsite Representative:
S�
Integrator:
�.:
Certified Operator:
_
�rs _1 �`�4a'�'1
t ���.
Certification Number:
La er
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Current
I Desi -'n � 4u�rent
g =#C
Design CEr—rent
❑ Ni
�.:
... CapacttyCattle
i V
Capacity Po
Finish
La er
Dai Cow
Feeder
7Farrow
Non -La er
Dai Calf
o Finish
DO
m'' "
Dai Heifer
o Wean=DesignCurrent
D Cow
o FeederD
. I;ou1�Ca ci Pa=.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
113eef Brood Cow
�_ _ ma=r
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Tg No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ Ni
❑ Yes
❑ No
[:]NA
❑ NE
[:]Yes ❑ No
❑ Yes JR] No
❑ Yes �LNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Faciti Number: - 3p iDate of Inspection:
1 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
❑ NA ❑ NE
Identifier:
[:)Yes
2] No
❑ NA ❑ NE
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
V9 -No
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R No
❑ NA
® NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
2_No
❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EC .No
[] NA
r] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KA ❑ 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
El Outside of Acceptable Crop Window ❑ Evidence of Wind Drift /❑1Application Outside of Approved Area
12. Crop Type(s): ;641"�Gt j!!�D / n l Lcifi��T`%S -s
13. Soil Type(s): _., J f /)(/O 4-5/
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 X[ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes U�LNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes [jjNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:)Yes
2] No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall 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 fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
V9 -No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

i'acili Number: Date of inspection:
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 Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®, 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
g 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
S 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
gNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
O 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
5. No
❑ NA
❑ NE
Comments refer toquestion-ft Explain any YES answers and/or any additional recommendations ©r'an othertcoiaiirneuts x ''
se.drawtngso.f facility to better explain situations (use additional pages as necessary). i`
-..
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3 `
Phone: 91�.3�.7300
Date: % --lb —r7/
2/4/2011
30 3-01,5-1

Type of Visit: @'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — . Arrival Time: Departure Time: IV Z> County: rr --- Region:
Farm Name: j�� to < r),-- g- r �� Owner Email:
Owner Name: f�n� i/ � Wyo Phone:
Mailing Address:
Physical Address:
Facility Contact: Awk fouiW 1 Title: LAW /Xpl � Phone:
Onsite Representative: J u-+- Integrator: -J71 zl_ �„
dV
Certified Operator: Certification Number: Z %E%`]
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters'of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes SNo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes ❑ No
[]Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued
-.
III Design Currents Design Current
Design Current
Swine ""'
Capacity Po� etPoultry Capacity Pop
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I X I INon-Layer
Dairy Calf
Feeder to Finish F `_"= - -
Dairy Heifer
Farrow to Wean
-_ Design Current_
Cow
Farrow to Feeder
- _D . Poult , Ca aci P,o
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters'of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes SNo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes ❑ No
[]Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of
_ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 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): �If
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA [:]NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ®. No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [SNo ❑ 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 [8,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) --
13. Soil Type(s): _/10a 3 Z 'Xj ?) _T-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tff 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 [Z No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes F%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 [2f 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 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 2/4/2011 Continued

Facili Number: - Date of -inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ;�J-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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'! I f 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
allo
❑ NA
❑ NE
❑ Yes
fD No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes �No [:]NA [:]NE
❑ Yes j:jj No ❑ NA ❑ NE
❑ Yes C!fNo ❑ NA ❑ NE
❑ Yes ONO
[:]Yes M -Vo
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
and/or any.additional recommendations an ottier�comments.:�`
Comments (refer to quesiton #):'Explain any YES ansv►ers: y
Use drawings of facility "to"better.eaplain situations (use additional pages. as necessary).''
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: 0 6�XIW
Date:
214/2011

Type of Visit ['Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit G -Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r 0 Departure Time: ;O County: Region:
Farm Name: fDW �e I k 1Far`on- ..2—/3 Owner Email:
Owner Name: L re) we. Phone:
Mailing Address:
Physical Address:
Facility Contact:_ Y�1SLTitle: /1L(1/1r1_ Phone No:
Onsite Representative: .• Integrator:-Yri'SJGY��i
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =e =1 =" Longitude: =° E--]' 0 u
Design Current
swine,C*apacity Population
r �.
Wet Poultry
_ r
Design Current Design Current
Capachy Popuiadan _ Caftle $ Capacity Population
❑ Wean to Finish
JEI Layer 1
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Cow
❑ Wean to Feeder
JEI Non -Layer I
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ farrow to Wean
D Poult
{�
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
"'
❑ Non -Dairy
❑ Farrow to Finish
❑Lavers
JL
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ No
❑ Beef Feeder
❑ Baars
❑ Pullets
❑ Yes
❑ Beef Brood Co
Otherg
❑ Turkeys.
❑ Turke Poults
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
�
❑ OtherG
❑ Othcr
❑ NE
k
M mber�of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Ycs
E.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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VUo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: FOIES. Date of Inspection
X] No
❑ NA
Waste Collection & Treatment
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
21 No
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 I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[9No ❑ 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?
ayes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P,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
V�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®FNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
Lf
12. Crop type(s) . A., -n L e. -J 101 vl f j- L
r
13. Soil type(s) _ f V?�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No ❑ NA [:1 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
X] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
21 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
JZNo
❑ NA
EINE
18. is there a lack of properly operating waste application equipment? ❑ Yes
RINo
❑ NA
❑ NE
Comments (r•to quesdtin #)E plaany YES answers and/or any recommendations ar any,"�ot!►er comments::-.
Use drawlu sy
{use '
gs of facility to Det[ erlex plalnTruatIA additional pages�as ecessary,): r
r
`uzv'r f'
p
r
U/'u
Re"ewer/inspector Name -.� Phone: 970 A'33 33o D
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: —T,301 Date of Inspection
{ Re uired Records & Documents
s
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WuP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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
IN No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RLNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
59 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZ[No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J25No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
2� 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
54No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
C&No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 N
❑ NA
❑ NE
Additional:Comments and/or Drawings:
Page 3 of 3 12/28/04

03
Complaint Q Follow up Q Referral Q Emergency O Other ❑Denied Access
Date of Visit: Arrival. Time: Departure Time: I ZTV County: Region: f
Farm Name:./Lk P® ✓' -1.3 Owner Email:
Owner Name: �ita�i L _�P, lu'Z�_ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone No:
Certified Operator: Operator Certification Number: _ l 7q— ._
Sack -up Operator:
Sack -up Certification Number:
Location of Farm: Latitude: [=0
= = Longitude: 0 ° 0 I = u
S'ne
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Fopulation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ -Layer
❑ Dairy Cow
❑ Dai Calf
El Wean to Feeder
Other
❑ Other
® Feeder to Finish
9-DEl
Dty Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
ElTurkeys
El Turkey Poults
El Other
El Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cowl
Number of Structures:
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation? El Yes U -No ❑ NA ❑ NE
Discharge originated at: El Structure E] Application Field El Other
a. Was the conveyance man-made? [I Yes ❑ No ❑ NA EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El 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) E] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:1 Yes JjNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State [:1 Yes B -N
type of Visit (3 -Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outing 0
❑ Boars
Other
❑ Other
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation? El Yes U -No ❑ NA ❑ NE
Discharge originated at: El Structure E] Application Field El Other
a. Was the conveyance man-made? [I Yes ❑ No ❑ NA EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El 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) E] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:1 Yes JjNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State [:1 Yes B -N
type of Visit (3 -Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outing 0
o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number:r9Z 5301 Date of Inspection — r -v
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes C3 -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: nO PZr_W
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Designed Freeboard (in): f
0 No
Observed Freeboard (in):
❑ NE
17. Does the facility lack adequate acreage for land application?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes S.No ❑ NA ❑ NE
through a waste management or closure plan?
❑ NA
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?
[9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CBNo [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [bio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenancehinprovement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)(L /
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
RNo
❑ 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
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R,No
❑ NA
❑ NE
Comments (refer to question ##) Explain any�YESYanswers•andlor any'recommendations or any other comments
Use drawings`of facility to better explain sitho s (use additional pages a5 neeessa`ry) Ate,
g
(1ad,�-
r
Reviewer/Inspector Name'ssy �� Phone: _T3 OC?
Reviewer/Inspector Signature: Date:
I L/LO/U4F l.(I�lIIRJJY!!

Facility Number: 5— Date of Inspection %
i
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP El Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes 0:No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
jgNo
❑ NA
❑ NE
❑ Yes
JS No
❑ NA
❑ NE
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
❑Yes
0 N
[:1 NA
El NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes E9 No ❑ NA EINE
❑ Yes 05 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NF
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
"t#tldEhonal,�Commetits�and/or Drawrn �" ' _, .
11./18/04
11./18/04

Type of Visit Qtomplia ce Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint Q Follow up Q Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: i V Departure Time: County• �Region:
Farm Name: 11i 1� lea-_ / _ 13 Owner Email:
Owner Name: AIA PVUj 10 /! Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ ,. Integrator:Tia a; �
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
71"
Longitude: = ° E T =U
Discharges &Stream Impacts
1, Is any discharge observed from any part of the operation? ❑Yes 04 No ❑ NA ❑ NE
Discharge originated at: El Structure ❑Application Field ❑Other
a. Was the conveyance man-made? E-1 Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El 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) El Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [__1 Yes 14 No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes X
r Design Current
Design �Curreuf ...
Design Current
Swine
,apacrt} ;Population Wet Poultry Capacity Popula_tioa
Cattle Capacity Population
El Wean to Finish
❑ Layer
ElDairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑Dai Heifer
Farrow to Wean
Dry Poultry".
E] Dry Cow
El Farrow to Feeder
'``
E]Non-Dairy
❑ Farrow to Finish
ElLayers
El Beef Stocker
❑Gilts
5 ElNon-La Non -Layers
El Beef Feeder
El Boars
Pullets
El Beef Brood Co
-
❑ Turke s
Other
❑ Other
3 t - ❑ TurkeyPou Its
NO Other
Number of Structures:
No
❑ NA
Discharges &Stream Impacts
1, Is any discharge observed from any part of the operation? ❑Yes 04 No ❑ NA ❑ NE
Discharge originated at: El Structure ❑Application Field ❑Other
a. Was the conveyance man-made? E-1 Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El 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) El Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [__1 Yes 14 No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes X
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/28/04
Continued

Date of Inspection
Waste Collection & Treatment
❑ Yes
E4No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
❑No
[:INA
❑NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ Yes
KNo
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U9 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
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 C�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes ®No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V •No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E4No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
.8No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ 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):
r
Reviewer/Inspector Name '� ��� Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 .01 - 11/18104 Continued

Facility Nuntber: Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have 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 [K No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ' No [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Ca Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to instal I and maintain a rain gauge?
❑ Yes
9!.No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ISNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tj�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
rd,
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5kNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D4 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

f.�
ivision of Water Quality
Facility Number d O Division of Soil and Water Conservation s✓
O Other Agency
Type of Visit Qk—onpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date orvisit: L� Arrival Time: L Departure Time: �"� r County:, Region:
Farm Name: _ uJe11_ Faun, 9- 1-3 Owner Email:
Owner Name: , - [Za-/ eu// Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: .10kci a ge
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=,
= Longitude: = e = I =
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®I
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 X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: —n I Date of Inspection 7
O-
Waste Collection & Treatment
Reviewer/inspector Name Phone: qy-j-3 [X�
Reviewer/Inspector Signature: Date: �rff—O
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2�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
[�I'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
2�No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
.Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LKNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C&No
[:INA ❑ NE ,
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
��qq
K No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) o
'
z
13. Soil type(s) ApJas
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JR 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
A No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�ffNo
❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
O-
T
Reviewer/inspector Name Phone: qy-j-3 [X�
Reviewer/Inspector Signature: Date: �rff—O
IV28/04 Continued

1.
i Facility Number; — Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P�No ❑ NA ❑ NE
the appropirate box. Q WOP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 25 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
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P9 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
19 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J.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
JKNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
J9 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departures Time: County Region:
Farm Name: X/1 PB L[,,e_,z 25n/ �*� _ / �� Owner Email:
Owner Name: n ®I.LJG�� Phone: J
Mailing Address: S� 7 /�1LO/S►-tj4�-e � eL; g�" /� ��
Physical Address:
Facility Contact: ��lU� l� —Title:
Onsite Representative: _S0t.1.e
Phone No: i
Integrator: r
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o E__1' E]" Longitude: 00 0' ❑ «
Swine
❑ Wean to Finish
Wean to Feeder
Design Current
Capacity Population
Wet P©nitry
❑ Layer
❑ Non -La er
Design Current Design Current
Capacity P0pulati4on, Cattle Capacity Population
,. .
❑Dai Cow
❑Dai Calf
Feeder to Finish
b4707
❑ NA
airyHeifer
Farrow to Wean
MNo
Dray Poultry
ElD Cow
El Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ NE
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Soars
❑ Pullets
�
" ❑ Beef Brood Co
El Turke s
Other
❑ TurkeyPoults
t �t =•� : `'
❑Other
❑Other
`'TNitmber ofStructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached Waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
;M No
❑ NA
❑ NE
❑ Yes
V.No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[9 No
❑ Yes ;allo
❑ Yes �&No
❑ NA ❑ NE
El NA El NE
Page I of 3 12/28/04 Continued

Facility Number -53A Date of Inspection %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes Wo ❑ 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 4 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 V9 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?
KYes ❑ 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 [9 -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5�LNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r/"n9 Q &-ro epert W ,,
13. Soil type(s) &Z&E Z Al 2)
14. Do the receiving crops differ tiom those designated in the CAWMP? ❑ Yes [9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z.No ❑ NA ❑ NE
M No ❑ NA ❑ NE
g.No ❑ NA ❑ NE
Dq-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments :i
a
Use drawings of facility to better explain situations. (use additional pages as necessary):oz
�.7
Reviewer/Inspector Name �d� 1 0"�� Phone: 9,1 ,90
Reviewer/Inspector Signature: Date: D b
Page l of 1 12/28/04 Continued

fFacility N©tuber: Date of Inspection
❑ Yes
® No
❑ NA
❑ NE
Regnired Records & Documents
❑ Yes
CS No
❑ NA
❑ NE
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
JR 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.
❑ W[JP El Checklists ❑Design ❑Maps El Other
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
H No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CS No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
tKNo
❑ 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
0 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
P.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
CgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5.No
❑ NA
❑ NE
Page 3 of 3 12128104

t
Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access I
Date of Visit: Tune:
Facility Number i►t
rO Not Operational C Below Threshold
Wirmitted D ertified ©Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
404-_._1R'7
Farm Name: .._.•-.--f- .e �.r.._........_.......W __._. _ _. County: _._..�Fi��d s<firx _ . _ . . Ff�0 _.
Owner Name: ._ 1`�7r. _.� 4�'�l/.. _ _ . __. Phone No:
Mailing Address:.._. a y ........ _7'.;[�ea_�! L
Facility Contact: nlj�r ....i . .t. In/%_._ .__._. WW_Title: __ W.___...._._ _. _._W. _. ----- Phone No: _Ma9_ 0 -C4r5 ..
Onsite Representative:..-,_. �ri�.__1r. �_—�_ _ _---------_ .. Integrator•.
Certified Operator: -_ r+ f .._ pv c�� _ Operator Certification Number:
Location of Farm:
E -ine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° �" Longitude �• �' �"
Design Current -Design Currii:n = T pulaho
-PoQ1 _ _ .
-Swine.Ca ` Po - elation .,, Yom_ . _ Ca ci Po ulatiba .. Cattle
Ca 0 as -; Po n
Wean to Feeder ^3
eederto Finish GA?pr ._'26-14?
Farrow to Wean
Farrow to Feeder
Farrow to Finish
El Gilts
El Boars
Layer ❑ Dairy
Non -Layer 'LL; ❑ Non -Dairy
Other
Y Total Design Capacity
F
ToWiSS w C
Nor
U71 16. I.aoon5
44MA4a:Pnneie'l:Cnlui"Fr...c':.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑-Pio
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B -No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes BNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Q -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑-No-
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier= _._......_._�.- ....
Freeboard (inches): 5-
12112103
12112103 Continued

1 Facility Number: .;2
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 maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste .Aaplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑go'
❑ Yes 0wo,
❑ Yes [a.M
❑ Yes ON -6
❑ Yes i o
❑ Yes S -Ko
❑ Yes 3.14
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes
[lo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ado
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
01110
15. Does the receiving crop need improvement?
❑ Yes
0,90
I6. Is there a lack of adequate waste application equipment?
❑ Yes
13140
Odor Issues
AE 6ort,15
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?
Reviewer/Inspector Signature: %7�:a Date: S-
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
040-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[ado
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
cxo'
Air Quality representative immediately.
Comments (refer to q eshan #} �Eiplaau any YFS answers aad/br any or anyother cements.
- -
;Use diawutgs of lty to bettexplarn s tnadons. (ase additsanal pages as necessary) -eld Copy ❑ Final Notes t'
.s � ,.: �'.:.zY .._"LF..!�_~--�»r �C.'. n�Y:...,� .� _.. �--C. x�•`4T' �Xw:.-«-'"'":C.iY_.��
!'!I, aG �/� �.S vcr�,',�� Gh e� 57a7�'s�,,,� DJ004/ 9ras5 f "Ver 0;n a irr
11l
do 7Ae X ��5,✓r O� Ne f a sa /PPar,r.n� a SMu/� CPvC// af- f/rF
to, ntJ
/ /
ad d,,,4, el, tion heuie
NV Pimp
FGr rpm � S G✓"G �� �(�� T
AE 6ort,15
Reviewer/Inspector Name % .
m
..--
Reviewer/Inspector Signature: %7�:a Date: S-
12/12103 Continued

}
' Facility Number: — t, Date of Inspection .
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
- —— - =,
ddltronal CommCrlLS`and/or Dr$Winx— $.
....x :..�..,.a
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
"i slv �r�r
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[ o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q -No-
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
qNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
E]W6 -
26. Fail to notify regional DWQ of emergency situations as required by General Pe niit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
allo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
E No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[a NO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 -No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
E Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�io
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[g No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
011140
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 0416)
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form ---
113 violations or deficiencies were noted during
this visit You will receive no further correspondence about this visit.
- —— - =,
ddltronal CommCrlLS`and/or Dr$Winx— $.
....x :..�..,.a
"i slv �r�r
S��vt y /d
12112103

Site Requires Immediate Attcn ' n: L
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SrM 'VISITATION RECORD
DATE: '1995
Time. _ L2 „1 G
Farm Name/Owner­ A^r4-3
Maisirtg Addmfi:e
Cotmty: _ _ — S naS
Integrator _ - - P rqllx4rte,c - Phone: ,gLa
On Site Reprasentative.4,_ P��.�e - _ Phone: �
Physical Address/Location: ;,s (�46A r L 49'_ F ,.-,A ,�� s:e ;s:4tca. &(,k, l
r
Type of Operation: Swine X_ Poultry Cattle
Design Capacity: Number of Animals on Site: c�
DEM Certification Number. ACE DEM 0artiScation Number. ACNEW
Latitude. Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foci + 25 year 24 hour stornn event
(approximately I Foot + 7 inches) e or No Actual Freeboard: ,fit. o Inches
Was any seepage observed from the lagoon(s)? Yeas orJSio was any erosion observed? Yes o
Is adoquate land available for spray?(Yj or No is the cover crop adequate?Y�or No
Crop(s) being utilized:
Docs the facility n-cet SCS niinirnum setback criteria? 240 Feet from Dwellings: or No
100 Feet from Wells? Yew' ar No
Is the animal Avaste stockpiled within 100 Feet of USGS Blue tine Stream? Yes o"
Is animal waste land applied or spray irrigated within 25 Fest of a USGS Map Blue Linc? Yes or(
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes of�g If Yes, Please EXPisin_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acrege with cover crop)?or No
Additional Comments:
C., t
r.4 ca
w
cc: Facility A essment Unit Use Attachments if Nec&d.